脑卒中患者双重任务能力恢复的神经机制研究

Stroke has a high mortality rate and mutilation rate. It is one of ten major diseases of human. The patient who suffers from it often has a function disorder in motion and cognition. Recently, the only way to alleviate the function disorder for stroke patients is rehabilitation training. However, current rehabilitation therapy only focuses on simple functional exercise. It limits the functional independence of patients in varying degrees. The discharged patients cannot adapt the real family life. Studies indicated that if patients do motion and cognition training at the same time, the effect of therapy was well. The dual-task training can compensate for the deficiency of current therapy, but its mechanism was not clear. We conjectured that when patients execute dual-task, their brains might activate relevant encephalic region by conforming various modalities to achieve better functional remodeling of nerves. Based on our pilot study, and by the design of randomized control trail, cohort study, and cross-sectional study, combined with the functional magnetic resonance and diffusion tensor imaging to explore the evidence for nerves functional remodeling in the dual-task training after stroke, and to approach the effects of the Dual-task training on stroke patientsa’ daily activities participation, community reintegration and risk of falls. This study provided new evidence for the availability of the Dual-task training administration. It added evidence of evidence-based medicine for nerves remodeling for new therapy development. It had important scientific significance for promoting the progress of rehabilitation medicine.

卒中有高死亡率和高致残率，是人类十大疾病之一，常伴有运动、认知等功能障碍。目前，康复训练是缓解卒中患者功能障碍的唯一方法。但现有康复疗法只关注单一的功能训练，不同程度的限制了患者的功能独立，患者出院后不能适应真实的家庭生活。研究表明，双重任务训练疗法（Dual-task training），如对患者同步实施运动与认知任务训练，取得较好疗效，可弥补现有疗法的不足，但其神经机制尚不清楚。我们推测，患者执行双重任务时大脑可能通过多模态整合激活相应脑区，以实现更好的神经功能重塑。本课题拟在前期实验基础上，通过随机对照实验、队列和断面研究，结合功能磁共振成像、弥散张量成像技术，探索卒中后双重任务疗法的神经功能重塑证据，探讨双重任务疗法对卒中患者的日常活动参与度、社区再融入及跌倒风险等影响。为双重任务疗法的推广提供新证据，为发展新疗法增添神经重塑循证医学证据，对促进康复医学发展具有重要科学意义。

卒中有高死亡率和高致残率，是人类十大疾病之一，常伴有运动、认知等功能障碍。双重任务训练疗法，如对患者同步实施运动与认知任务训练，取得较好疗效，可弥补现有疗法的不足，但其神经机制尚不清楚。本课题拟在前期实验基础上，进行双重任务与单一任务的随机对照研究，纳入昆明医科大学第二附属医院康复医学部并且符合 2015 版脑卒中诊断标准的亚急性期脑卒中患者30名，对患者进行为期3周的训练，随机分配到实验组15例进行双重任务康复训练和单一任务康复训练；对照组15例进行单一任务康复训练以及进行相应的临床功能评估，使用简易精神状态检查量表（Mini-Mental State Examination，MMSE）；Berg平衡量表（Berg Balance Scale，BBS）、运动功能评定量表（Fugl-Meyer assessment，FMA）、改良生活指数评定（Modified Barthel Index，MBI）、汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD），在治疗前后分别对两组患者，进行临床评估并记录结果。发现双重任务训练对脑卒中患者的认知、平衡、运动功能、生活能力及抑郁情绪改善效果优于单一任务训练。联合fMRI和DTI，探索双重任务训练的脑神经生理机制及其神经恢复机制，发现双重任务训练使亚急性期脑卒中患者的皮质脊髓束发生了可塑性变化，在体素水平观察到大脑功能连接改变，尾状核和楔前叶与双重任务训练后大脑神经的恢复机制密切相关。