脑卒中后进行功能性上肢任务时，运动表现下降但感觉运动皮层激活增加。

Increased Sensorimotor Cortex Activation With Decreased Motor Performance During Functional Upper Extremity Tasks Poststroke.

机构信息

Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada (S.B.L., J.J.E.); Rehabilitation Sciences, Faculty of Graduate Studies, University of British Columbia, Vancouver, Canada (S.B.L.); and Department of Physical Therapy, University of British Columbia, Vancouver, Canada (J.J.E.).

出版信息

J Neurol Phys Ther. 2019 Jul;43(3):141-150. doi: 10.1097/NPT.0000000000000277.

DOI:10.1097/NPT.0000000000000277

PMID:31136449

Abstract

BACKGROUND AND PURPOSE

Current literature has focused on identifying neuroplastic changes associated with stroke through tasks and in positions that are not representative of functional rehabilitation. Emerging technologies such as functional near-infrared spectroscopy (fNIRS) provide new methods of expanding the area of neuroplasticity within rehabilitation. This study determined the differences in sensorimotor cortex activation during unrestrained reaching and gripping after stroke.

METHODS

Eleven individuals with chronic stroke and 11 neurologically healthy individuals completed reaching and gripping tasks under 3 conditions using their (1) stronger, (2) weaker, and (3) both arms together. Performance and sensorimotor cortex activation using fNIRS were collected. Group and arm differences were calculated using mixed analysis of covariance (covariate: age). Pairwise comparisons were used for post hoc analyses. Partial Pearson correlations between performance and activation were assessed for each task, group, and hemisphere.

RESULTS

Larger sensorimotor activations in the ipsilesional hemisphere were found for the stroke compared with healthy group for reaching and gripping conditions despite poorer performance. Significant correlations were observed between gripping performance (with the weaker arm and both arms simultaneously) and sensorimotor activation for the stroke group only.

DISCUSSION AND CONCLUSIONS

Stroke leads to significantly larger sensorimotor activation during functional reaching and gripping despite poorer performance. This may indicate an increased sense of effort, decreased efficiency, or increased difficulty after stroke. fNIRS can be used for assessing differences in brain activation during movements in functional positions after stroke. This can be a promising tool for investigating possible neuroplastic changes associated with functional rehabilitation interventions in the stroke population.Video Abstract available for more insights from the authors (see Video Abstract, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A269).

摘要

背景与目的

目前的文献主要集中在通过非代表性的功能康复任务和姿势来识别与中风相关的神经可塑性变化。功能近红外光谱（fNIRS）等新兴技术为扩大康复领域的神经可塑性提供了新方法。本研究旨在确定中风后自由伸展和抓握时感觉运动皮层的激活差异。

方法

11 名慢性中风患者和 11 名神经健康个体分别使用（1）优势侧、（2）非优势侧和（3）双侧手臂完成 3 种伸展和抓握任务。使用 fNIRS 收集运动表现和感觉运动皮层的激活情况。使用混合协方差分析（协变量：年龄）计算组间和手臂间差异。采用事后配对比较进行分析。针对每个任务、组和半球，评估了运动表现和激活之间的部分 Pearson 相关性。

结果

尽管中风患者的运动表现较差，但与健康组相比，中风患者的对侧感觉运动皮层在伸展和抓握时的激活更大。仅在中风组中观察到抓握表现（使用非优势侧手臂和双侧手臂）与感觉运动激活之间存在显著相关性。

讨论与结论

尽管运动表现较差，但中风后在功能伸展和抓握时会导致感觉运动皮层的激活显著增加。这可能表明中风后患者的努力感增加、效率降低或难度增加。fNIRS 可用于评估中风后在功能位置进行运动时大脑激活的差异。这可能是一种很有前途的工具，可用于研究中风患者功能康复干预相关的神经可塑性变化。视频摘要（见视频摘要，补充数字内容 1，可在 http://links.lww.com/JNPT/A269 获得）可提供来自作者的更多见解。