基于具身认知的动作词句加工对脑卒中运动功能的调控及多维动态脑机制

Embodied cognition has been the focus of neuroscience, psychology and linguistics. Evidence from healthy subject studies have indicated that language processing is based on brain networks for motor control and language and motor processing couple together and influence each other. Recently, a lot of studies have confirmed that "action observation" improve the language function of stroke patients with aphasia. However, it has not yet been known that whether language processing can promote motor function of hemiplegic limb.Our preliminary experiments show that semantic processing of action words (such as "raise hand") has immediate effect on the motor reaction of hemiplegic upper limb in stroke patients. Our functional magnetic resonance imaging (fMRI) and event related potentials (ERP) pre-experiments have confirmed that action words processing may activate the key motor control cortex such as premotor and posterior parietal cortex. Meanwhile, action words processing increases the motor evoked potential (MEP) significantly when using single pulsed transcranial magnetic stimulation (TMS) to stimulate the primary motor cortex(M1). Nevertheless, how about the specific modulation role of action words/sentence processing on motor function of hemiplegic limb? And how about the mechanism of this modulation effect？Both key questions need further studies to answer.In our project, we will adopt integrated techniques including behavioral, brain imaging, electroencephalogram and electromyography experiments to explore the distinct modulation effects of action words/ sentence processing on motor function of hemiplegic limb of stroke patients and the corresponding brain mechanisms. Implementation of this project will has broad application prospects and important theoretical significance not only for providing the innovative treatment approaches for functional rehabilitation of hemiplegic limb, but also for providing the pathological evidence for embodied cognition theory.

神经科学、心理学、语言学研究热点- - 具身认知加工领域中来自正常人的研究证据支持语言加工建立在运动控制脑网络之上，语言加工和运动彼此偶联并双向影响。近几年有研究证实"动作观察"对脑卒中失语症患者语言功能促进，但语言加工是否促进偏瘫肢体运动功能？尚无答案。本项目组预实验发现动作词（如"举手"）语义加工对脑卒中患者偏瘫上肢的运动反应有即刻促进作用；功能性磁共振、事件相关电位预实验初步证实动作词加工引起前运动皮质和后顶叶等关键运动控制区激活；动作词加工使经颅磁刺激初级运动皮质的运动诱发电位显著增高。然而，动作词/句加工对偏瘫肢体运动功能具体有何调控作用？对应的脑机制如何？都值得进一步研究。本项目将利用行为学、脑成像、脑电和肌电技术，深入探索动作词/句加工对偏瘫肢体运动功能的调控作用和动态脑机制，为脑卒中偏瘫肢体康复提供创新方法，为具身认知理论提供病理证据，有着广阔的应用前景和重要的理论意义。

脑卒中发生率高，三分之二伴有运动障碍（即偏瘫）影响患者的活动和生活质量。目前康复手段多以“自下而上”的肢体运动训练为主，常遇到疗效瓶颈，需要探寻新的尤其是基于神经环路机制的康复方法。. 神经科学、心理学、语言学研究热点--具身认知（embodied cognition）加工领域中的研究表明，抽象的认知加工包括语言加工是建立在具象的运动控制脑网络之上，语言加工和运动加工彼此偶联并交互影响。近几年有研究证实“动作观察”对脑卒中失语症患者的语言功能有促进作用，但语言加工是否通过激活运动控制网络来促进偏瘫肢体运动功能恢复，尚无答案。. 本项目采用自身对照的交叉设计研究，把基于具身认知理论的动作词汇加工和非动作词汇加工进行比较，并借助 fMRI、TMS-MEP显示动作词汇加工和非动作词汇加工的脑激活差异和镜像神经元系统尤其是运动区的关系特点。研究发现脑卒中偏瘫患者在运动神经网络受损的同时，尽管没有失语症，但基于该网络的动作词汇的加工受到影响，主要是加工速度变慢。对于动作词汇的加工过程会涉及到病灶周围保留的运动网络，有利于功能重塑和重组，因而在进行常规康复训练基础上辅以具体动作词汇语义加工训练较辅以抽象动词语义加工训练更有利于提高偏瘫侧上肢功能。TMS-MEP和fMRI的实验结果提示这种动作词汇加工改善运动障碍的机制可能与动作词汇语义加工激活了运动控制相关脑皮质促进受损环路重塑有关。. 本研究一方面为具身认知加工理论提供了证据，即抽象的语言功能由具象的运动环路所承载，另一方面为脑卒中运动障碍康复提供了新的思路和技术。通过发表的本项目相关的十多篇中外期刊论文，主办的继续教育项目，国际国内大会交流，把本研究的发现和成果进行广泛分享。转化的康复新技术已在国内数十家医院推广使用，获得较好评价。