功能性近红外光谱成像技术在脑卒中运动功能障碍康复中的应用进展

功能性近红外光谱成像技术(fNIRS)是一种非侵入性脑成像技术, 可用于评估脑卒中运动功能障碍患者的皮质激活情况和功能连接水平等。观察不同神经康复治疗方法对脑卒中运动功能障碍患者大脑皮质激活的影响, 可以为评定神经功能损伤程度和神经可塑性变化提供依据, 有利于个体化、精准化康复。     

功能性近红外光谱成像技术在脑卒中后非运动功能障碍康复中的应用研究进展

功能性近红外光谱成像技术（fNIRS）可作为脑卒中患者治疗过程中的神经反馈工具、辅助诊断和疗效评估工具,本文旨在通过总结fNIRS在脑卒中后伴有抑郁、认知障碍、吞咽障碍和失语症的相关研究,以期为脑卒中后非运动障碍的康复提供借鉴和参考。     

基于近红外脑功能成像技术指导下运动想象训练在脑卒中后上肢运动功能康复中的应用

目的:观察运用近红外脑功能成像(fNIRS)技术筛选出想象策略的运动想象训练对脑卒中后上肢功能障碍的疗效,并探讨其作用机制。方法:将28例脑卒中患者随机分为对照组与研究组各14例。2组均给予常规康复治疗,研究组运用fNIRS技术筛选出有效的想象策略进行运动想象训练,对照组不固定想象内容进行运动想象训练。治疗前后采用上肢运动功能评定量表(FMA-UE)、上肢动作研究量表(ARAT)及改良Barthel指数评定量表(MBI)进行评定。结果:治疗4周后,2组患者的FMA-UE、ARAT及MBI评分均较治疗前显著提高(P<0.01),且研究组高于对照组(P<0.05)。结论:运用fNIRS技术筛选出的想象策略进行运动想象训练,可以更好地改善脑卒中患者的上肢运动功能及日常生活能力,其机制可能与提高运动相关脑区兴奋性有关。     

社区脑卒中康复适宜技术对脑卒中患者社会功能活动的影响

目的研究社区脑卒中康复适宜技术对脑卒中患者社会功能活动的影响。方法选择38例脑卒中患者应用社区脑卒中康复适宜技术训练,采用社会功能活动问卷评测治疗3个月前后脑卒中患者的社会功能。结果训练3个月后与训练前相比,脑卒中患者的社会功能得到改善。结论社区脑卒中康复适宜技术对脑卒中患者有疗效,且易教易学,适于在社区推广。     

功能性近红外光谱技术在神经疾病中的应用

功能性近红外光谱技术(fNIRS)是一种非侵入式脑功能成像技术。在脑卒中患者中,fNIRS可用于观察康复训练后患侧脑区激活情况和健侧代偿作用,还可用于对神经系统疾病的辅助诊断。     

基于功能性近红外光谱技术的脑卒中患者下肢功能康复研究进展

<正>脑卒中是导致患者残疾和死亡的主要原因^[1]。患者因残疾无法独立生活,给家庭和社会带来巨大负担^[2-3]。脑功能检测技术可监测大脑活动期间的变化,为评估脑卒中康复治疗的效果提供帮助^[1]。相关的脑功能检测技术有脑电图(electroencephalogram,EEG)、功能性磁共振成像(functional magnetic resonance imaging,fMRI)、正电子发射型计算机断层显像(positron emission computed tomography,PET)、功能性近红外光谱(functional near-infrared spectroscopy,fNIRS)等^[4-5]。     

基于功能性近红外光谱技术的脑卒中后上肢运动功能障碍患者单侧上肢训练和双侧上肢训练脑网络功能连接对比研究

目的 采用功能性近红外光谱(fNIRS)比较上肢运动功能障碍脑卒中患者单侧和双侧上肢运动时的脑网络功能连接差异。方法 2021年4月至6月,华山医院康复医学科脑卒中后上肢运动功能障碍患者40例分别行患侧单侧和双侧上肢运动,运动前后各采集fNIRS数据8 min,基于氧合血红蛋白,分析前额叶(PFC)、上肢与手功能区(H)以及初级躯体感觉区(S1)的功能活动和功能连接。结果 单侧任务后,患侧H区功能活动较运动前增强(t = -3.135, P < 0.05),患侧H区与患侧S1区、患侧H区与健侧S1区、患侧S1区与健侧S1区间功能连接强度较任务前增强(|t| > 3.218, P < 0.05)。双侧任务后,各区功能强度和各区间功能连接均无显著性差异(|t| < 2.385, P > 0.05)。单侧任务对患侧H区功能连接的增强效应高于双侧任务(t = 2.026, P < 0.05)。结论 相比双侧任务,脑卒中患者单侧上肢训练对强化相应功能脑区的即时效果更好,可对脑功能连接产生更明显的调控效应。     

社区康复简易技术对恢复期脑卒中患者日常生活活动能力以及平衡功能的影响

目的 探讨康复简易技术对脑卒中患者日常生活活动能力以及平衡功能的影响,验证该技术的有效性.方法 选取医院住院的脑卒中患者48例,分为对照组22例和治疗组26例,治疗组采用设计脑卒中社区康复简易技术,结合常规治疗,对照组的患者仪给与常规治疗.分别于入选时,治疗后1个月、治疗后3个月采用Barthel指数(BI)、Fugl-Meyer平衡量表进行评价.结果 治疗组和对照组患者日常生活活动能力、平衡功能在治疗前后均有提高(P<0.05).治疗组的日常生活活动能力、平衡功能在治疗后3个月均优于对照组(P<0.05).结论 脑卒中的康复简易技术可以提高患者的日常生活活动能力和平衡功能,是有效、实用的康复技术.     

脑卒中社区康复简易技术的研究

目的：探讨脑卒中社区康复简易技术对脑卒中患者运动功能和日常生活活动能力的影响。方法：采用小样本、随机对照研究方法，选取北京广外医院的脑卒中患者48例，分为对照组22例和治疗组26例，设计脑卒中社区康复简易技术训练，结合常规治疗，治疗组患者进行集体训练，对照组患者仅进行常规治疗。分别于入选时、治疗1个月后、治疗3个月后采用量表进行评测。结果：两组患者在治疗前和治疗后1个月时运动功能和日常生活活动能力均无显著性差异（P>0.05），在治疗后3个月时治疗组的运动功能和日常生活活动能力与对照组相比较，有显著性增加，差异有显著性意义（P<0.05）。结论：脑卒中社区康复简易技术有助于提高脑卒中患者运动功能和日常生活活动能力。     

脑卒中社区简易康复技术的应用与评价

目的通过对脑卒中患者运动功能和日常生活活动能力的评价分析简易康复技术在社区推广的可行性。方法在北京市望京社区共纳入患者65例,采用简易脑卒中康复干预技术,结合常规治疗,分别于入选时,治疗后3个月采用Fugl-Meyer量表、Barthel指数(BI)和社会功能活动问卷表进行评价。结果 3个月后简化Fugl-Meyer量表的评分与治疗前相比,总得分有明显提高(P<0.01),上肢和下肢的运动功能也均有所改善(P<0.01);干预后患者分日常生活活动能力有明显提高,差异具有统计学意义(P<0.01),社会功能活动能力也有所好转,干预前后差异具有统计学意义(P<0.01)。结论脑卒中的简易康复技术有助于改善脑卒中患者的运动功能、日常生活活动能力以及社会活动能力,可在社区推广可实施。     

Developing empirical models to enhance stroke rehabilitation

PURPOSE: Models identifying functional indicators most strongly associated with favourable and unfavourable outcomes may bolster evidence to improve stroke rehabilitation assessment and intervention. This study examined the feasibility of decision analysis methods for developing data-driven models that examined associations between specific functional indicators and global disability. METHOD: Data were derived from functional assessment of 67 participants 3 months following stroke. Decision analysis methods were used to examine specific activity and body function indicators associated with global disability, and the degree of limitation or impairment that contributed to favourable and unfavourable outcomes, in 2 models. The feasibility of decision analysis methods was evaluated. RESULTS: Of the 26 activity indicators, dressing was most strongly associated with global disability, followed by bill mailing, shopping and sweeping. Of 15 body function indicators, facial weakness and mental functions were most strongly associated with global disability. The misclassification risk estimates were fair for the two models. CONCLUSIONS: Findings suggest that decision analysis methods show promise for developing models examining associations between specific functional indicators and disability. Further study with these methods may identify specific priorities for functional assessment and intervention in stroke rehabilitation.     

Developing empirical models to enhance stroke rehabilitation

Purpose. Models identifying functional indicators most strongly associated with favourable and unfavourable outcomes may bolster evidence to improve stroke rehabilitation assessment and intervention. This study examined the feasibility of decision analysis methods for developing data-driven models that examined associations between specific functional indicators and global disability.

Method. Data were derived from functional assessment of 67 participants 3 months following stroke. Decision analysis methods were used to examine specific activity and body function indicators associated with global disability, and the degree of limitation or impairment that contributed to favourable and unfavourable outcomes, in 2 models. The feasibility of decision analysis methods was evaluated.

Results. Of the 26 activity indicators, dressing was most strongly associated with global disability, followed by bill mailing, shopping and sweeping. Of 15 body function indicators, facial weakness and mental functions were most strongly associated with global disability. The misclassification risk estimates were fair for the two models.

Conclusions. Findings suggest that decision analysis methods show promise for developing models examining associations between specific functional indicators and disability. Further study with these methods may identify specific priorities for functional assessment and intervention in stroke rehabilitation.     

亚急性脑卒中患者康复过程中优势与非优势脑半球功能变化差异

目的 基于功能性近红外光谱技术探讨亚急性脑卒中患者康复过程中优势与非优势大脑半球功能变化的差异。     

Inferring deep-brain activity from cortical activity using functional near-infrared spectroscopy

Functional near-infrared spectroscopy (fNIRS) is an increasingly popular technology for studying brain function because it is non-invasive, non-irradiating and relatively inexpensive. Further, fNIRS potentially allows measurement of hemodynamic activity with high temporal resolution (milliseconds) and in naturalistic settings. However, in comparison with other imaging modalities, namely fMRI, fNIRS has a significant drawback: limited sensitivity to hemodynamic changes in deep-brain regions. To overcome this limitation, we developed a computational method to infer deep-brain activity using fNIRS measurements of cortical activity. Using simultaneous fNIRS and fMRI, we measured brain activity in 17 participants as they completed three cognitive tasks. A support vector regression (SVR) learning algorithm was used to predict activity in twelve deep-brain regions using information from surface fNIRS measurements. We compared these predictions against actual fMRI-measured activity using Pearson’s correlation to quantify prediction performance. To provide a benchmark for comparison, we also used fMRI measurements of cortical activity to infer deep-brain activity. When using fMRI-measured activity from the entire cortex, we were able to predict deep-brain activity in the fusiform cortex with an average correlation coefficient of 0.80 and in all deep-brain regions with an average correlation coefficient of 0.67. The top 15% of predictions using fNIRS signal achieved an accuracy of 0.7. To our knowledge, this study is the first to investigate the feasibility of using cortical activity to infer deep-brain activity. This new method has the potential to extend fNIRS applications in cognitive and clinical neuroscience research.OCIS codes: (170.0170) Medical optics and biotechnology, (170.2655) Functional monitoring and imaging     

Outcome measures in stroke

Stroke is the third leading cause of death after heart disease and cancer. The care of stroke patient involves objective measurements of outcome, which are critical to assessment and evaluations of treatment regimens. Nontraumatic brain injury is influenced by endless variables and a variation in severity. Brain injury can result in significant changes in cognitive, emotional, and functional status, leading to many challenges to the clinical management of the patient. The measurement of outcome is fundamental for effective evaluation in clinical management of stroke patients. Neurological outcome research has predominantly focused on the effects of treatment, management, and on predictive indicators. A reliable measure of deficits after a stroke is important, not only to serve as a baseline for the evaluation of therapeutic measures, but also for rehabilitation and health care planning. The goal of this article is to provide information on 6 different measurement scales used to assess and measure outcomes of strokes.     

Chedoke-McMaster stroke assessment and modified Barthel Index self-assessment in patients with vascular brain damage

With the conception of interdisciplinary and joint rehabilitation, and the adherence to impairment, activity and participation as rehabilitation goals, a comparison of assessment instruments that use different perspectives (professional, lay person, patient) and are employed by different professional groups addressing different issues such as in occupational therapy and in physical therapy, is required. The clinical admission-discharge assessment of the Chedoke-McMaster stroke assessment and the Barthel index data of 127 vascular brain-damaged patients, including patients with other neurological disorders, were compared. The German language version of these instruments proved highly reliable; the factorial structure indicated, with a few exceptions, the conceptualized dimensions and the Barthel index contributed to this structure with an additional dimension of drinking and eating as well as a continence factor. It takes eight items of the Barthel index to predict a substantial part of the total variance of the 15-item Chedoke-McMaster stroke assessment (r2=76), but only three Chedoke-McMaster items to predict the Barthel index total (r2=77). It is suggested that although further analyses of all instruments used in a rehabilitation centre are required, addressing their relationship to each other and their usefulness as admission-discharge measures, a rehabilitation conceptualization should proceed closely linked with the optimization of the assessment measures, thus providing a lean but comprehensive monitoring system.     

Issues for selection of outcome measures in stroke rehabilitation: ICF activity

PURPOSE: To evaluate the psychometric and administrative properties of outcome measures in the WHO International Classification of Functioning, Disability and Health (ICF) Activity category used in stroke rehabilitation research and reported in the published literature. METHOD: Critical review and synthesis of measurement properties for nine commonly reported instruments in the stroke rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature. RESULTS: The reporting of specific measurement qualities for outcome instruments was relatively consistent across measures located within the same general ICF category. There was evidence to suggest that the measures were responsive to change as well as being valid and reliable tools. The best available instruments were associated with the assessment of activities of daily living, balance (static and dynamic), functional independence, and functional mobility. CONCLUSIONS: Given the diversity that exists among available measures, the reader is encouraged to examine carefully the nature and scope of outcome measurement used in reporting the strength of evidence for improved functional activity in stroke rehabilitation. However, there appears to be good consensus regarding the most important indicators of successful rehabilitation outcome, especially in the case of functional mobility.     

Outcome indicators for stroke: application of an algorithm treatment across the continuum of postacute rehabilitation services

OBJECTIVE: To determine the feasibility and utility of applying a case-mix adjusted algorithm for treatment across the continuum of stroke rehabilitation. DESIGN: Implementation of a clinical algorithm developed through national expert panels to standardize rehabilitation assessment and treatment of veterans with stroke. Stroke patients were stratified into initial severity groups using FIM instrument-Function Related Groups (FIM-FRG) classifications and were followed up from first rehabilitation referral to completion of all active restorative functional goals. FIM-FRG assignments were used to establish case-mix adjusted outcome indicators for the continuum of rehabilitation services. SETTING: Rehabilitation services in medical and surgical units, intermediate care units, inpatient rehabilitation bed units, and outpatient settings in 10 participating Veterans Affairs (VA) medical centers. PATIENTS: Stroke patients (n = 421) who received rehabilitation in the 10 participating VA centers. MAIN OUTCOME MEASURES: Patients' functional gains, length of treatment (LOT), functional status at discharge, LOT efficiency, costs, cost efficiency, and disposition location. RESULTS: Two hundred twenty-three patients began rehabilitation while in acute medical or surgical units, 171 in inpatient rehabilitation units, 24 in intermediate care, and the remainder while in other settings. With cases compiled across all settings, average total rehabilitation costs for patients in the lowest FRG class (most severe disabilities) were more than twice those for patients assigned to the highest FRG class (least severe disabilities). FIM gains were greatest in the subset of younger stroke patients with the most severe disabilities. CONCLUSIONS: Implementing a standard algorithm of rehabilitation care that includes outcome indicators adjusted to patients' disability severity is feasible. The algorithm's utility is evident because it encompasses rehabilitation care provided across the full continuum, promotes access to care by advocating assessment of all stroke patients, encourages early initiation of treatment, and promotes a smooth transition though various levels of care while encouraging cost containment.     

康复介入时间对急性缺血性脑卒中功能恢复的影响

目的了解急性脑卒中患者康复治疗开始时间对功能恢复的影响。方法对两组各35例急性脑卒中患者进行运动功能康复,一组于发病1周内开始康复,称为早康复组;另一组于发病1～3周开始康复,称为晚康复组,两组均接受同样的康复治疗和常规药物治疗。疗效评定,运动功能选择Fulg-Meyer运动功能测评,ADL测评选择FIM方法中反映上下肢功能的亚项,测评分别于入组时(治疗前)和病程28～30 d进行,比较两组患者病程1个月时的功能状态。结果运动功能积分:治疗前两组间差异无统计学意义(P>0.05),治疗后早康复组手、腕、上肢积分显著高于康复组(P<0.05)。ADL积分:治疗前早康复组上、下肢积分均低于晚康复组(上肢P<0.05,下肢P<0.01),治疗后早康复组上肢积分高于晚康复组差异有统计学意义(P<0.01)。结论急性脑卒中偏瘫康复治疗开展的越早运动功能恢复的越快,尽早康复治疗可以加快恢复进程。