Miyawaki Yu, Yoneta Masaki, Okawada Megumi, Kawakami Michiyuki, Liu Meigen, Kaneko Fuminari
Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
Neurorehabilitation Research Center, Kio University, Nara, Japan.
Front Syst Neurosci. 2022 Jan 10;15:804263. doi: 10.3389/fnsys.2021.804263. eCollection 2021.
Therapy with kinesthetic illusion of segmental body part induced by visual stimulation (KINVIS) may allow the treatment of severe upper limb motor deficits in post-stroke patients. Herein, we investigated: (1) whether the effects of KINVIS therapy with therapeutic exercise (TherEx) on motor functions were induced through improved spasticity, (2) the relationship between resting-state functional connectivity (rs-FC) and motor functions before therapy, and (3) the baseline characteristics of rs-FC in patients with the possibility of improving their motor functions. Using data from a previous clinical trial, three path analyses in structural equation modeling were performed: (1) a mediation model in which the indirect effects of the KINVIS therapy with TherEx on motor functions through spasticity were drawn, (2) a multiple regression model with pre-test data in which spurious correlations between rs-FC and motor functions were controlled, and (3) a multiple regression model with motor function score improvements between pre- and post-test in which the pre-test rs-FC associated with motor function improvements was explored. The mediation model illustrated that although KINVIS therapy with TherEx did not directly improve motor function, it improved spasticity, which led to ameliorated motor functions. The multiple regression model with pre-test data suggested that rs-FC of bilateral parietal regions is associated with finger motor functions, and that rs-FC of unaffected parietal and premotor areas is involved in shoulder/elbow motor functions. Moreover, the multiple regression model with motor function score improvements suggested that the weaker the rs-FC of bilateral parietal regions or that of the supramarginal gyrus in an affected hemisphere and the cerebellar vermis, the greater the improvement in finger motor function. The effects of KINVIS therapy with TherEx on upper limb motor function may be mediated by spasticity. The rs-FC, especially that of bilateral parietal regions, might reflect potentials to improve post-stroke impairments in using KINVIS therapy with TherEx.
通过视觉刺激诱导节段性身体部位的动觉错觉（KINVIS）进行治疗，可能有助于治疗中风后患者严重的上肢运动功能障碍。在此，我们研究了：（1）KINVIS疗法联合治疗性运动（TherEx）对运动功能的影响是否通过改善痉挛来诱导，（2）静息态功能连接（rs-FC）与治疗前运动功能之间的关系，以及（3）运动功能有可能改善的患者rs-FC的基线特征。利用先前一项临床试验的数据，进行了结构方程模型中的三项路径分析：（1）一个中介模型，绘制KINVIS疗法联合TherEx通过痉挛对运动功能的间接影响；（2）一个使用测试前数据的多元回归模型，控制rs-FC与运动功能之间的虚假相关性；（3）一个使用测试前和测试后运动功能评分改善情况的多元回归模型，探索与运动功能改善相关的测试前rs-FC。中介模型表明，虽然KINVIS疗法联合TherEx没有直接改善运动功能，但它改善了痉挛，从而导致运动功能得到改善。使用测试前数据的多元回归模型表明，双侧顶叶区域的rs-FC与手指运动功能相关，未受影响的顶叶和运动前区的rs-FC与肩部/肘部运动功能有关。此外，使用运动功能评分改善情况的多元回归模型表明，双侧顶叶区域或患侧半球缘上回和小脑蚓部的rs-FC越弱，手指运动功能的改善就越大。KINVIS疗法联合TherEx对上肢运动功能的影响可能由痉挛介导。rs-FC，尤其是双侧顶叶区域的rs-FC，可能反映了在使用KINVIS疗法联合TherEx改善中风后损伤方面的潜力。
