单侧脑瘫患者上肢双侧运动协调的脑激活模式：一项近红外光谱研究。
Brain activation patterns underlying upper limb bilateral motor coordination in unilateral cerebral palsy: an fNIRS study.
机构信息
Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
出版信息
Dev Med Child Neurol. 2020 May;62(5):625-632. doi: 10.1111/dmcn.14458. Epub 2020 Feb 7.
AIM
To explore cortical activation during bimanual tasks and functional correlates in unilateral cerebral palsy (CP).
METHOD
This cross-sectional study included eight participants with unilateral CP (six females, two males; mean age [SD] 20y 10mo [5y 10mo], 13y 8mo-31y 6mo) in Manual Ability Classification System levels II to III and nine age-matched participants with typical development (seven females, two males; mean age [SD] 17y 8mo [5y 7mo], 9y 4mo-24y 2mo). They performed bimanual symmetric squeezing (BSS) and bimanual asymmetric squeezing (BAS) tasks at 1Hz, and a pouring task with dominant hand (DPour) and a pouring task with non-dominant hand (NDPour) at 0.67Hz, all while a custom array of functional near-infrared spectroscopy (fNIRS) optodes were placed over their sensorimotor area. Mixed-effects were used to contrast groups, tasks, and hemispheres (corrected p-values [q] reported). Analysis of variance and t-tests compared performance measures across groups and tasks.
RESULTS
Participants with unilateral CP showed greater activation in both hemispheres during BAS (non-lesioned: q<0.001; lesioned: q<0.001), and in the lesioned hemisphere during BSS (q<0.001), DPour (q=0.02), and NDPour (q=0.02) than those with typical development. The lesioned hemisphere in unilateral CP showed more activity than the non-lesioned one (BSS: q=0.01; BAS: q=0.009; NDPour: q=0.04). During BAS, higher cortical activity correlated with more synchronous arm activation (r=0.79; p=0.02); activity lateralized towards the non-lesioned hemisphere correlated with better Pediatric Evaluation of Disability Inventory computer adaptive test scores (r=0.81; p=0.03).
INTERPRETATION
Results suggest abnormally increased sensorimotor cortical activity in unilateral CP, with implications to be investigated.
WHAT THIS PAPER ADDS
Cortical activity in manual tasks is described with functional near-infrared spectroscopy in typical and atypical cohorts. Activation levels in unilateral cerebral palsy appear to escalate with task difficulty. Increased brain activity may be associated with poorer selective manual control. Specific patterns of brain activity may be related to impaired bimanual function.
目的
探讨单手脑瘫患者双侧双手任务时的皮质激活及其功能相关性。
方法
本横断面研究纳入 8 名单侧脑瘫患者（6 名女性，2 名男性；平均年龄[标准差]20 岁 10 个月[5 岁 10 个月]，13 岁 8 个月-31 岁 6 个月），改良手功能分级系统（Manual Ability Classification System）Ⅱ级至Ⅲ级，以及 9 名年龄匹配的正常发育者（7 名女性，2 名男性；平均年龄[标准差]17 岁 8 个月[5 岁 7 个月]，9 岁 4 个月-24 岁 2 个月）。他们以 1Hz 的频率进行双侧对称挤压（Bimanual Symmetric Squeezing，BSS）和双侧不对称挤压（Bimanual Asymmetric Squeezing，BAS）任务，以 0.67Hz 的频率进行优势手倾倒（Dominant Hand Pouring，DPour）和非优势手倾倒（Non-Dominant Hand Pouring，NDPour）任务，同时在其感觉运动区放置一组定制的近红外光谱（functional near-infrared spectroscopy，fNIRS）光极。使用混合效应对比组间、任务间和半球间差异（报道校正后的 p 值[q]）。方差分析和 t 检验比较各组和任务间的性能指标。
结果
单侧脑瘫患者在 BAS 时双侧半球激活增加（非病变半球：q<0.001；病变半球：q<0.001），BSS（q<0.001）、DPour（q=0.02）和 NDPour（q=0.02）时病变半球激活增加，与正常发育者相比。单侧脑瘫的病变半球比非病变半球活动更多（BSS：q=0.01；BAS：q=0.009；NDPour：q=0.04）。在 BAS 时，更高的皮质活动与手臂更同步的激活相关（r=0.79；p=0.02）；偏向非病变半球的活动与更好的小儿残疾评估量表计算机适应测试成绩相关（r=0.81；p=0.03）。
结论
研究结果提示单侧脑瘫患者的感觉运动皮质活动异常增加，具体影响尚待进一步研究。
本研究的意义
使用近红外光谱技术描述了典型和非典型队列在手部任务中的皮质活动。单侧脑瘫患者的活动水平似乎随着任务难度的增加而升高。增加的脑活动可能与选择性手部控制能力下降有关。特定的脑活动模式可能与双侧功能受损有关。
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