Wen Xin, Peng Junwei, Zhu Yanying, Bao Xiao, Wan Zihao, Hu Rongliang, Liu Huiyu, Li Fang, Liu Zicai
Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China.
School of Rehabilitation Medicine Gannan Medical University, Ganzhou, Jiangxi, China.
Med Phys. 2023 Aug;50(8):5166-5175. doi: 10.1002/mp.16535. Epub 2023 Jun 14.
BACKGROUND: Dysphagia is one of the major post-stroke complications, understanding post-stroke changes in cortical excitability and promoting early remodeling of swallowing-related cortical areas to enable accurate treatment is essential for recovery of patients. OBJECTIVES: We aimed to investigate hemodynamic signal changes and functional connectivity in acute stroke patients with dysphagia compared to age-matched healthy participants in response to volitional swallowing using functional near-infrared spectroscopy (fNIRS) in this pilot study. METHODS: Patients with first-ever post-stroke dysphagia having an onset of 1-4 weeks and age-matched right-handed healthy subjects were recruited in our study. fNIRS with 47 channels was utilized to detect the oxyhemoglobin (HbO ) and reduced hemoglobin (HbR) concentration changes when volitional swallowing. Cohort analysis was performed by a one-sample t-test. Two-sample t-test was utilized to compare the difference in cortical activation between patients with post-stroke dysphagia and healthy subjects. Furthermore, the relative changes in the concentration of the HbO throughout the experimental procedure were extracted for the functional connectivity analysis. The Pearson correlation coefficients of the HbO concentration of each channel were analyzed on a time series, and then a Fisher Z transformation was then performed, and the transformed values were defined as the functional connection strengths between the channels. RESULTS: In this present study, a total of nine patients with acute post-stroke dysphagia were enrolled in the patient group and nine age-matched healthy participants in the healthy control group. Our study observed that the extensive regions of the cerebral cortex were activated in the healthy control group, while the activation area of patient group's cortical regions was quite limited. The mean functional connectivity strength of participants was 0.485 ± 0.105 in the healthy control group, and 0.252 ± 0.146 in the patient group, with a significant difference between the two groups (p = 0.001). CONCLUSION: Compared to the healthy individuals, cerebral cortex regions of acute stroke patients were only marginally activated during volitional swallowing task, and the average functional connectivity strength of cortical network in patients was relatively weaker.
背景：吞咽困难是中风后的主要并发症之一，了解中风后皮质兴奋性的变化并促进吞咽相关皮质区域的早期重塑以实现精准治疗对患者的康复至关重要。 目的：在这项初步研究中，我们旨在使用功能近红外光谱技术（fNIRS），调查吞咽困难的急性中风患者与年龄匹配的健康参与者相比，在自主吞咽时的血流动力学信号变化和功能连接情况。 方法：本研究招募了首次中风后1 - 4周出现吞咽困难的患者以及年龄匹配的右利手健康受试者。使用47通道的fNIRS检测自主吞咽时氧合血红蛋白（HbO）和还原血红蛋白（HbR）浓度的变化。采用单样本t检验进行队列分析。使用两样本t检验比较中风后吞咽困难患者与健康受试者之间皮质激活的差异。此外，提取整个实验过程中HbO浓度的相对变化进行功能连接分析。对每个通道的HbO浓度的Pearson相关系数进行时间序列分析，然后进行Fisher Z变换，变换后的值定义为通道之间的功能连接强度。 结果：在本研究中，患者组共纳入9例急性中风后吞咽困难患者，健康对照组纳入9名年龄匹配的健康参与者。我们的研究观察到，健康对照组中大脑皮质的广泛区域被激活，而患者组皮质区域的激活面积相当有限。健康对照组参与者的平均功能连接强度为0.485±0.105，患者组为0.252±0.146，两组之间存在显著差异（p = 0.001）。 结论：与健康个体相比，急性中风患者在自主吞咽任务期间大脑皮质区域仅被轻微激活，且患者皮质网络中的平均功能连接强度相对较弱。
Neurorehabil Neural Repair. 2013-12-2
J Neurol Neurosurg Psychiatry. 2009-12
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