Cortical changes underlying balance recovery in patients with hemiplegic stroke
Cortical changes underlying balance recovery in patients with hemiplegic stroke
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DOI：
10.1016/j.neuroimage.2013.05.014
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发表时间：
2014-01-15
期刊：
影响因子：
5.7
通讯作者：
Mochizuki, Hideki
中科院分区：
文献类型：
--
作者：
Fujimoto, Hiroaki;Mihara, Masahito;Mochizuki, Hideki
平衡问题是中风的主要后遗症，与日常生活能力恢复不良有关。在一项横断面研究中，使用50通道事件相关功能近红外光谱，我们先前报道了中风后个体的平衡能力与辅助运动区(SMA)和前额叶皮质中姿势扰动相关的皮质激活之间的显著相关性。然而，中风后平衡恢复的神经机制仍不清楚。在此，我们通过测定偏瘫卒中患者的纵向局部皮质激活变化，研究了皮质参与卒中后平衡恢复的情况。本研究以本院收治的20例皮质下卒中患者为研究对象。在住院患者强化物理和作业治疗康复前后，我们评估了与平台上快速向前和向后联合运动引起的外部姿势扰动相关的皮质激活。强化康复后，患侧和健侧大脑半球SMA中与体位扰动相关的皮质激活显著增加。健侧SMA的体位扰动相关氧合血红蛋白信号的增加与Berg平衡量表测量的平衡功能增强显著相关。这些发现支持了SMA在姿势平衡控制中的重要作用的结论，并提示SMA是偏瘫后平衡恢复的关键区域。(C)2013 Elsevier Inc.保留所有权利。
Balance problems are a major sequelae of stroke and are implicated in poor recovery of activities of daily living. In a cross-sectional study, using 50-channel event-related functional near-infrared spectroscopy we previously reported a significant correlation between individual balance ability after stroke and postural perturbation-related cortical activation in the supplementary motor area (SMA) and the prefrontal cortex. However, the neural mechanisms underlying balance recovery after stroke remain unclear. Herein, we examined the cortical involvement in balance recovery after stroke by determining longitudinal regional cortical activation changes in patients with hemiplegic stroke. Twenty patients with subcortical stroke admitted to our hospital for post-acute inpatient rehabilitation participated in this study. Before and after intensive inpatient physical and occupational therapy rehabilitation, we evaluated cortical activation associated with external postural perturbations induced by combined brisk forward and backward movement on a platform. Postural perturbation-related cortical activation in the SMA of the affected and unaffected hemispheres was significantly increased after intensive rehabilitation. The increment of the postural-perturbation-related oxygenated hemoglobin signals in the SMA of the unaffected hemisphere was significantly correlated with the gain in balance function measured by the Berg Balance Scale. These findings support the conclusion that the SMA plays an important role in postural balance control, and suggest that the SMA is a crucial area for balance recovery after hemiplegic stroke. (C) 2013 Elsevier Inc. All rights reserved.