Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Neurol India. 2012 Nov-Dec;60(6):570-6. doi: 10.4103/0028-3886.105188.
Recovery in stroke is mediated by neural plasticity. Neuro-restorative therapies improve recovery after stroke by promoting repair and function. Mirror neuron system (MNS) has been studied widely in humans in stroke and phantom sensations.
Study subjects included 20 patients with chronic stroke and 10 healthy controls. Patients had clinical disease-severity scores, functional magnetic resonance imaging (fMRI) and diffuse tensor imaging (DTI) at baseline, 8 and at 24 weeks. Block design with alternate baseline and activation cycles was used with a total of 90 whole brain echo planar imaging (EPI) measurements (timed repetition (TR) = 4520 ms, timed echo (TE) = 44 ms, slices = 31, slice thickness = 4 mm, EPI factor 127, matrix = 128 × 128, FOV = 230 mm). Whole brain T1-weighted images were acquired using 3D sequence (MPRage) with 120 contiguous slices of 1.0 mm thickness. The mirror therapy was aimed via laptop system integrated with web camera, mirroring the movement of the unaffected hand. This therapy was administered for 5 days in a week for 60-90 min for 8 weeks.
All the patients showed statistical significant improvement in Fugl Meyer and modified Barthel Index (P < 0.05) whereas the change in Medical Research Council (MRC) power grade was not significant post-therapy (8 weeks). There was an increase in the laterality index (LI) of ipsilesional BA 4 and BA 6 at 8 weeks exhibiting recruitment and focusing principles of neural plasticity.
Mirror therapy simulated the "action-observation" hypothesis exhibiting recovery in patients with chronic stroke. Therapy induced cortical reorganization was also observed from our study.
中风后的恢复是由神经可塑性介导的。神经修复疗法通过促进修复和功能来改善中风后的恢复。镜像神经元系统（MNS）在中风和幻肢感觉中已在人类中广泛研究。
研究对象包括 20 名慢性中风患者和 10 名健康对照者。患者在基线、8 周和 24 周时具有临床疾病严重程度评分、功能磁共振成像（fMRI）和弥散张量成像（DTI）。使用具有总共有 90 个全脑回波平面成像（EPI）测量的交替基线和激活周期的块设计（时间重复（TR）= 4520 ms，时间回波（TE）= 44 ms，切片= 31，切片厚度= 4 mm，EPI 因子 127，矩阵= 128×128，FOV = 230 mm）。全脑 T1 加权图像使用具有 120 个连续 1.0mm 厚切片的 3D 序列（MPRage）采集。镜像治疗通过与网络摄像头集成的笔记本电脑系统针对目标，镜像未受影响手的运动。这种治疗每周进行 5 天，每天 60-90 分钟，持续 8 周。
所有患者的 Fugl Meyer 和改良 Barthel 指数均显示出统计学上的显著改善（P <0.05），而治疗后运动研究协作组（MRC）力量等级的变化不显著（8 周）。在 8 周时，患侧 BA4 和 BA6 的侧化指数（LI）增加，表现出神经可塑性的募集和聚焦原则。
镜像疗法模拟了“动作观察”假说，表现出慢性中风患者的恢复。我们的研究还观察到治疗诱导的皮质重组。
