tDCS调控脑网络重塑促进卒中后上肢运动功能康复机制与长时疗效研究

Stroke is the most common central nervous system disease in the world. Up to 80% of upper limbs dysfunction occurs after stroke. The upper limbs dysfunction is difficult to recover, hard to prognosis and cure, which is a key problem to be solved urgently in clinic. Recently, the emerging transcranial direct current stimulation (tDCS) technology, which has outstanding advantages of small current, adjustable polarity, easy operation, safe and reliable opens up a new way for the regulation of brain activity and promotion of motor rehabilitation. Studying the mechanism of tDCS regulating neuroplasticity and promoting functional reconstruction are key points to ensure its long-term curative effect and to reduce the impact of individual differences after stroke, which has great scientific significance and application value. The project plans to firstly explore neural network regulation of cerebral cortex after stroke and upper limb motor functional network remodeling mechanism for different tDCS stimulation mode, thus establishing a brain network response model and screening to the best stimulation mode for improving the rehabilitation. Then, we study the long-term effect of upper limb motor functional rehabilitation after stroke for 8 weeks using the best stimulation mode of tDCS to explore the central neural network reconstruction effect and develop a quantitative evaluation method of neural network activation adapting the dynamic changes of neural network with the process of rehabilitation, which could provide scientific basis for regulating brain functional network remodeling and treatment program optimization to upper limb motor functional rehabilitation after stroke using tDCS technology.

脑卒中是全球最常见中枢神经系统疾病，卒中后上肢功能障碍发生率高达80%且康复难、预后差、治愈率低，为临床亟待解决重点难题。近年兴起的经颅直流电刺激(tDCS)技术具有电流小、极性可调、操作简便、安全可靠等突出优势，为调控大脑神经活动、促进运动功能康复开辟了新途径。研究tDCS调控神经可塑性机制和促进功能重建效应是确保其用于卒中后上肢运动功能康复长时疗效、减少个体差异影响的关键，有重要科学意义与应用价值。本项目首次探讨不同tDCS刺激模式对卒中皮层神经网络调控作用和上肢运动功能网络重塑机制，建立脑网络响应模型并筛选提高康复疗效的最佳刺激模式；进而研究最佳模式连续8周tDCS刺激对卒中上肢运动功能康复长时疗效，探讨其中枢神经网络重塑效果，发展可适应神经网络随康复进程动态变化的脑皮层网络激活定量评估技术，为tDCS调控脑功能网络重塑、促进卒中后上肢运动功能康复治疗方案优选及合理评测提供科学依据。

脑卒中后发生上肢功能障碍的患者高达80%，是临床诊治的难点。非侵入的经颅直流电刺激（tDCS）技术可以调控大脑神经活动，为促进患者的运动功能康复提供了新思路，但其调控机制还需进一步探索研究。本项目据此开展了以下三方面的研究，一是探索了不同tDCS刺激模式对脑卒中患者大脑皮层的神经网络调控效应；二是采用不同tDCS模式结合上肢特定任务训练来研究上肢功能改善的短时效应；三是对阳极tDCS的长时程疗效进行进一步探究。研究发现了受tDCS刺激影响的相关脑区（初级运动皮层、前额叶、颞叶）以及不同的刺激模式对患者脑功能产生的不同影响；此外EEG信号参数在反映大脑皮层对不同tDCS干预策略之间的响应差异上具有较高的敏感性，且与卒中时间、运动功能损伤程度等临床指标相关。tDCS干预结合运动任务治疗的结果显示tDCS刺激可能也有提高肌肉耐受性或者缓解疲劳作用，长时程的干预有利于脑功能网络的进一步激活，提高网络传输效率。本研究从各个角度较全面的分析了tDCS对脑功能重塑的作用效果，进一步完善了tDCS调控脑功能网络重塑机制的研究、为临床促进卒中后上肢运动功能康复治疗方案优选提供了一定指导依据。依托本项目共发表论文14篇，其中SCI论文7篇，申请中国发明专利2项，培养博士研究生2名，硕士研究生2名，项目成果参加会议交流多次。