Assessment of cerebral plasticity in stroke subjects before and after rehabilitation with functional MRI★

Abstract

AIM：To study the change of the brain function regions activated after stroke during rehabilitation with function MRI (fMRI), and discuss cerebral cortex plasticity in different movement models.

METHODS：Eight patients with cortical cerebral infarction admitted in the Department of Rehabilitation, The General Hospital of Daqing Oil Field between February and October 2003. Rehabilitation training should be done for two months continuously from a week after stroke. Before rehabilitation, a month, two months after rehabilitation, Brunnstrom Scale and Caroll upper limb function Scale were used to evaluate function of hand in all the patients (0－100 scores, higher scores indicated better function). At the same time, patients were inspected by fMRI of GE MR/I HiSpeed 1.5 superconducting MRI scanner. Patient did simple hand motor task (repetitive and sequential finger-to-thumb opposition movements in turn) and voluntary motor task (grasping different shape objects) with paralytic hand. Then fMRI activated image was obtained.

RESULT: All 8 patients were involved in the result analysis.①Brunnstrom Scale and Caroll upper limb function Scale scores in patients had significantly improved after rehabilitation.②Simple hand motor task of illed-hand: There were no active in brain, because seven of eight patients did not do finger-to-thumb opposition movements in early damages. M1, supplementary motor areas (SMA), premotor areas (PMA) and cerebellum presented the activation of one side-double sides-one side change. Count of active function regions appeared decrease tendency with time prolonged, and was near to normal brain function.③Voluntary motor task of illed-hand: Count of active function regions varied in disorder, but five patients appeared obvious decrease tendency. Many function regions with determination for movement were not active. And active function regions went up with functonal recovery, same to simple hand motor task.

CONCLUSION:①Simple hand motor task with ill-hand recovers well after stroke, and activation of cerebral motor function region is identical with normal brain function region after 2-month rehabilitation.②Voluntary motor task with ill-hand recovers difficultly after stroke and the activation appears irregular change. The motor function regions are more activated with motor functional recovery.

Li Y, Liu SW, Zhang LJ, Cao LH, Wang XF, Dai WJ, Sui XL.Assessment of cerebral plasticity in stroke subjects before and after rehabilitation with functional MRI.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2007;11(13):2449-2453(China)
[www.zglckf.com/zglckf/ejournal/upfiles/07-13/13k-2449(ps).pdf]

摘要
目的：应用功能磁共振成像观察脑卒中后及康复过程中，在相应脑内运动功能区激活的变化情况，探讨不同运动模式下皮质功能再塑的表现。
方法：选取2003－02/10大庆油田总医院康复科住院的皮质下脑梗死患者8例，在发病后1周始进行连续两个月的康复。在康复前、康复1，2个月时运用Brunnstrom分级、Caroll上肢功能量表（0~100分，评分越高功能越好）对其手功能进行评价，并采用GE MR/i HiSpeed 1.5超导磁共振扫描机进行磁共振成像功能激发检查。患者用病手执行简单运动（快速连续的拇指与其他各指的对指动作）、随意运动（用病手摸不同形状的木块），获得脑功能激发图像，观察脑内相关功能区的激活情况。
结果：8例受试者均进入结果分析。①康复后所有患者Brunnstrom分级和Caroll上肢功能评分均较康复前有明显改善。②病手简单运动时脑内相关功能区的激活情况：8例受试者7例在损伤后早期手指不能对指，所以没有激活；M1，SMA，PMA脑区和小脑呈现单侧激活－双侧激活－单侧激活的变化过程；随着运动功能恢复，脑内激活数目随时间呈下降趋势，几乎接近正常人脑功能表现。③病手随意运动时脑内相关功能区的激活情况：实验中发现引起的运动相关功能区的激发情况变化多样，规律性较差，但其中5例受试者表现出损伤后激发数目明显减少，许多对运动起决定性支配作用的功能区亦不激活；随着运动功能恢复，激发区数目呈上升趋势，同损伤后简单运动的激活表现。
结论：①脑卒中后病手经过康复治疗简单运动恢复较好，康复治疗2个月后脑内运动功能相关区域激活的规律已同正常人。②脑卒中后病手随意运动恢复较困难，康复治疗后不如简单运动恢复好，脑内相关运动功能区激活无明显的规律性。随着运动功能的恢复，脑内相应的运动功能区激活增多。
关键词：功能磁共振；脑卒中；大脑再塑；功能重组

李艳，刘世文，张丽君，曹丽华，王雪峰，戴文晋，隋晓亮.应用功能磁共振成像分析脑卒中患者康复治疗前后大脑再塑机制[J].中国组织工程研究与临床康复，2007，11(13):2449-2453 [www.zglckf.com/zglckf/ejournal/upfiles/07-13/13k-2449(ps).pdf]