脑机交互结合功能性电刺激康复训练新技术对慢性期脑卒中大脑可塑性的影响

发布时间：2018-06-24 09:02

本文选题：脑卒中 + 脑机接口　；参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：目的：1.验证脑机接口结合功能性电刺激（BCI-FES）在慢性期脑卒中康复中的可行性；2.研究脑机交互的中枢神经康复机制。方法：将4名符合纳入标准的受试者分入BCI-FES训练组或单纯FES训练组，其中1名受试者在接受完第I阶段的BCI-FES训练后经过20周的洗脱期再次接受了第II阶段的单纯FES训练。每一阶段训练持续4周，40分钟/次，共20次。每阶段训练前、训练后各进行一次上肢运动功能评价，功能性磁共振成像（fMRI）检测及弥散张量成像（DTI）检测，训练结束后4周再进行一次随访上肢运动功能评价。上肢运动功能评价包括患侧手最快抓握速度、Fugl-Meyer上肢运动功能评价、上肢主要肌群徒手肌力检查（MMT）、九孔柱测试、BoxBlock测试、Jebson-Taylor测试。fMRI检测包含“运动”、“想象”及“休息”刺激组块，对采集到的图像进行分析，绘制脑激活图，，计算激活体积及偏侧系数（LI）。对DTI扫描数据进行感兴趣区（ROI）的纤维走行描绘、各向异性分数（FA）值、FA指数及表观弥散系数（ADC）值计算。结果：1.MMT两组受试者训练后均无显著改善，患手最快抓握速度FES组平均值在训练后略下降，BCI-FES组平均值训练后升高，其余上肢功能检测两组受试者在训练后平均值均较训练前提高，且BCI-FES组各项平均提高值均高于FES组；2.BCI-FES组全部上肢运动功能评价项目的平均值在随访点也均表现出较训练前提高，除九孔柱测试外，其他评价项目的平均值均低于训练后测试值；3.全部受试者在患手真实运动及运动想象时大脑激活模式与正常人不同，表现为同侧初级运动区（M1）激活的增多，对侧M1激活的减少，以及更多次级运动区的参与；4.BCI-FES训练后受试者执行患手真实运动和运动想象时较训练前出现更多脑区的参与。单纯FES训练后则无明显的激活脑区增加；5.比较真实运动，运动想象有更多次级运动区的参与，而对于初级运动区的激发不如真实运动明显；6.BCI-FES训练及单纯FES训练均可在一定程度上增加脑激活体积，而BCI-FES训练的增加程度要明显高于单纯FES训练；7.经过BCI-FES训练，慢性期脑卒中患者在执行瘫痪手任务（真实运动或运动想象）时，平均LI值提高，大脑激活平衡向损伤侧半球转移。而单纯FES训练后大脑激活平衡向损伤对侧半球轻度转移，平均LI值下降；8.全部受试者病灶周围区域白质纤维数量低于对侧半球相应区域，损伤侧半球内囊后肢区域白质纤维数量也低于对侧半球内囊后肢；9.BCI-FES训练后病灶周围区域及损伤半球内囊后肢区域白质纤维数量及完整性均较训练前提高，单纯FES训练则无此效应；10.全部BCI-FES组受试者病灶周围区域FA值及FA指数、病灶侧内囊后肢区域FA值及FA指数均在训练后有所提高，FES组受试者病灶周围区域FA值、FA指数训练后平均升高，但升高幅度低于BCI-FES组，病损侧内囊后肢FA值、FA指数则均下降；11.BCI-FES组病灶周围区域及损伤半球内囊后肢区域ADC值在训练后平均下降，单纯FES组则平均升高。12.训练前后，患手真实运动时的fMRI-LI的改变与病灶周围区域的FA值的改变（P=0.017，r=0.9412）及病灶侧半球内囊后肢区域FA值的改变（P=0.034，r=0.9065）呈显著线性正相关。结论：1.BCI-FES应用于存在脑损伤的脑卒中患者的康复训练是可行的；2.BCI-FES康复训练新技术可促进慢性期脑卒中患者上肢运动功能的改善，其改善要优于单纯FES治疗，且这种改善至少可以在训练结束后1个月仍有体现；3.BCI-FES技术可促进慢性期脑卒中患者中枢神经系统重塑，这种重塑在皮层水平和皮层下水平均有体现，且其可塑性的改善要明显优于单纯FES治疗。
[Abstract]:Objective : 1 . To verify the feasibility of brain - computer interface combined with functional electrical stimulation ( BCI - fes ) in the rehabilitation of cerebral apoplexy .
2 . To study the central nervous rehabilitation mechanism of brain - machine interaction .

Methods : Four subjects who met the inclusion criteria were divided into the training group of the BCI - fes training group or the simple fes training group . One of the subjects was trained in Phase II only by 20 - week washout period after the training of BCI - fes in Phase I . The functional evaluation of upper limb exercise included the fastest grasping speed of the affected side , the function of Fugl - Meyer upper limb movement , and the Jebson - Taylor test . The functional evaluation of the upper limb included " motion " , " imagination " and " rest " stimulation group . The functional evaluation of the upper limb included " motion " , " imagination " and " rest " stimulation group . The functional evaluation of the upper limb was performed by plotting the active volume and the partial coefficient ( LI ) . The fiber trace drawing , the anisotropy fraction ( FA ) value , FA index and the apparent diffusion coefficient ( ADC ) value of the region of interest ( ROI ) were calculated for DTI scan data .

Results : 1 . There was no significant improvement after the training of 1 . MMT in both groups . The average value of the fastest grasping speed was slightly decreased after the training , and the average value of the group was increased after the training , while the rest of the upper limb function test showed that the average values of the two groups were higher before the training , and the average increase of the average values of the BCI - fes group was higher than that of the group ' s group ;
2 . The average value of all upper limb exercise functional evaluation items of BCI - fes group was higher than that before training before training , except for nine - hole column test , and the average value of other evaluation items was lower than that of post - training test value ;
3 . In all the subjects , the brain activation pattern is different from that of the normal person in the event of the real movement of the hand and the movement of the hand , showing the increase of the activation of the ipsilateral primary motion region ( M1 ) , the reduction of the activation of the contralateral M1 , and the participation of the more stages of the motion region ;
4 . After training , the subjects were involved in more brain areas than before training .
5 . Compared with the real motion , the motion picture has more involvement of the motion region , but the excitation of the primary motion region is not as obvious as the real motion ;
6 . The training of BCI - fes and the training of simple fes can increase the brain activation volume to a certain extent , while the degree of increase of BCI - fes training is much higher than that of simple fes training ;
7 . The average LI value was increased and the cerebral activation balance was transferred to the injured lateral hemisphere during the exercise of the paralyzed hand task ( real motion or exercise imagination ) .
8 . The number of white matter fibers in the area around the lesion was lower than that in the contralateral hemisphere , and the number of white fibers in the posterior limb region of the injured lateral hemisphere was lower than that of the contralateral hemisphere .
9 . The quantity and integrity of white matter in the area around the lesion and in the posterior limb region of the injured hemisphere were higher than before training .
10 . The FA value and FA index of the lesion were increased after the training , FA value and FA index of the lesion were increased after the training , but the FA value and FA index increased after the training , but the increase was lower than that of the BCI - fes group . The FA value and FA index of the lesion were decreased .
12 . Before and after the training , the changes of the F - LI and FA values in the area around the lesion ( P = 0.034 , r = 0.9065 ) were positively correlated with the changes of FA value in the area around the lesion ( P = 0.034 , r = 0.9065 ) .

Conclusion : 1 . BCI - fes can be used in rehabilitation training of stroke patients with brain injury .
2 . The new technique can promote the improvement of the upper limb movement function of stroke patients in the chronic stage , and the improvement is superior to that of the simple fes treatment , and the improvement can be embodied at least 1 month after the end of the training ;
3 . BCI - fes can promote the remodeling of the central nervous system in the patients with chronic stroke . This remodeling is reflected in the cortical level and the subcortical water , and the improvement of plasticity is much better than that of the simple fes treatment .
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R493;R743.3

【参考文献】