动态功能性磁共振成像在强制性使用运动疗法治疗脑卒中上肢偏瘫中的应用研究

目的：对1例脑卒中上肢偏瘫患者进行强制性使用运动疗法治疗，同时连续进行动态功能性磁共振成像观察，以探讨大脑功能重组与功能恢复之间的相关性。方法：对患者进行2周的强制性使用运动疗法治疗，使用夹板限制健侧上肢活动2周，每天保持6小时的患侧上肢训练。在治疗前1天、治疗后当天、治疗后2周分别在患者对指运动时进行功能磁共振扫描。结果：与治疗前基线相比，患者上肢Carroll评分提高29．1％，金子翼评分提高18．4％，3个月后随访，Carroll上肢功能评分提高30．6％，金子翼上肢功能评分提高26．2％。对健手限制2周后，其运动功能没有下降。在治疗前，患手运动时使用功能磁共振扫描可以发现对侧中央前后回、对侧额叶前部、同侧大脑皮层中央前回激活；健手运动时，以对侧中央前后回兴奋为主。经过强制性使用治疗后，患手运动时同侧和对侧大脑皮层广泛的激活，健手运动时，大脑对侧中央前后回的兴奋区域明显变小；治疗结束2周后，患侧上肢运动时，患手运动时其同侧和对侧大脑皮层广泛的激活的现象明显降低，激活区集中在对侧的中央前后回，在健手运动时，又重新恢复对侧中央前后回兴奋区域。结论：强制性使用运动疗法可明显提高脑卒中患者上肢运动功能，使用功能性磁共振证明这种变化与大脑可塑性改变相关联，同时限制健侧肢体活动不会影响其运动功能，大脑激活区域的变化为一过性改变。

A study of dynamic functional MRI in upper-limb stroke hemiplegia treated with constraint-induced movement

Objective:To test constraint-induced movement therapy for chronic upper-limb stroke hemiparesis and investigate the neural correlates of recovery with functional magnetic resonance imaging(fMRI)in one subject.Method:Constraint-induced movement therapy consisted of6hour of daily upper-limb training for2week.A restrictive splint was worn on the nonparetic limb during walking hours.fMRI with a1.5T scanner was performed at the time of the subjects attempting sequential finger-tapping at pretreatment,posttreatment and two weeks after treatment.Result:Compared with baseline,the Carroll test improved29.1%,and a Japan upper extremity function test improved18.4%.The Carroll test continued to improve up to30.6%and Japan upper extremity function test improved up to26.2%3months after training.After constrainting the nonparetic limb,the the functional movement didn't decrease.Before training,on fMRI,the activated regions were in the contralateral primary sensorimotor cortex,contralatreral anterior frontal lobe and ipsilateral motor area during the paretic hand movement.Activation in the contralateral primary sensorimotor cortex was found during the nonparetic hand movement.After training,the subject showed scattered activity in ipsilateral and contralateral cortex during the paretic hand movement.Activation in the contralateral primary sensorimotor cortex was found became small during the nonparetic hand movement.2weeks after training,Scattered activity in ipsilateral and contralateral cortex markedly decreased and activated regions were mainly in the contralateral primary sensorimotor cortex during the paretic hand movement.Activation in the contralateral primary sensorimotor cortex was recovery during the nonparetic hand movement.Conclusion:Constraint-induced movement therapy produces significant functional improvement in upper-limb stroke hemiplegia and results in plasticity as demonstrated by fMRI.Constrainting the nonparetic limb have no difference in the functional movement.The change in activated regions in subject's brain is transient.