基于具身认知理论的动作词汇加工对健康人运动皮质兴奋性及脑卒中患者上肢功能的影响

目的 探讨基于具身认知理论的动作词汇加工对健康人运动皮质兴奋性及对脑卒中患者偏瘫上肢运动功能的影响。 方法 实验一：利用经颅磁刺激-运动诱发电位（TMS-MEP）检查18例健康志愿者在进行具体动作动词及抽象动词语义理解加工时其大脑运动皮质兴奋性变化。实验二：在常规康复干预基础上，采用自身交叉设计的前后对照方法对8例脑卒中后偏瘫患者进行3周观察。在第1周、第3周要求患者认真观察代表具体动作的动词文字图片，并进行默读、复述和语义理解；第2周要求患者观察代表抽象动词词汇的文字图片，并进行默读、复述和语义理解。每周训练5d，每天训练30min。分别于训练前、训练1周、训练2周、训练3周后采用改良Ashworth量表（MAS）、Fugl-Meyer运动功能量表（FMA）上肢部分、香港版偏瘫上肢功能测试（FTHUE-HK）、简易上肢功能量表（STEF）进行上肢运动功能评定。 结果 TMS-MEP检查显示具体动作动词语义加工较抽象动词语义加工能引起MEP波幅显著增高、潜伏期明显缩短。经3周训练后8例脑卒中患者上肢FMA评分、STEF评分均较治疗前明显改善（P<0.05）；与抽象动词加工训练比较，动作动词加工训练能更显著提高患者上肢FMA评分、STEF评分（P<0.05）。训练1周、2周、3周后患者MAS评分均较训练前显著改善（P<0.05）。训练1周后与训练前FTHUE-HK评分差值以及训练3周后与训练2周后评分差值均显著大于训练2周后与训练1周后评分差值。 结论 具体动作动词语义加工较抽象动词语义加工能更显著增强健康志愿者运动皮质兴奋性，具体动作动词加工训练更有利于提高脑卒中偏瘫患者上肢运动功能。

Action verb processing for exciting the motor cortex and promoting the recovery of upper limb function after stroke

Objective To explore the effect of action verb processing on the excitability of the motor cortex and any effect on the upper limb motor function of stroke survivors. Methods Experiment 1: The motor evoked potential by transcranial magnetic stimulation (TMS-MEP) was measured while 18 healthy subjects were processing concrete action verbs or abstract verbs. Experiment 2: Eight hemiplegic stroke survivors were asked to read silently text describing concrete hand actions, and then repeat and explain the meaning of the action verbs used in the text. This was repeated for 30 minutes per day, 5 days per week for 3 weeks. In the 2nd week the same training was conducted except that the text was about abstract verbs. The modified Ashworth scale (MAS), Fugl-Meyer assessment (FMA), the Hong Kong version of the functional test for a hemiplegic upper extremity (FTHUE-HK) and a simple test for evaluating hand function (STEF) were used to assess upper limb motor function before and after the training each week. Results Experiment 1: Processing the concrete action verbs induced significantly greater MEP than processing the abstract verbs. Experiment 2: The average FMA and STEF ratings improved significantly after the training each week. Training with the concrete action verbs resulted in significantly better FMA and STEF scores than with the abstract verbs. The average MAS score increased significantly week by week. There was significantly more improvement in the average FTHUE-HK rating after the 1st and 3rd week of training than after the 2nd week. Conclusion Action verb processing induces greater motor cortex excitation than abstract verb processing among healthy subjects and better improves the upper limb motor function of stroke survivors.