rTMS联合认知训练对发展性计算障碍的干预效果及其脑机制研究

According to the epidemiological investigation across the world, the estimated prevalence of developmental dyscalculia (DD) is about 5%. There are about 14 million of people with dyscalculia in about 280 million of children and adolescents in China. The dyscalculia seriously affected the daily life and the quality of learning in children. Studies showed that children with DD mainly have deficits in intraparietal sulcus being in charge of numerical processing and cognitive training is the principal intervention method, and the technology of repetitive transcranial stimulation can promote the transfer of intervention effect in cognitive training and have long-term effect. However, the intervention effect of repetitive transcranial magnetic stimulation (rTMS) combining with cognitive training on DD children and its neural mechanism is still unclear. Accordingly, the hypothesis of this study is that low frequency rTMS stimulating in right intraparietal sulcus combined with cognitive training in DD children can improve their arithmetic ability, the cognitive abilities related with arithmetic and the specific neural circuits. In the current study, we will carry out the technology of rTMS combining with cognitive training to intervene children with DD, and we will use the cognitive tests to evaluate the short-term and long-term intervention effect and employ the technology of functional magnetic resonance imaging to illuminate neural mechanism of intervention effect. The project makes technology application innovation of rTMS combining with cognitive training，and aims to provide the scientific evidence of effectively improvement in mathematical cognitive function and learning ability for DD children by comprehensive evaluation of intervention effects with the methods of cognitive psychology and neuroimaging.

根据国内外流行病学调查，约有5%的儿童存在发展性计算障碍（DD），中国2.8亿儿童青少年中则有约1400万计算障碍患者。计算障碍严重影响了儿童的日常生活和学习质量。研究表明DD儿童在数字加工相关的顶内沟存在功能异常，其干预方法以认知训练为主。而经颅刺激技术能够促进认知训练干预效果的迁移，并且具有长期效应。然而，重复经颅磁刺激（rTMS）联合认知训练对DD儿童的干预效果及其脑机制尚不清楚。据此本项目提出假设：低频rTMS刺激右侧顶内沟同时联合认知训练能够长期改善DD儿童的计算及其相关认知能力和特定神经环路。我们将采用rTMS联合认知训练对DD儿童进行干预，使用认知测验评估短期和长期干预效果，同时结合功能磁共振成像阐明干预效果的脑神经机制。本项目针对rTMS联合认知训练技术进行方法应用创新，结合认知心理学和神经影像学全面评估干预效果，为有效改善DD儿童的数学认知功能和学习能力提供科学证据。

发展性计算障碍是一种特定学习障碍，根据国内外流行病学调查，约有5%的儿童存在发展性计算障碍（Developmental dyscalculia, 简称DD），我国约有1400万计算障碍患者。计算障碍的数字和计算能力缺陷严重影响了儿童认知发育，降低了儿童的日常生活和学习质量。计算机认知训练可以提高DD儿童的数字比较能力，改善数字空间表征功能，但干预效果难以迁移到计算相关的其他认知能力。而经颅刺激技术能够促进认知训练干预效果的迁移，并且具有长期效应。然而，重复经颅磁刺激（rTMS）联合认知训练对DD儿童的干预效果及其脑机制尚不清楚。本项目采用认知测验和磁共振成像探讨发展性计算障碍儿童的认知和脑功能特征、阐明rTMS联合认知训练对计算障碍儿童的干预效果及其神经机制。. 本研究有如下发现：（1）计算障碍儿童的认知特征主要表现为数目加工和形状知觉加工缺陷；（2）脑电-行为相关分析揭示非符号数感、形状知觉与算术计算在枕叶存在神经关联；（3）使用数字加工fMRI实验范式揭示数学优等生和数学障碍者主要在枕叶区域存在大脑活动差异；（4）揭示基于非符号数感的知觉训练对计算障碍儿童数学能力的促进作用及其认知机制，并且rTMS联合认知训练能够促进计算障碍儿童的数学能力，其神经机制是改变了大脑顶枕脑区的活动。. 本研究的结果具有理论意义和实践意义。首先，以往的研究表明DD儿童计算能力缺陷与非符号数感能力有关，本项目的干预研究结果进一步证实DD儿童计算能力与非符号数感能力存在因果关系，丰富了数字模块缺陷理论；其次，基于大样本儿童认知能力测评数据，建立了用于诊断计算障碍儿童的测验常模，形成了儿童数学认知能力诊断测验组套。基于干预训练的研究成果，我们开发了一套适用于临床的计算机远程数学能力提升工具。本研究将脑科学和教育实践相结合，为有效改善DD儿童的数学学习能力提供科学证据。