Xiao Xiang, Lin Qiang, Lo Wai-Leung, Mao Yu-Rong, Shi Xin-Chong, Cates Ryan S, Zhou Shu-Feng, Huang Dong-Feng, Li Le
Department of Rehabilitation Medicine, Guangdong Engineering Technology Research Center for Rehabilitation Medicine and Clinical Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Rehabilitation Medicine, Luohu People's Hospital, Shenzhen, China.
Behav Neurol. 2017;2017:6261479. doi: 10.1155/2017/6261479. Epub 2017 Jun 28.
Functional magnetic resonance imaging (fMRI) is a promising method for quantifying brain recovery and investigating the intervention-induced changes in corticomotor excitability after stroke. This study aimed to evaluate cortical reorganization subsequent to virtual reality-enhanced treadmill (VRET) training in subacute stroke survivors.
Eight participants with ischemic stroke underwent VRET for 5 sections per week and for 3 weeks. fMRI was conducted to quantify the activity of selected brain regions when the subject performed ankle dorsiflexion. Gait speed and clinical scales were also measured before and after intervention.
Increased activation in the primary sensorimotor cortex of the lesioned hemisphere and supplementary motor areas of both sides for the paretic foot ( < 0.01) was observed postintervention. Statistically significant improvements were observed in gait velocity ( < 0.05). The change in voxel counts in the primary sensorimotor cortex of the lesioned hemisphere is significantly correlated with improvement of 10 m walk time after VRET ( = -0.719).
We observed improved walking and increased activation in cortical regions of stroke survivors after VRET training. Moreover, the cortical recruitment was associated with better walking function. Our study suggests that cortical networks could be a site of plasticity, and their recruitment may be one mechanism of training-induced recovery of gait function in stroke. This trial is registered with ChiCTR-IOC-15006064.
功能磁共振成像（fMRI）是一种很有前景的方法，可用于量化脑恢复情况，并研究中风后干预引起的皮质运动兴奋性变化。本研究旨在评估亚急性中风幸存者在虚拟现实增强跑步机（VRET）训练后的皮质重组情况。
8名缺血性中风患者每周进行5节VRET训练，共训练3周。当受试者进行踝背屈时，采用fMRI量化选定脑区的活动。在干预前后还测量了步态速度和临床量表。
干预后观察到，患侧半球的初级感觉运动皮层以及双侧辅助运动区对患侧足部的激活增加（<0.01）。步态速度有统计学意义的改善（<0.05）。患侧半球初级感觉运动皮层体素计数的变化与VRET训练后10米步行时间的改善显著相关（=-0.719）。
我们观察到VRET训练后中风幸存者的步行能力改善，且皮质区域的激活增加。此外，皮质募集与更好的步行功能相关。我们的研究表明，皮质网络可能是可塑性的位点，其募集可能是中风后训练诱导步态功能恢复的一种机制。本试验已在Chinese Clinical Trial Registry（ChiCTR）注册，注册号为ChiCTR-IOC-15006064。
