新型步态训练改变慢性脑卒中患者行走时的功能脑连接：一项随机对照初步试验。
Novel gait training alters functional brain connectivity during walking in chronic stroke patients: a randomized controlled pilot trial.
机构信息
Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.
Department of Physical Therapy and Assistive Technology, National Yang-Ming University, 155, Sec 2, Li Nong St., Shih-Pai, Taipei, 112, Taiwan.
出版信息
J Neuroeng Rehabil. 2019 Feb 28;16(1):33. doi: 10.1186/s12984-019-0503-2.
BACKGROUND
A recent study has demonstrated that a turning-based treadmill program yields greater improvements in gait speed and temporal symmetry than regular treadmill training in chronic stroke patients. However, it remains unknown how this novel and challenging gait training shapes the cortico-cortical network and cortico-spinal network during walking in chronic stroke patients. The purpose of this study was to examine how a novel type of gait training, which is an unfamiliar but effective task for people with chronic stroke, enhances brain reorganization.
METHODS
Subjects in the experimental and control groups received 30 min of turning-based treadmill training and regular treadmill training, respectively. Cortico-cortical connectivity and cortico-muscular connectivity during walking and gait performance were assessed before and after completing the 12-session training.
RESULTS
Eighteen subjects (n = 9 per group) with a mean age of 52.5 ± 9.7 years and an overground walking speed of 0.61 ± 0.26 m/s consented and participated in this study. There were significant group by time interactions for gait speed, temporal gait symmetry, and cortico-cortical connectivity as well as cortico-muscular connectivity in walk-related frequency (24-40 Hz) over the frontal-central-parietal areas. Compared with the regular treadmill training, the turning-based treadmill training resulted in greater improvements in these measures. Moreover, the increases in cortico-cortical connectivity and cortico-muscular connectivity while walking were associated with improvements in temporal gait symmetry.
CONCLUSIONS
Our findings suggest this novel turning-based treadmill training is effective for enhancing brain functional reorganization underlying cortico-cortical and corticomuscular mechanisms and thus may result in gait improvement in people with chronic stroke.
TRIAL REGISTRATION
ACTRN12617000190303 . Registered 3 February 2017, retrospectively registered.
背景
最近的一项研究表明，与常规跑步机训练相比，基于转向的跑步机训练方案能使慢性脑卒中患者的步速和时间对称性得到更大改善。然而，目前尚不清楚这种新颖且具有挑战性的步态训练如何在慢性脑卒中患者行走时塑造皮质-皮质网络和皮质-脊髓网络。本研究旨在探讨一种新的步态训练方式如何增强大脑重组，这种新的步态训练方式对慢性脑卒中患者来说是一种陌生但有效的任务。
方法
实验组和对照组的受试者分别接受基于转向的跑步机训练和常规跑步机训练，时长均为 30 分钟。在完成 12 节训练课程前后，评估了行走时的皮质-皮质连通性和皮质-肌肉连通性以及步态表现。
结果
18 名受试者（每组 9 名，平均年龄 52.5±9.7 岁，地面行走速度为 0.61±0.26m/s）同意并参与了这项研究。在步态速度、时间步态对称性以及与行走相关的额-中央-顶区域的频带（24-40Hz）的皮质-皮质连通性和皮质-肌肉连通性方面，存在显著的组间时间交互作用。与常规跑步机训练相比，基于转向的跑步机训练在这些指标上的改善更为显著。此外，行走时皮质-皮质连通性和皮质-肌肉连通性的增加与时间步态对称性的改善相关。
结论
我们的研究结果表明，这种新颖的基于转向的跑步机训练方案能够有效地增强皮质-皮质和皮质-肌肉机制下的大脑功能重组，从而可能改善慢性脑卒中患者的步态。
临床试验注册
ACTRN12617000190303。于 2017 年 2 月 3 日注册，回顾性注册。
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