Catalogna Merav, Hadanny Amir, Parag Yoav, Adler Moran, Elkarif Vicktoria, Efrati Shai
Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Front Neurol. 2023 Sep 29;14:1233841. doi: 10.3389/fneur.2023.1233841. eCollection 2023.
Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investigate the neural response mechanisms and functional reorganization underlying hyperbaric oxygen therapy (HBOT)-induced motor rehabilitation in a chronic post-stroke patient suffering from severe upper-limb motor impairment.
We studied motor task fMRI activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb, 2 years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and at the end of the treatment using the Fugl-Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC).
Following HBOT, the FMA score improved from 17 (severe impairment) to 31 (moderate impairment). Following the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity ( = 0.002) and a between-network connectivity increase (-score: 0.35 ± 0.21 to 0.41 ± 0.21, < 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex.
This study provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients.
日常生活活动（ADL）受损是中风后康复的主要关注点。特别是上肢运动障碍与生活质量低下相关。在本病例报告中，我们使用基于任务和静息态功能磁共振成像（fMRI）工具，研究了一名患有严重上肢运动障碍的慢性中风患者在高压氧治疗（HBOT）诱导的运动康复过程中的神经反应机制和功能重组。
我们研究了一名61岁右利手男性患者在急性损伤两年后，接受60次每日HBOT治疗前后的运动任务fMRI激活和静息态功能连接（rsFC）。在基线和治疗结束时使用Fugl-Meyer评估（FMA）和握力最大自主收缩（MVC）评估运动功能。
HBOT治疗后，FMA评分从17分（严重损伤）提高到31分（中度损伤）。在涉及患手的试验干预后，观察到双侧辅助运动区（SMA）和运动前区（PMA）的fMRI激活增加。偏侧化指数（LI）从1降至0.63，表明对侧半球的参与。感兴趣区域（ROI-to-ROI）分析显示干预后半球间连接增加（ = 0.002），网络间连接增加（-评分：0.35±0.21至0.41±0.21，<0.0001）。以右侧SMA为种子的基于种子点到体素的rsFC分析显示与左侧后顶叶皮层、左侧初级体感皮层和运动前区的连接增加。
本研究为HBOT诱导的慢性中风患者脑可塑性和功能改善提供了更多见解。
