多通道功能性电刺激结合任务导向训练对脑卒中上肢偏瘫患者脑功能网络的即刻影响

doi:10.3969/j.issn.1006-9771.2024.04.012

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (4): 462-467.doi: 10.3969/j.issn.1006-9771.2024.04.012

多通道功能性电刺激结合任务导向训练对脑卒中上肢偏瘫患者脑功能网络的即刻影响

陈园月¹^,², 李加斌³, 蒯凤³, 彭丽丽³, 项洁⁴()

1.徐州医科大学第二临床医学院，江苏徐州市 221000
2.盐城德馨医院，江苏盐城市 224000
3.盐城市第一人民医院，江苏盐城市 224000
4.徐州医科大学附属医院，江苏徐州市 221000

收稿日期:2024-02-02 修回日期:2024-02-27 出版日期:2024-04-25 发布日期:2024-05-08
通讯作者: 项洁(1968-)，女，汉族，江苏南通市人，博士，主任医师、教授，博士生导师，主要研究方向：脑高级功能康复。E-mail： 18052268386@163.com
作者简介:陈园月(1988-)，女，汉族，江苏盐城市人，硕士研究生，主管技师，主要研究方向：神经系统疾病康复。
基金资助:
国家重点研发计划项目(2020YFC2006604)

Immediate effect of multi-chancel functional electrical stimulation combined with task-oriented training on brain functional network in stroke patients with upper limb hemiplegia

CHEN Yuanyue¹^,², LI Jiabin³, KUAI Feng³, PENG Lili³, XIANG Jie⁴()

1. The Second Medical School of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
2. Dexin Hospital of Yancheng, Yancheng, Jiangsu 224000, China
3. The First People's Hospital of Yancheng, Yancheng, Jiangsu 224000, China
4. Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China

Received:2024-02-02 Revised:2024-02-27 Published:2024-04-25 Online:2024-05-08
Contact: XIANG Jie, E-mail: 18052268386@163.com
Supported by:
National Key Research and Development Program of China(2020YFC2006604)

摘要/Abstract

摘要：

目的应用功能性近红外光谱(fNIRS)观察脑卒中上肢偏瘫患者在多通道功能性电刺激(FES)结合任务导向训练诱导下的脑功能网络变化。

方法选取2023年4月至10月在盐城市第一人民医院住院治疗的脑卒中偏瘫患者15例，通过掷币决定阳性刺激和阴性刺激的顺序。阳性刺激在多通道FES下行任务导向训练，阴性刺激在伪刺激下行任务导向训练，间隔1 d。每次训练时，采用fNIRS测量患者双侧前额叶皮质(PFC)、前运动皮质(PMC)、辅助运动区(SMA)、感觉运动皮质(SMC)的氧合血红蛋白的浓度，计算总体功能连接强度和感兴趣区的功能连接强度差异。

结果与阴性刺激相比，阳性刺激下，大脑皮质总体功能连接强度降低(t = -2.735, P < 0.05)，损伤对侧PFC-损伤同侧PFC和损伤对侧PFC-损伤对侧PMC的功能连接降低(P < 0.05)。

结论多通道FES结合任务导向训练可以优化脑卒中上肢偏瘫患者的皮质功能连接。

关键词: 脑卒中, 多通道功能性电刺激, 任务导向训练, 功能性近红外光谱, 脑功能网络

Abstract:

Objective To observe the change of brain functional network of stroke patients with upper limb hemiplegia during task-oriented training under multi-channel functional electrical stimulation (FES) using functional near-infrared spectroscopy (fNIRS).

Methods From April to October, 2023, 15 stroke inpatients with upper limb hemiplegia were selected from the First People's Hospital of Yancheng. They accepted task-oriented training, under real stimulation and sham stimulation determined with tossing a coin, with an interval of a day. The real stimulation was induced with multi-channel FES, and sham stimulation was induced with no stimulation. During the training, fNIRS was used to measure the concentrations of oxygenated hemoglobin in the bilateral prefrontal cortex (PFC), premotor cortex (PMC), supplementary motor area (SMA) and sensorimotor cortex (SMC), to obtain the overall functional connectivity and the difference of functional connectivity based on region of interest.

Results Compared with the sham stimulation, the overall functional connectivity reduced (t = -2.735, P< 0.05); the functional connectivity between the contralesional PFC to ipsilateral PFC, and the contralesional PFC to contralesional PMC also reduced (P< 0.05) under real stimulation.

Conclusion Multi-channel FES combined with task-oriented training can optimize the cortical functional connectivity in stroke patients with upper limb hemiplegia.

Key words: stroke, multi-channel functional electrical stimulation, task-oriented training, functional near-infrared spectroscopy, brain functional network

中图分类号:

R743.3

陈园月, 李加斌, 蒯凤, 彭丽丽, 项洁. 多通道功能性电刺激结合任务导向训练对脑卒中上肢偏瘫患者脑功能网络的即刻影响[J]. 《中国康复理论与实践》, 2024, 30(4): 462-467.

CHEN Yuanyue, LI Jiabin, KUAI Feng, PENG Lili, XIANG Jie. Immediate effect of multi-chancel functional electrical stimulation combined with task-oriented training on brain functional network in stroke patients with upper limb hemiplegia[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 462-467.

图/表 3

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项目	量值
性别(男/女)/n	12/3
年龄/岁	60.6±6.96
病程/d	39(23, 238)
卒中类型(梗死/出血)/n	11/4
损伤侧(左/右)/n	7/8
FMA-H评分	7.53±2.64
MMSE评分	28.33±1.99

多通道功能性电刺激结合任务导向训练对脑卒中上肢偏瘫患者脑功能网络的即刻影响

Immediate effect of multi-chancel functional electrical stimulation combined with task-oriented training on brain functional network in stroke patients with upper limb hemiplegia

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