Plasticity of premotor cortico-muscular coherence in severely impaired stroke patients with hand paralysis.
Plasticity of premotor cortico-muscular coherence in severely impaired stroke patients with hand paralysis.
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DOI：
10.1016/j.nicl.2017.03.005
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Gharabaghi A
中科院分区：
文献类型：
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作者：
Belardinelli P;Laer L;Ortiz E;Braun C;Gharabaghi A
严重受损的中风患者的运动恢复通常非常有限。为了完善治疗干预措施以恢复该患者组的运动控制，需要检测神经元可塑性的功能相关机制。皮质肌肉一致性（CMC）可以提供生理和地形洞察来实现这一目标。假设将肢体运动与运动相关的大脑激活同步可以重建由 CMC 索引的皮质运动控制。在本研究中，右利手、患有右半球病变和左手麻痹的慢性中风患者参加了为期四个星期的左上肢训练。大脑-机器人接口将动觉运动想象过程中与事件相关的受损感觉运动皮层的β带去同步化转变为机器人矫形器打开瘫痪的手。在训练计划之前和之后，使用同步 MEG/EMG 记录和 MRI 的单个模型进行 CMC 检测和受影响手指伸肌的皮质肌肉连接的源重建。患者上肢 FMA 从 16.23 ± 6.79 显着改善至 19.52 ± 7.91 (p = 0.0015)。所有患者的 β 频段 CMC 均显着增加，具有分布的双半球模式和相当大的个体间差异。 CMC 变化的位置与运动损伤的严重程度、运动改善或病变体积无关。皮层重叠的分组分析揭示了干预后所有患者的一个共同特征：同侧运动前 CMC 水平显着增加，从额上回延伸至额中回和下回，同时对侧运动前皮层中 CMC 增加的限制区域也增加。总之，在接受脑机器人辅助康复训练后，长期严重运动缺陷的患者可以检测到 CMC 的功能相关调节。运动前β带CMC可以作为该患者组新治疗方法的生物标志物和治疗靶点。严重受损的中风患者表现出分布式的双半球模式，并且皮质肌肉一致性（CMC）存在相当大的个体间差异。将肢体运动与运动相关的大脑激活同步可以重建由 CMC 索引的皮质运动控制。运动前β带CMC可以作为运动缺陷患者的生物标志物和治疗靶点。
Motor recovery in severely impaired stroke patients is often very limited. To refine therapeutic interventions for regaining motor control in this patient group, the functionally relevant mechanisms of neuronal plasticity need to be detected. Cortico-muscular coherence (CMC) may provide physiological and topographic insights to achieve this goal. Synchronizing limb movements to motor-related brain activation is hypothesized to reestablish cortico-motor control indexed by CMC. In the present study, right-handed, chronic stroke patients with right-hemispheric lesions and left hand paralysis participated in a four-week training for their left upper extremity. A brain-robot interface turned event-related beta-band desynchronization of the lesioned sensorimotor cortex during kinesthetic motor-imagery into the opening of the paralyzed hand by a robotic orthosis. Simultaneous MEG/EMG recordings and individual models from MRIs were used for CMC detection and source reconstruction of cortico-muscular connectivity to the affected finger extensors before and after the training program. The upper extremity-FMA of the patients improved significantly from 16.23 ± 6.79 to 19.52 ± 7.91 (p = 0.0015). All patients showed significantly increased CMC in the beta frequency-band, with a distributed, bi-hemispheric pattern and considerable inter-individual variability. The location of CMC changes was not correlated to the severity of the motor impairment, the motor improvement or the lesion volume. Group analysis of the cortical overlap revealed a common feature in all patients following the intervention: a significantly increased level of ipsilesional premotor CMC that extended from the superior to the middle and inferior frontal gyrus, along with a confined area of increased CMC in the contralesional premotor cortex. In conclusion, functionally relevant modulations of CMC can be detected in patients with long-term, severe motor deficits after a brain-robot assisted rehabilitation training. Premotor beta-band CMC may serve as a biomarker and therapeutic target for novel treatment approaches in this patient group. Severely impaired stroke patients show a distributed, bi-hemispheric pattern and considerable inter-individual variability of cortico-muscular coherence (CMC). Synchronizing limb movements to motor-related brain activation reestablishes cortico-motor control indexed by CMC. Premotor beta-band CMC may serve as a biomarker and therapeutic target for patients with motor deficits.