具身运动想象联合常规康复对卒中后感觉运动网络影响的研究

目的探讨具身认知视角下的运动想象疗法（以下简称具身运动想象）联合常规康复对首发卒中偏瘫患者感觉运动网络（SMN）的影响及相关神经机制。 方法选取2020年1~6月于南京医科大学附属脑科医院神经内科及康复医学科住院的15例首发卒中偏瘫患者纳入治疗组，进行具身运动想象联合常规康复治疗；同时，选取15名年龄、性别及文化程度和治疗组相匹配的健康受试者作为对照组。治疗组患者治疗前和治疗4周后均进行静息态功能磁共振（rs-fMRI）扫描，记录Fugl-Meyer运动功能评定（FMA）量表评分和改良Barthel指数（MBI）评分。采用rs-fMRI构建SMN，并且通过对治疗组治疗前后以及对照组的SMN脑区进行功能连接（FC）分析来研究网络内的变化，并采用基于种子点的患侧初级感觉运动皮层（S1M1）与全脑间FC的变化情况，研究S1M1与全脑之间的FC重组。 结果治疗后，治疗组FMA评分由（65.67±16.95）分升高到（149.58±17.95）分，MBI评分由（24.17±8.21）分升高到（65.00±8.79）分，差异均有统计学意义（P<0.05）。SMN内FC显示，治疗前，治疗组较对照组双侧S1M1、患侧S1M1和辅助运动区（SMA）、患侧S1M1和小脑、SMA和小脑间FC降低，差异有统计学意义（P<0.05）。治疗组治疗后患侧S1M1和小脑的FC较治疗前增强，差异有统计学意义（P<0.05）。基于种子点的全脑FC分析显示，治疗前，治疗组患侧S1M1和健侧距状回、患侧中央后回FC减弱，差异有统计学意义（P<0.05）；治疗后患侧S1M1和患侧额中回、健侧小脑FC较治疗前增强，差异有统计学意义（P<0.05）。相关性分析发现，患侧S1M1和小脑的FC连接强度增量与FMA增量有中度相关性（r=0.581，P=0.023），与MBI增量有强相关性（r=0.757，P=0.002）。 结论具身运动想象联合常规康复可改善首发卒中偏瘫患者的运动功能和日常生活能力，相关脑重塑机制可能是其可显著修复SMN网络内和全脑的FC，增加与认知相关的脑区FC。

Therapeutic effect of motor imagination therapy from the perspective of embodied cognition and conventional therapy on sensorimotor network in stroke patients with hemiplegia

ObjectiveTo investigate the therapeutic effect and explore the neural mechanisms of motor imagination therapy from the perspective of embodied cognition (hereafter referred to as embodied motor imagination therapy) combined with conventional rehabilitation on sensorimotor network (SMN) of first-episode stroke patients with hemiplegia. MethodsFrom January to June 2020, 15 first-episode stroke patients with hemiplegia who were hospitalized in the Neurology Department and Rehabilitation Medicine Department of the Affiliated Brain Hospital of Nanjing Medical University were selected to be included in the experimental group for embodied motor imagination therapy combined with conventional rehabilitation. At the same time, 15 healthy subjects matched with the experimental group in age, sex and education were selected as the control group. Before and after 4 weeks of treatment, the experimental group received the Fugl-Meyer assessment (FMA) and the modified Bathel index (MBI) and the fMRI scan. The functional magnetic resonance (fMRI) was used to construct the SMN, and study these changes within the network through the functional connectivity analysis of SMN brain regions in the experimental group before and after treatment and in healthy controls. Besides, functional connectivity (FC) reorganization between S1M1 and the whole brain was investigated using changes in functional connectivity between the primary sensory-motor cortex (S1M1) and the whole brain based on seed points on the side of injury. ResultsAfter treatment, the FMA score of the experimental group increased from (65.67±16.95) to (149.58±17.95) and the MBI score increased from (24.17±8.21) to (65.00±8.79), with statistically significant differences (P<0.05). Functional connectivity within the SMN showed that before treatment, the patients in the embodied cognitive group had lower functional connections than the healthy control group between the affected bilateral S1M1, the affected side S1M1-SMA, the affected side S1M1-cerebellum, and SMA-cerebellum (P<0.05). After treatment, the functional connections between the affected S1M1 and the affected frontal middle gyrus and the healthy postcentral gyrus were enhanced compared with those before treatment in the experimental group (P<0.05). The whole-brain FC analysis showed that effective connections from the affected S1M1 to the healthy talar gyrus and the affected postcentral gyrus were diminished in the test group before treatment (P<0.05). After treatment, the functional connections from the affected S1M1 to the affected frontal middle gyrus and the healthy cerebellar gyrus were enhanced (P<0.05). Correlation analysis revealed that the incremental FC connection strength of the affected S1M1 and cerebellum was moderately correlated with the incremental FMA (r=0.581, P=0.023) and strongly correlated with the incremental MBI (r=0.757, P=0.002). ConclusionEmbodied motor imagination therapy combined with conventional rehabilitation can improve the motor function and daily living ability of the first-episode stroke patients with hemiplegia. The relevant brain remodeling mechanism may be that the functional connectivity within and between the SMN of patients was significantly repaired, and the functional connectivity of brain regions related to cognition was also increased.