基于功能磁共振成像（fMRI）和弥散张量成像（DTI）的居家远程康复对中风患者的有效性及神经机制：一项随机对照试验的研究方案
Effectiveness and neural mechanisms of home-based telerehabilitation in patients with stroke based on fMRI and DTI: A study protocol for a randomized controlled trial.
作者信息
Chen Jing, Liu Mingli, Sun Dalong, Jin Yan, Wang Tianrao, Ren Chuancheng
机构信息
Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, 801 Heqing Road, Minhang District Division of Gastroenterology, Department of Internal Medicine, Zhongshan Hospital Affiliated to Fudan University, Xuhui District Department of Rehabilitation Department of Radiology, Shanghai Fifth People's Hospital, Fudan University, Minhang District Departments of Neurology, Shanghai East Hospital Affiliated to Tongji University, Pudong New Area, Shanghai, China.
出版信息
Medicine (Baltimore). 2018 Jan;97(3):e9605. doi: 10.1097/MD.0000000000009605.
BACKGROUND
Stroke is one of leading diseases causing adult death and disability worldwide. Home-based telerehabilitation has become a novel approach for stroke patients as effective as conventional rehabilitation, and more convenient and economical than conventional rehabilitation. However, there is no study assessing the mechanism of home-based telerehabilitation in promoting motor recovery among stroke patients with hemiplegic.
AIMS
This study is designed to determine the efficacy and explore the mechanism of motor recovery after home-based telerehabilitation in stroke patients with motor deficits.
METHODS/DESIGN: In a single-blinded randomized controlled pilot study, patients with acute subcortical stroke (n = 40) are assigned to receive home-based telerehabilitation or conventional rehabilitation. Task-based or resting-state functional magnetic resonance imaging (rs-fMRI), diffusion tensor imaging (DTI), and Fugl-Meyer assessment (FMA) score will acquired before and after rehabilitation. Activation volume of bilateral primary motor (M1), supplementary motor area (SMA), premotor cortex (PMC); lateralization index (LI) of interhemispheric M1, SMA, and PMC; functional connectivity of bilateral M1, SMA, PMC; fractional anisotropy (FA) will be measured; correlation analyses will be performed between neuroimaging biomarkers and FMA score pre- and postrehabilitation.
DISCUSSION
We present a study design and rationale to explore the effectiveness and neural mechanism of home-based rehabilitation for stroke patients with motor deficits. The study limitations related to the small-amount sample. Moreover, home-based rehabilitation may provide an alternative means of recovery for stroke patients. Ultimately, results of this trial will help to understand the neural mechanism of home-based telerehabilitation among stroke patients with hand movement disorder.
背景
中风是全球导致成人死亡和残疾的主要疾病之一。家庭远程康复已成为中风患者的一种新方法，其效果与传统康复相当，且比传统康复更方便、经济。然而，尚无研究评估家庭远程康复对偏瘫中风患者运动恢复的作用机制。
目的
本研究旨在确定家庭远程康复对有运动功能障碍的中风患者运动恢复的疗效并探索其机制。
方法/设计：在一项单盲随机对照试验研究中，将40例急性皮质下中风患者分为两组，分别接受家庭远程康复或传统康复。在康复前后获取基于任务或静息态功能磁共振成像（rs-fMRI）、扩散张量成像（DTI）和Fugl-Meyer评估（FMA）评分。测量双侧初级运动区（M1）、辅助运动区（SMA）、运动前区皮质（PMC）的激活体积；半球间M1、SMA和PMC的偏侧化指数（LI）；双侧M1、SMA、PMC的功能连接；分数各向异性（FA）；并对康复前后神经影像生物标志物与FMA评分进行相关分析。
讨论
我们提出了一项研究设计和基本原理，以探索家庭康复对有运动功能障碍的中风患者的有效性和神经机制。该研究的局限性在于样本量小。此外，家庭康复可能为中风患者提供另一种恢复途径。最终，本试验结果将有助于了解家庭远程康复对有手部运动障碍的中风患者的神经机制。
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