基于Bold-fMRI观察双侧上肢训练对脑梗死后上肢运动功能恢复的影响

发布时间：2018-03-25 17:21

本文选题：脑梗死　切入点：双侧上肢训练　出处：《成都体育学院》2017年硕士论文

【摘要】：研究目的:利用静息态功能磁共振(Resting State Functional Magnetic Resonance Imaging,rs-fMRI)观察脑梗死患者经过双侧上肢训练技术治疗后上肢运动功能恢复情况,及观察与其相匹配的临床康复评定量表之间的关系,为脑梗死患者的康复提供理论及技术的支持。研究方法:对四川省人民医院康复科的住院病人根据本实验的筛选标准进行筛选,选出符合标准的20例患者,分为双侧上肢治疗组10人(男6人,女4人),对照组10人(男5人,女5人)。所有患者都进行常规物理治疗,作业治疗,针灸等常规治疗,单侧和和双侧上肢训练组在此基础上再给予统一制定的上肢运动技术治疗。训练时长1个月,每天一次。所有患者于入院当日入院时进行上肢功能评分(Fugl-Meyer上肢运动功能评定)、常规T1WI(T1 weighted imaging,T1加权成像)、T2WI(T2 weighted imaging,T2加权成像)及静息态功能磁共振扫描(rs-fMRI),在进行一个月的治疗后,再次进行评定与扫描。将所收入的数据及图像运用Matlab2012a软件分析,测量所有患者治疗前后患侧初级运动皮层(primary motor cortex,M1)区的Reho值及Alff值,最后纳入REST进行统计学分析。研究结果:1.经过治疗后,双侧上肢治疗组和对照组所有患者在患侧M1区的Reho激活都有所增加,双侧治疗组增加更多(p0.05);2.双侧上肢治疗组患侧M1区的的Alff值较对照组更明显的降低(p0.05);3.所有患者患者患侧M1区的ReHo和Allf治疗前后的变化值与临床上肢功能评分(Fugl-Meyer)的治疗前后变化都呈正相关,与双侧上肢治疗组的正相关性较明显。双侧治疗组的ΔReHo与ΔFugl-Meyer相关系数r=0.793(p=0.006),ΔAlff与ΔFugl-Meyer相关系数r=-0.837(p=0.003),对照组的ΔReHo与评分量表相关系数r=0.647(p=0.043),ΔAlff与ΔFugl-Meyer相关系数r=-0.764(p=0.01)。结论:双侧上肢训练在对脑梗死患者上肢运动功能的康复比传统的只针对单侧上肢疗法更有效;ReHo和Allf可以作为运用功能磁共振观察脑梗死后上肢运动功能康复的指标。
[Abstract]:Objective: to observe the recovery of upper limb motor function after bilateral upper limb training in patients with cerebral infarction by resting State Functional Magnetic Resonance imagingrs-fMRI, and to observe the relationship between the corresponding clinical rehabilitation rating scales. To provide theoretical and technical support for the rehabilitation of patients with cerebral infarction. Methods: according to the screening criteria of this experiment, 20 patients with cerebral infarction were selected from the rehabilitation department of Sichuan Provincial people's Hospital. The patients were divided into bilateral upper limb treatment group (6 men, 4 women) and control group (5 men and 5 women). All patients were treated with routine physical therapy, occupational therapy, acupuncture and other routine treatment. On this basis, the unilateral and bilateral upper limb training groups were treated with unified upper limb motor techniques. The training time was 1 month. Once a day. All the patients were assessed with Fugl-Meyer upper limb motor function on admission day, and the routine T1WI(T1 weighted imagingT1-weighted imaging T _ 2WI _ I _ T _ 2 weighted imaging T _ 2 weighted imaging and resting functional magnetic resonance imaging were performed after one month's treatment. The data and images were analyzed by Matlab2012a software. The Reho and Alff values of primary motor cortexus M1 were measured in all patients before and after treatment. After treatment, the activation of Reho in the affected M1 region was increased in all the patients in the bilateral upper limb treatment group and the control group. The Alff value of M1 area in bilateral upper limb treatment group was significantly lower than that of control group. The changes of ReHo and Allf in the affected M1 area of all patients before and after treatment and the clinical upper limb function score were significantly lower than those in the control group. There was a positive correlation between the changes before and after treatment, The correlation coefficient between 螖 ReHo and 螖 Fugl-Meyer was 0.793p0.006, the correlation coefficient between 螖 Alff and 螖 Fugl-Meyer was r ~ (-0.837) p ~ (0.003), the correlation coefficient between 螖 ReHo and score scale was r 0.647 ~ (?) p 0.043, and the correlation coefficient between 螖 Alff and 螖 Fugl-Meyer was r ~ (-0.764) p ~ (0.01). Conclusion: bilateral upper limb training has a significant correlation with 螖 ReHo and 螖 Fugl-Meyer. Conclusion: bilateral upper extremity training is an important factor in bilateral upper extremity training, and the correlation coefficients of 螖 ReHo and 螖 Fugl-Meyer are 0. 647, p 0. 043, r = 0. 764, P = 0. 01, respectively. The rehabilitation of upper limb motor function in patients with cerebral infarction is more effective than traditional unilateral upper limb therapy. ReHo and Allf can be used as an index to observe the recovery of upper limb motor function after cerebral infarction with functional magnetic resonance imaging (fMRI).
【学位授予单位】：成都体育学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.33;R493

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