基于镜像神经元的康复策略促进脑卒中患者上肢功能重建的多模态脑功能成像研究

With high incidence, poor prognosis and limited strategies for rehabilitation, upper limb dysfunction after stroke has become a major problem to be resolved in the field of neurorehabilitation. The strategies based on theory of mirror neuron system have been applied in the recovery of upper limb dysfunction after stroke. However systematic and contrast studies were limited. We are to apply clasical strategies based on the theory of mirror neuron system to improve the function of impaired upper limb due to stroke, and intend to use the task-state functional magnetic resonance imaging (ts-fMRI) to determine the location and extent of mirror neurons activated by the therapy in stroke patients with upper limb dysfunction. And the resting-state functional magnetic resonance imaging (rs-fMRI) would be employed to study developments of cerebral connection network among certified mirror neurons and associated brain areas in stroke patients, and clarify the relationship between the plasticity of brain functional connection network and upper limb functional reconstruction. Meanwhile, the multi-modal brain functional imaging techniques, combination of fMRI and electroencephalograph, will be used to investigate the relationship between reorganization of brain networks and electrophysiological signal changes. Combined with behavioral performance, the effective brain connection may be determined, and much more effective therapy can be explored. The theoretical and practical application basis of this mirror neuron therapy can be established.

脑卒中后上肢功能障碍以其发病率高、预后差及康复策略有限的特点已成为国内外神经康复领域亟待解决的一大难题。针对脑卒中后上肢功能障碍，基于镜像神经元理论的相关策略已有报道，但缺乏对有关方法作用机制的深入和对比研究。本项目针对经典的镜像神经元策略在脑卒中患者上肢功能康复中的应用，拟采用任务态功能磁共振成像技术，确定经干预后脑卒中患者镜像神经元激活的位置和程度；应用静息态功能磁共振成像技术，研究已确定的镜像神经元与相关脑功能区的网络连接的动态变化，阐明脑功能网络连接可塑性与患者上肢功能重建的关系；同时，通过脑代谢功能成像与脑电生理成像的结合，即采用fMRI/EEG多模态脑功能成像技术，研究重组的脑功能网络与电生理信号变化之间的关系，结合行为学表现，确定镜像神经元策略促进上肢功能康复的有效脑连接，挖掘更有应用价值的镜像神经元策略，并为其优化与临床应用提供重要的理论依据。

脑卒中后上肢功能障碍以其发病率高、预后差及康复策略有限的特点已成为国内外神经康复领域亟待解决的一大难题。针对脑卒中康复的难点和瓶颈——上肢功能障碍，基于镜像神经元理论，本研究采用任务态功能磁共振成像技术，确定经运动观察干预后上肢功能障碍患者镜像神经元激活的位置和程度，对比运动观察策略与镜像运动治疗两种康复手段的神经机制；结合行为学表现，确定运动观察策略对脑卒中患者上肢运动功能及日常生活活动能力作用，研究发现：运动观察策略可以激活双侧大脑皮层，镜像运动可以激活主要的视觉皮层和更高级别的视觉区域—楔前叶；运动观察策略能显著提高脑卒中偏瘫患者的上肢运动功能及日常生活活动能力，为脑卒中上肢运动功能障碍的患者提供了一项有效的治疗策略。