Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy; Italian Multiple Sclerosis Foundation, Scientific Research Area, Genoa, Italy.
Neuroscience. 2019 Jul 1;410:150-159. doi: 10.1016/j.neuroscience.2019.05.004. Epub 2019 May 11.
The aim of this work was to investigate changes in motor performance and in the brain activation pattern during finger movements, following upper limb motor training in multiple sclerosis. Thirty people with multiple sclerosis with mild upper limb sensorimotor deficits were randomly allocated to one of two groups: the experimental group (n = 15) received an upper limb treatment based on voluntary task-oriented movements; the control group (n = 15) underwent passive mobilization of shoulder, elbow, wrist and fingers. All participants completed three treatment sessions per week for eight weeks. Before and after the intervention, all participants were evaluated for motor performance by means of Action Research Arm Test, Nine Hole Peg Test, and grip strength by a dynamometer, and for brain activations by functional magnetic resonance imaging during right finger opposition movements. Similar effects on motor performance were found in the two groups. A significant improvement with time was found in both groups at NHPT and in GRIP strength; a similar trend was found at ARAT. However, only the experimental group showed increased lateralization towards more normal brain activation following treatment, with activation clusters mainly located in the left brain hemisphere and right cerebellum. In conclusion, both active and passive interventions were effective in improving motor performance. However, only the treatment based on voluntary task-oriented movements could induce changes in brain activity that may have reflected skill acquisition by the right hand, reducing the activation of compensatory areas and decreasing brain resource demand.
这项工作的目的是研究多发性硬化症患者在上肢运动训练后，手指运动的运动表现和大脑激活模式的变化。30 名上肢感觉运动功能轻度受损的多发性硬化症患者被随机分配到两组中的一组：实验组（n=15）接受基于自愿任务导向运动的上肢治疗；对照组（n=15）接受肩、肘、腕和手指的被动运动。所有参与者每周接受三次治疗，共八周。在干预前后，所有参与者均通过动作研究上肢测试、九孔钉测试和测力计测量握力来评估运动表现，并通过功能磁共振成像在进行右侧手指对指运动时评估大脑激活情况。两组的运动表现均有类似的改善效果。两组在 NHPT 和 GRIP 力量方面均随着时间的推移而显著改善；ARAT 也有类似的趋势。然而，只有实验组在治疗后显示出大脑活动向更正常的侧化方向的变化，激活簇主要位于左半球和右小脑。总之，主动和被动干预都能有效改善运动表现。然而，只有基于自愿任务导向运动的治疗才能诱导大脑活动的变化，这可能反映了右手技能的获得，减少了代偿区域的激活，降低了大脑资源的需求。
