近红外光谱仪在脑卒中瘫痪康复评定中的应用

目的：评价运动疗法对脑血流的影响,探讨脑卒中后瘫痪康复的机制,客观评估脑卒中后瘫痪的结局。方法：应用近红外光谱仪（near infrared spectroscopy,NIRS)观察23例脑卒中后偏瘫患者及9例无脑部疾病者4项不同的主动及被动运动局部脑血流变化,结果：运动时可见脑血流随时间而上升,。在运动末达到峰值,休息时逐渐下降,主动运动引起的局部脑血流比被动运动增加更明显,肢体近端运动引起的脑血流变化明显高于肢体远端运动。对照组左侧肢体与右侧肢体运动时引起的脑血流血流血氧变化无明显差异,病例组患侧肢体运动时比健侧血流增加更多。结论：脑卒中后患肢的主动运动比被动运动更有利于改善脑血流状况,脑卒中后早期NIRS观察运动相关的脑血流变化可以提示预后,运动疗法可改善患侧大脑的侧支循环和局部微循环,达到神经康复的目的。     

早期康复治疗对脑梗死偏瘫患者脑血流的影响

目的:探讨早期康复治疗对脑梗死偏瘫患者脑血流的影响,评价早期康复治疗的效果及指标.方法:脑梗死偏瘫患者87例,按人院顺序分为观察组48例和常规组39例,并选择46例同期体检的健康人(健康组)作为健康对照,观察组和常规组均在神经内科按脑梗死常规处理,以药物治疗为主.观察组在此基础上配合Bobath疗法.治疗前后和健康组均应用TCD检测双侧大脑中动脉(MCA)的平均血流速度(Vm),同时应用Fugl-Meyer法(FMA)评价瘫痪肢体的功能.结果:治疗30 d后FMA评分与治疗前比较,观察组和常规组均有显著提高(P＜0.01).治疗前观察组和常规组MCA健患侧Vm均低于健康组(P＜0.01或0.05);治疗后观察组有明显提高,与健康组比较差异无显著性意义;常规组患侧较治疗前明显提高.但仍低于观察组和健康组(P＜0.05).结论:早期康复治疗可以增加脑梗死偏瘫患者的脑血流量,促进功能恢复,TCD可以作为评价其早期疗效的指标,优于FMA评分.     

Cerebral oxygenation and hemodynamics during blood donation studied by near-infrared spectroscopy

BACKGROUND: Blood donation is a safe human model for acute blood loss. This study investigated associated changes in regional cerebral oxygenation and cerebral blood volume (CBV) by near-infrared spectroscopy (NIRS). STUDY DESIGN AND METHODS: Fifty healthy blood donors donated 450 mL of whole blood within 4 to 9 minutes. Changes in regional cerebral oxygen saturation (rSO2) and cerebral tissue Hb concentration (HbT) were semiquantitatively measured by NIRS. Venous Hb concentration was measured before and after blood donation. The predonation and postdonation CBV was estimated from HbT and venous Hb concentration. Differences between pre- and postdonation study parameters were analyzed by paired t tests (p < 0.05). RESULTS: Within the study group, rSO2 decreased by 0.44 sat percent (p < 0.01) on average during blood donation, which is still within the range of individual physiologic baseline variation. The average venous Hb concentration decreased significantly by 4.6 percent, whereas HbT increased significantly by 2.5 percent and CBV increased even by 7.5 percent on average. CONCLUSION: The increase in CBV indicates cerebral vasodilation, which seems to be the major compensation mechanism during acute blood loss. The decrease in rSO2 was relatively small, indicating that cerebral oxygenation was maintained within the physiologic range.     

三七提取物并早期康复对脑梗死患者微循环及血液流变学的影响

背景三七总皂甙具有活血化瘀,增加脑血管和冠状动脉血流量,改善微循环等作用,应用中医药方法和采用易化技术进行早期康复是否对脑卒中患者的康复有明显促进作用?目的观察中药三七提取物血塞通并早期康复对脑梗死患者微循环、血液流变学的影响,探讨其治疗作用的机制.设计以诊断为依据的随机对照试验.方法对经头颅CT或MRI确诊的高血压动脉硬化性脑梗死患者200例,按入院次序采用随机数字表法分为两组,研究组100例给予血塞通每次200mg加50 g/L葡萄糖或生理盐水250～500mL静脉滴注,1次/d,当生命体征稳定后采用易化技术进行早期康复治疗;对照组100例,按传统方法治疗.两组治疗前后采用临床神经功能缺损程度评分标准评定疗效、Brunstrom分级评定偏瘫恢复程度、Barthel指数(BI)评定日常生活活动(ADL)能力.同时观察两组治疗前后甲襞微循环、血液流变学的变化.主要观察指标①两组患者ADL恢复情况.②两组患者偏瘫恢复程度.③两组患者临床疗效.④两组患者甲襞微循环变化.⑤两组患者血液流变学变化.结果研究组患者ADL能力的恢复、偏瘫的功能恢复比对照组的效果要好;其有效率为93%,显效率52%,与对照组比较差异有显著性意义(x2=19.46,P＜0.005),通过对实验室各项观察指标结果的对比分析看出,研究组患者治疗后其微循环、血液流变性有明显的改善.结论中药三七提取物血塞通并早期康复是通过改善微循环、血液流变性等机制,而达到较好的临床治疗效果,是脑梗死急性期治疗的优选方法.     

Reproducibility of cerebral blood volume measurements by near infrared spectroscopy in 16 healthy elderly subjects

Near infrared spectroscopy (NIRS) is a non-invasive method to monitor cerebral haemodynamics. Used either alone or in combination with other non-invasive methods such as transcranial Doppler sonography, this technique is well suited for use in cerebrovascular research in ageing. Reproducibility of NIRS, however, has only been determined in neonates and adults. We applied controlled desaturation (the O(2)-method) to measure the cerebral blood volume (CBV) with NIRS in 16 healthy subjects aged 65 to 88. This method uses deoxygenated haemoglobin (the concentration of which is manipulated by desaturation) as an intravascular tracer for NIRS. We determined repeatability (between tests interval: 2 min), short-term reproducibility (intervals of 20 and 40 min) and long-term reproducibility (interval > 2 weeks). We found a coefficient of variation (CV) of 12.5% for repeatability and a CV of 11.7% for short-term reproducibility. The CV for long-term reproducibility was 15%. We conclude that NIRS can reproducibly measure CBV in subjects aged 65 and older, using the O(2)-method. In this group of healthy subjects, this method was well tolerated.     

Reliability of near-infrared spectroscopy measures of cerebral oxygenation and blood volume during handgrip exercise in nondisabled and traumatic brain-injured subjects

We compared the test-retest reliability of near-infrared spectroscopy (NIRS) measures of cerebral oxygenation and blood volume during a rhythmic handgrip exercise in 13 nondisabled subjects and 25 subjects with moderate to severe traumatic brain injury (TBI). Subjects with TBI (average Glasgow Coma Scale score = 4.2, average time since injury = 21 mo) had completed an acute brain injury rehabilitation program. After 2 min of rest, each subject performed 60 s of maximal rhythmic handgrip contractions with the right hand in two trials 24 to 48 h apart. We used NIRS to measure cerebral oxygenation and blood volume responses from the left prefrontal lobe. Both groups' cerebral oxygenation and blood volume increased during handgrip contractions. The change in cerebral oxygenation was significantly lower in subjects with TBI compared with nondisabled subjects. Intraclass correlations between the two trials for cerebral oxygenation and blood volume were 0.83 and 0.80, respectively, in nondisabled subjects and 0.70 and 0.64, respectively, in subjects with TBI. The findings indicate that NIRS is a reliable noninvasive technique for evaluating cerebral oxygenation and blood volume changes during motor function. NIRS can be useful in monitoring recovery of cerebral oxygenation during rehabilitation of patients with TBI.     

Investigation of cerebral haemodynamics by near-infrared spectroscopy in young healthy volunteers reveals posture-dependent spontaneous oscillations

Autonomic reflexes enable the cardiovascular system to respond to gravitational displacement of blood during changes in posture. Spontaneous oscillations present in the cerebral and systemic circulation of healthy subjects have demonstrated a regulatory role. This study assessed the dynamic responses of the cerebral and systemic circulation upon standing up and the posture dependence of spontaneous oscillations. In ten young healthy volunteers, blood pressure and cerebral haemodynamics were continuously monitored non-invasively using the Portapres and near-infrared spectroscopy (NIRS), respectively. Oscillatory changes in the cerebral NIRS signals and the diastolic blood pressure (DBP) signal have been identified by the fast Fourier analysis. Blood pressure increased during standing and returned to basal level when volunteers sat on a chair. The mean value of cerebral tissue oxygen index (TOI) as measured by NIRS did not demonstrate any significant changes. Oscillatory changes in DBP, oxyhaemoglobin concentration [O2Hb] and TOI showed a significant increase when subjects were standing. Investigation of the low frequency component (approximately 0.1 Hz) of these fluctuations revealed posture dependence associated with activation of autonomic reflexes. Systemic and cerebral changes appeared to preserve adequate blood flow and cerebral perfusion during standing in healthy volunteers. Oscillatory changes in [O2Hb] and TOI, which may be related to the degree of cerebral sympathetic stimulation, are posture dependent in healthy subjects.     

Cerebral oxygenation monitor during head-up and -down tilt using near-infrared spatially resolved spectroscopy

Reflectance near-infrared spectroscopy (NIRS) has become a suitable and easily manageable method to monitor cerebral oxygenation changes in presyncopal and syncopal symptoms caused by postural changing or standing. A new clinical tissue oxygenation monitor has been recently developed which measures absolute tissue haemoglobin saturation (Tissue Oxygenation Index, TOI) utilizing spatially resolved spectroscopy (SRS). The present study examined the effects of postural changes on cerebral oxygenation as reflected in SRS-NIRS findings. Cerebral oxyhaemoglobin (O2Hb), deoxyhaemoglobin (HHb), and the TOI were recorded from both sides of the forehead in five healthy male subjects (age range, 28-40 years) during 90 degrees head-up tilt (HUT) and -6 degrees head-down tilt (HDT). Three series of measurements were carried out on separate days. O2Hb was decreased during HUT. TOI was significantly lower in HUT than in the supine position (SUP). There was no significant change in TOI during HDT. A significant session effect was observed in the left forehead TOI during SUP, but not in the right. SRS-NIRS measurements confirmed sub-clinical alterations of cortical oxygenation during HUT. NIRS data from the left side of the forehead, which may vary with cognitive or emotional activation, were more variable than those from the right side.     

Addition of intensive repetition of facilitation exercise to multidisciplinary rehabilitation promotes motor functional recovery of the hemiplegic lower limb.

OBJECTIVE: To evaluate the effects of the intensive repetition of movements elicited by the facilitation technique to improve voluntary movement of a hemiplegic lower limb in patients with brain damage. DESIGN: A multiple-baseline design (A-B-A-B: A without specific therapy, B with specific therapy) across individuals. PATIENTS: The sample comprised 22 subjects with stroke and 2 brain tumour-operated subjects (age: 50.7 +/- 9.6 years, time after onset: 7.1 +/- 2.6 weeks). They were selected from among 165 patients with stroke who were admitted to our rehabilitation centre from September 1, 1995 to March 31, 1997. METHODS: Two 2-week facilitation technique sessions (more than 100 repetitions a day for each of 5 kinds of movement) were applied at 2-week intervals in patients with hemiplegia, who were being treated with continuous conventional rehabilitation exercise without the facilitation technique for hemiplegia. Motor function of the affected lower limb (Brunnstrom Recovery Stage of hemiplegia, the foot-tap test and the strength of knee extension/flexion) and walking velocity were evaluated at 2-week intervals. RESULTS: Significant improvements in Brunnstrom Stage, foot-tapping and the strength of knee extension/flexion of the affected lower limb were seen after the first conventional rehabilitation exercise session and after the first and second facilitation technique and conventional rehabilitation exercise sessions. The improvements after facilitation technique and conventional rehabilitation exercise sessions were significantly greater than those after the preceding conventional rehabilitation exercise sessions. CONCLUSION: Intensive repetition of movement elicited by the facilitation technique (chiefly proprioceptive neuromuscural facilitation pattern, stretch reflex and skin-muscle reflex) improved voluntary movement of a hemiplegic lower limb in patients with brain damage.     

Changes in cerebral oxygenation and haemodynamics during postural blood pressure changes in patients with autonomic failure

Patients with autonomic failure suffer severe postural hypotension that may be associated with symptoms of cerebral hypoperfusion. This study utilized near-infrared spectroscopy (NIRS) to measure changes in cerebral oxygenation and haemodynamics during the head-up tilt table test in 18 patients with autonomic failure and 10 healthy age-matched volunteers. Heart rate, blood pressure (MAP), oxygen saturation, cerebral tissue oxygen index (TOI) and total cerebral haemoglobin concentration [HbT] were measured continuously. In patients with autonomic failure there was a mean (SD) reduction in MAP of 46.7 (26.5) mmHg (p < 0.005) associated with a reduction in TOI of 8.6 (6.2)% (p < 0.005) during the head-up tilt table test. In healthy volunteers mean (SD) MAP rose by 12.3 (8.0) mmHg (p < 0.005) and TOI fell by 2.6 (3.2)% (p < 0.05). There was a mean (SD) reduction in [HbT] of 3.09 (2.82) micromol l(-1) (p < 0.005) in patients, equivalent to a decrease in cerebral blood volume of 0.2 (0.18) ml/100 g. There were no changes in [HbT] in the healthy volunteers. Postural hypotension in patients with autonomic failure is associated with a substantial decrease in absolute cerebral oxygenation measured by NIRS and this might reflect a critical reduction in cerebral oxygen delivery.     

Increased cerebral vasomotor reactivity in migraine with aura: an autoregulation disorder? A transcranial Doppler and near-infrared spectroscopy study

Migraine with aura (MA) is associated with changes in cerebral blood flow (CBF), whereas the role of cerebral autoregulation is uncertain. This study aimed to evaluate basal CBF, cerebral blood volume (CBV) and vasomotor reactivity (VMR) in MA patients. Twenty-one controls and 16 MA patients (eight with side predominance) underwent simultaneous examination of flow velocity in the middle cerebral arteries by transcranial Doppler (TCD) and of near-infrared spectroscopy (NIRS) parameters [oxygen haemoglobin saturation: oxygen%, and total haemoglobin content (THC)] at rest and after hypercapnia. Cerebral VMR, THC and oxygen% increases were significantly greater on the predominant compared with the non-predominant migraine side, with both sides of patients without side predominance and with controls. These findings suggest altered autoregulation in MA patients, possibly secondary to impaired cerebrovascular autonomic control. Simultaneous TCD and NIRS investigation could represent a non-invasive approach to evaluate cerebral haemodynamics at the cortical and subcortical level.     

Different Cerebral Hemodynamic Responses Between Sexes and Various Vessels in Orthostatic Stress Tests

Objective. The argument about why the head‐up tilt table test (HUT) does not include the posterior cerebral circulation, which is mainly responsible for syncope, as a monitor target has not been resolved. It is also unclear whether there is a sex difference in cerebral blood flow (CBF) changes. We hypothesized that orthostatic CBF changes more in the posterior circulation than in the anterior circulation and is different between sexes. Methods. Thirty healthy volunteers (13 female and 17 male) were recruited for the HUT. The blood pressure (BP), middle cerebral artery flow velocity (MCAFV), and posterior cerebral artery flow velocity (PCAFV) were monitored simultaneously. Static cerebral autoregulation (CA) was calculated. Results. The female volunteers had a lower BP, but there was no difference in orthostatic BP changes (female versus male: 1.29% ± 5.26% versus 4.22% ± 12.65%; P = .65). The female volunteers had a significantly greater orthostatic drop in the PCAFV than in the MCAFV (23.8% ± 9.1% versus 18.2% ± 7.3%; P = .008). The static CA in the middle cerebral artery was better than in the posterior cerebral artery, although not significantly (13.6% ± 34.8% versus ? 2.8% ± 12.2%; P = .15). Conclusions. Our study showed the different cerebral hemodynamic responses between anterior and posterior circulations and between sexes during the HUT. We conclude that HUT studies for syncope should include the posterior cerebral circulation, especially for female patients.     

Near-infrared spectroscopy in evaluation of cerebral oxygenation during vasovagal syncope

Near-infrared spectroscopy (NIRS) offers a non-invasive, real-time monitoring of cerebral oxygenation. This method is based on the oxygenation and the light wavelength dependent absorption of near-infrared light by tissue chromophores, e.g. oxyhaemoglobin and deoxyhaemoglobin. The objective of the present study was the application of NIRS for evaluation of the brain function during vasovagal syncope (VVS). The VVS is a clinical syndrome affecting ca 3.5% of the population and for which the widely used diagnostic examination in this disease entity is the head-up tilt table test (HUT). In this study 69 patients with a history of VVS were examined using HUT. In 42 patients VVS was provoked. Results of the examination have shown that the changes in cerebral oxygenation measured by the NIRS technique are distinctly visible before the syncope. A gradual decrease of oxyhaemoglobin followed by its sudden drop was observed in all the VVS patients. Changes in the oxyhaemoglobin concentration measured by NIRS were observed on average 3.3 min before the syncope. They preceded the presyncope symptoms about 1.3 min (p < 0.005), the blood pressure and heart rate drop 2.2 min (p < 0.0001) and the arterial blood saturation 2.6 min (p < 0.00001).     

Near-infrared spectroscopy (NIRS) in cognitive neuroscience of the primate brain

We describe the use of near-infrared spectroscopy (NIRS) as a suitable means of assessing hemodynamic changes in the cerebral cortex of awake and behaving monkeys. NIRS can be applied to animals performing cognitive tasks in conjunction with electrophysiological methods, thus offering the possibility of investigating cortical neurovascular coupling in cognition. Because it imposes fewer constraints on behavior than fMRI, NIRS appears more practical than fMRI for certain studies of cognitive neuroscience on the primate cortex. In the present study, NIRS and field potential signals were simultaneously recorded from the association cortex (posterior parietal and prefrontal) of monkeys performing two delay tasks, one spatial and the other non-spatial. Working memory was accompanied by an increase in oxygenated hemoglobin mirrored by a decrease in deoxygenated hemoglobin. Both the trends and the amplitudes of these changes differed by task and by area. Field potential records revealed slow negative potentials that preceded the task trials and persisted during their memory period. The negativity during that period was greater in prefrontal than in parietal cortex. Between tasks, the potential differences were less pronounced than the hemodynamic differences. The present feasibility study lays the groundwork for future correlative studies of cognitive function and neurovascular coupling in the primate.     

Sex and age dependencies of cerebral blood volume changes during cognitive activation: a multichannel near-infrared spectroscopy study

In this study, we measured the change in cerebral hemoglobin concentrations during a cognitive task using multichannel near-infrared spectroscopy (NIRS), and investigated the relationship between regional cerebral blood volume and sex, age, and task performance. Thirty-nine healthy volunteers (24 males and 15 females; mean age, 33.0 years) participated after giving their informed consent and performed a word fluency task. The relative oxy-hemoglobin concentration ([oxy-Hb]) was measured using frontal and temporal probes with two sets of 24-channel NIRS machines. The effects of sex, age, and task performance on [oxy-Hb] changes were analyzed using analysis of covariance: with sex, age, and task performance as independent variables, and [oxy-Hb] changes as dependent variables, and years of education as covariates. The effects on [oxy-Hb] increase were significant in many channels in the frontal and temporal probes for sex, that is the most prominent effect, and in a few frontal channels for age: [oxy-Hb] increases were larger in males than in females, and in the young than in the middle-aged. The effects on [oxy-Hb] increase were not significant for task performance, but [oxy-Hb] increases in subjects with low performance tended to be larger than those in subjects with high performance. The results demonstrated that multichannel NIRS could detect cerebral activation during cognitive tasks and clarify sex- and age-dependent differences in such cerebral activation. Sex- and age-dependent differences in cerebral activation, as demonstrated in the present study, should be considered when interpreting cerebral blood volume, cerebral blood flow, and cerebral glucose metabolism data.     

神经肌肉促进技术在偏瘫上肢康复训练中的临床应用

目的:探讨神经肌肉促进技术在偏瘫上肢康复训练中的临床应用方法,并观察其疗效。方法:36例脑血管意外后的偏瘫患者被随机分成神经肌肉促进技术组(治疗组)与一般康复治疗组(对照组),其中治疗组17例,对照组19例,两组均接受每日1次、每周5次的治疗10-40次。采用Fugl-Meyer评价法的上肢主动运动功能积分及Barthel指数作为评定指标。结果:两组患者的Fugl-Meyer上肢主动运动功能积分和Barthel指数积分经治疗后都有明显提高(P<0.001),但治疗组的改善情形明显优于对照组(P<0.001或<0.01)。结论:本文所介绍的神经肌肉促进技术在偏瘫上肢康复训练中的临床应用方法对改善偏瘫上肢运动功能及患者日常生活活动能力方面(尤其是偏瘫上肢运动功能方面)有一定的疗效。     

脑外伤偏瘫的康复治疗

目的：观察康复治疗对脑外伤偏瘫的功能恢复和ＡＤＬ的影响。方法：采用以促进技术为主的综合康复疗法对２９例脑外伤偏瘫患者进行系统治疗，平均伤后２９．５±１６．１天接受治疗，共治疗３９．０３天。结果：治疗前后瘫痪肢体的运动功能Ｂｒｕｎｎｓｔｒｏｍ分级，经卡方检验，Ｐ＜０．００１，ＡＤＬＢａｒｔｈｅｌ指数评分治疗前后经配对ｔ检验，Ｐ＜０．００１。结论：综合康复治疗可以改善脑外伤偏瘫患者的运动功能和ＡＤＬ能力，减轻残疾的发生     

促通技术加主动性康复训练对脑出血患者上肢、手功能及步行能力的作用

目的观察促通技术加早期主动性康复训练对脑出血偏瘫患者上肢、手功能和步行能力恢复的影响。方法应用促通技术和主动性康复训练对68例脑出血患者(康复组)进行训练及观察,并与对照组比较。结果康复组上肢和手Fugl-Meyer评分明显好于对照组(P<0.05),步行能力训练后有明显提高。结论促通技术加主动康复训练可使正常的运动模式在没有异常运动模式的干扰下建立和发展。     

脑卒中康复训练程序化的研究

目的：观察脑卒中偏瘫患者进行康复训练的疗效。方法：２２例脑卒中患者分２组：康复组１２例，对照组１０例，两组均接受神经科常规药物治疗，康复组按“中风后程序化康复训练表”（见表２）进行康复训练，分别于康复前、康复后１个月和３个月进行疗效评定。结果：ＡＤＬ日常生活活动能力量表（采用Ｂａｒｔｈｅｌ指数评分）结果示：康复组有效率８３．３％（１０／１２），对照组３０％（３／１０），两组差别有显著意义（Ｐ＜０．０５）。神经功能缺损评分结果示：康复组有效率９１．７％（１１／１２），对照组４０％（４／１０），两组差别有显著意义（Ｐ＜０．０１）。结论：康复训练能降低脑卒中偏瘫患者的致残率，提高生活质量     

Reproducibility of the alterations in circulation and cerebral oxygenation from supine rest to head-up tilt

Cardiovascular stability, as affected by several diseases, may be assessed by head-up tilt testing. Follow-up studies are essential in both evaluating interventions and assessing progression. However, data on the reproducibility of the changes in circulatory status and cerebral oxygenation provoked by head-up tilt testing are fundamental to follow-up studies. The aim of this study was, therefore, to assess the reproducibility of the alterations in stroke volume (SV), mean arterial pressure (MAP), as well as oxygenated ([O₂Hb]) and deoxygenated haemoglobin ([HHb]) concentration in cerebral tissue from supine rest (SUP) to head-up tilt (HUT). SV was calculated by Modelflow, a pulse contour method, from the finger arterial pressure wave measured by Portapres, the portable version of Finapres. [O₂Hb] and [HHb] were measured using near-infrared spectroscopy (NIRS). Ten healthy individuals visited the laboratory on two different days. On both days, they underwent 10 min SUP followed by 10 min 70° HUT twice. SV decreased, which was (in part) compensated for by an increased heart rate, while MAP increased slightly during HUT compared with SUP. Although [HHb] increased during HUT, no presyncope symptoms were experienced. The circulatory variables (SV, HR and MAP) as well as [HHb] showed an acceptably small systematic and random error as well as reproducibility error compared with the observed difference between HUT and SUP and were similar between and within visits. Therefore, it is concluded that MAP measured by Portapres and SV calculated by Modelflow as well as HHb measured by NIRS seem to be reproducible and may therefore be used in follow-up studies.