基于多模态MR神经成像技术的脑tDCS与肢体FES协同治疗脑卒中偏瘫患者下肢运动障碍的脑网络机制研究

The ability of walking and activity of daily Living was seriously affected in subjects suffering stroke. It has been demonstrated in our previous study that the motor function of the lower limbs of the stroke suffers had been improved effectively by functional electrical stimulation (FES), with possible mechanisms of activating brain plasticity. We also found, in another pre-experiment applied functional resting-state MRI (rs-MRI) to investigate the connectivity of motor executive brain networks induced by transcranial direct current stimulation (tDCS), that functional connectivity of motor executive brain networks had been improved significantly after FES therapy. Therefore, we deduced that it could be a new underlying mechanism to the motor function recover of subjects with stroke. With such synchronization of brain structural network dynamics, we assume that the tDCS treatment combined with FES treatment facilitate the brain networks more effectively. All patients in this study will be assigned randomly to 1 of 4 groups for 2 weeks’ treatments. Before and after treatment, the clinical neural evaluation and kinematics assessment combined with magnetic resonance Imaging (MRI) were applied on each subject to compare the differences within each group and among the four groups. Special attention will be put on the coupling with the analysis of structural connectivity and functional connectivity, including the T1,DTI,Rest-state fMRI, and the brain structural and functional networks will be also built up. Through the tDCS facility with FES treatments, we aim to explore the brain structure and functional data in the response to this treatment protocol, and to find the relationship between improvements of motor function of the patients affected lower limb and brain network’s topology changes. Meanwhile, Based on the images markers and neurologic science evidences above, results of this study will show more scientific evidence to form a new, high efficient, collaborative treatment to subjects with stroke.

脑卒中偏瘫患者下肢运动障碍严重影响了其行走及日常生活活动。我们前期研究证实功能性电刺激（FES）能有效改善偏瘫肢体的运动功能，增强脑可塑性；预实验也发现经颅直流电刺激（tDCS）能增强患者脑磁共振静息态（RS）中与运动执行功能有关的网络连接，推测可能是tDCS改善运动功能的新机制。由此假设脑tDCS协同肢体FES治疗，通过脑结构网络动力学的同步化，或许可在时空连接上形成更有效的脑动态功能网络，提高治疗效果。本课题将脑卒中偏瘫患者随机分为4组，治疗2周，治疗前后采用磁共振T1、DTI、RS多模态成像技术，构建脑结构与功能网络，耦合分析结构连接和功能连接，并结合临床神经学和运动学评估，探讨tDCS协同FES治疗可能存在的脑结构和功能网络，回答两者协同治疗可否改变脑网络拓扑变化而提高临床疗效，为形成一种新的、高效的、协同治疗脑卒中偏瘫下肢方案提供脑网络影像学标记和神经科学依据。

脑卒中偏瘫患者下肢运动障碍严重影响了其行走及日常生活活动。我们前期研究证实功能性电刺激（FES）能有效改善偏瘫肢体的运动功能，增强脑可塑性；并发现经颅直流电刺激（tDCS）能增强患者脑磁共振静息态（RS）中与运动执行功能有关的网络连接，推测脑tDCS协同肢体FES治疗可能通过脑结构网络动力学的同步化，或许在时空连接上形成更有效的脑动态功能网络，提高疗效。本课题将脑卒中偏瘫患者随机分为3组：tDCS+FES组、tDCS +FES伪刺激组、tDCS伪刺激+FES组。采用tDCS与FES治疗2周，治疗前后采用磁共振T1、DTI、RS多模态成像技术，构建脑结构与功能网络，耦合分析结构连接和功能连接。同时，通过Berg 平衡量表（BBS）、Fugl-Meyer 运动功能评定、改良 Barthel 指数（MBI）、脑卒中患者姿势评分（posture assessment of stroke scale，PASS）、Holden步行量表、Brunnstrom运动分期、“起立-行走”计时测试(Timed Up and Go Test，TUGT)评估患者临床功能；通过三维步态分析仪进行步行步态分析，通过基于感觉整合与运动控制的平衡学分析评估患者动态平衡功能。将磁共振结果与临床神经功能、步态分析、平衡功能进行相关性分析。本项目发现，单用阳极tDCS、单用基于正常行走模式的四通道肢体FES，或tDCS同步FES均可有效改善脑卒中偏瘫患者下肢功能；其中，FES治疗在步态方面改善较tDCS治疗明显，tDCS同步FES的治疗效果在临床评估和三维步态分析上部分指标均优于单用tDCS和单用FES治疗，可以提高脑卒中偏瘫患者感觉整合的平衡能力，tDCS与FES同步治疗后左脑PMd区域连接激活。这可能与tDCS通过左脑PMd脑区的激活提高运动学习和感觉信息计算决策，从而提高患者的平衡能力，促进偏瘫下肢功能的恢复有关。本项目揭示了tDCS与FES协同治疗可改变脑网络拓扑变化而提高临床疗效，为形成一种新的、高效的协同治疗脑卒中偏瘫下肢方案提供脑网络影像学标记和神经科学依据。