CAJ | 학술논문

目的观察缺血性脑卒中患者患手执行主动及被动运动时的脑激活模式,探讨主动运动和被动运动治疗脑卒中后手功能障碍的中枢机制.方法对5例左侧大脑皮质下脑卒中患者患手执行主动及被动抓握-释放动作,执行动作期间采用血氧水平依赖性功能性磁共振(BOLD-fMRI)进行脑扫描,利用SPM5软件对上述患者试验数据进行分析,使用XJVIEW toolbox 8.11版软件得出入选患者在上述两种运动状态下的脑激活区分布图,并对其在不同运动状态下的脑激活模式特点进行分析比较.结果入选患者患手在执行主动运动时其脑激活部位主要位于对侧感觉运动区(SMC)、运动前区(PMC)、双侧小脑及双侧辅助运动区(SMA),另外同侧SMC及PMC区也有轻度激活;激活脑区主要位于对侧大脑及小脑半球.患手执行被动运动时的脑激活部位主要位于双侧SMC、PMC区、双侧小脑、SMA区;激活脑区平均分布于两侧大脑及小脑半球.与患手主动运动比较,患手被动运动时的脑区激活范围较广泛,激活强度也较高.结论患手执行主动运动和被动运动均可激活脑卒中患者运动相关脑区,提示对脑卒中患者进行主动运动及被动运动均可促进其脑功能重组.
목적 관찰결혈성뇌졸중환자환수집행주동급피동운동시적뇌격활모식,탐토주동운동화피동운동치료뇌졸중후수공능장애적중추궤제.방법 대5례좌측대뇌피질하뇌졸중환자환수집행주동급피동조악-석방동작,집행동작기간채용혈양수평의뢰성공능성자공진(BOLD-fMRI)진행뇌소묘,이용SPM5연건대상술환자시험수거진행분석,사용XJVIEW toolbox 8.11판연건득출입선환자재상술량충운동상태하적뇌격활구분포도,병대기재불동운동상태하적뇌격활모식특점진행분석비교.결과 입선환자환수재집행주동운동시기뇌격활부위주요위우대측감각운동구(SMC)、운동전구(PMC)、쌍측소뇌급쌍측보조운동구(SMA),령외동측SMC급PMC구야유경도격활;격활뇌구주요위우대측대뇌급소뇌반구.환수집행피동운동시적뇌격활부위주요위우쌍측SMC、PMC구、쌍측소뇌、SMA구;격활뇌구평균분포우량측대뇌급소뇌반구.여환수주동운동비교,환수피동운동시적뇌구격활범위교엄범,격활강도야교고.결론 환수집행주동운동화피동운동균가격활뇌졸중환자운동상관뇌구,제시대뇌졸중환자진행주동운동급피동운동균가촉진기뇌공능중조.
Objective To study the effects of active and passive movement of the affected hand after ischemic stroke on brain activity patterns using blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) and to explore the central mechanism of movement treatment for hand disability.Methods Five pa-tients with subcortical cerebral infarction in Brunnstrom stages 1 to 3 (both upper limb and hand affected) were investigated using BOLD-fMRI during active and passive clenching and relaxing of the affected hand.Statistical parametric mapping software (SPM5) was used to integrate the activity data and display them in one standard brain map.The activated areas were then compared.Results The BOLD-fMRI signals aroused by both active and passive move-ment were enhanced in the contralateral sensorimotor cortex,the contralateral premotor cortex,bilaterally in the sup-plementary motor area and in the bilateral cerebellum.Both movements also activated the ipsilateral sensorimotor cor-tex and premotor cortex,which are not normally activated during such movements in healthy people.The areas were more extensive and the activation was stronger during passive movement.Moreover,the activated brain areas induced by active movement were mainly on the contralateral side,while passive movement induced activation distributed over both hemispheres almost evenly.Conclusions Both active and passive movement significantly activate the brain areas responsible for movement of the affected hand.Both are useful for boosting brain reorganization after stroke.