Department of Anatomy & Neurobiology, University of California, Irvine, CA 92868, USA.
NeuroRehabilitation. 2013;33(1):13-24. doi: 10.3233/NRE-130923.
Good motor outcome after stroke has been found to correlate with increased activity in a dorsal premotor (PMd) brain circuit, suggesting that therapeutic strategies targeting this circuit might have a favorable, causal influence on motor status.
This study addressed the hypothesis that a Premotor Therapy that exercises normal PMd functions would provide greater behavioral gains than would standard Motor Therapy; and that Premotor Therapy benefits would be greatest in patients with greater preservation of PMd circuit elements.
Patients with chronic hemiparetic stroke (n = 15) were randomized to 2-weeks of Premotor Therapy or Motor Therapy, implemented through a robotic device.
Overall, gains were modest but significant (change in FM score, 2.1 ± 2.8 points, p < 0.02) and did not differ by treatment assignment. However, a difference between Therapies was apparent when injury to the PMd circuit was considered, as the interaction between treatment assignment and degree of corticospinal tract injury was significantly related to the change in FM score (p = 0.018): the more the corticospinal tract was spared, the greater the gains provided by Premotor Therapy. Similar results were obtained when looking at the interaction between treatment assignment and PMd function (p = 0.03).
Targeted engagement of a brain circuit is a feasible strategy for stroke rehabilitation. This approach has maximum impact when there is less stroke injury to key elements of the targeted circuit.
研究发现，中风后良好的运动功能预后与背侧运动前区（PMd）脑回路活动增加相关，这表明针对该回路的治疗策略可能对运动状态产生有利的因果影响。
本研究旨在验证以下假设：锻炼正常 PMd 功能的运动前区疗法将比标准运动疗法提供更大的行为获益；并且 PMd 回路元素保存较好的患者将从 PMd 疗法中获益最大。
将 15 例慢性偏瘫中风患者随机分为 2 周的运动前区疗法或运动疗法组，通过机器人设备实施。
总体而言，增益虽然适度但具有统计学意义（FM 评分变化，2.1 ± 2.8 分，p < 0.02），且与治疗分配无关。然而，当考虑 PMd 回路损伤时，两种疗法之间存在差异，因为治疗分配和皮质脊髓束损伤程度之间的相互作用与 FM 评分的变化显著相关（p = 0.018）：皮质脊髓束损伤越小，运动前区疗法提供的增益越大。当观察治疗分配与 PMd 功能之间的相互作用时，也得到了类似的结果（p = 0.03）。
靶向大脑回路的参与是中风康复的一种可行策略。当目标回路的关键元素受到的中风损伤较小时，这种方法的影响最大。
