Mental practice with motor imagery: Evidence for motor recovery and cortical reorganization after stroke
Mental practice with motor imagery: Evidence for motor recovery and cortical reorganization after stroke
复制标题
DOI：
10.1016/j.apmr.2006.08.326
复制
发表时间：
2006-12-01
影响因子：
4.3
通讯作者：
Page, Stephen J.
中科院分区：
文献类型：
--
作者：
Butler, Andrew J.;Page, Stephen J.
目的：测量结合心理和身体练习的方案与仅由强制性诱导运动疗法（CIMT）或仅由心理练习组成的方案对脑卒中患者上肢损伤水平和上肢功能结局的有效性，并建立血氧水平依赖性（BOLD）变化之间的关系。在特定运动或想象任务期间的功能性磁共振成像反应和干预组之间运动功能的改善。设计：病例系列。设置：有执照的，56张床位的独立式大学附属康复医院。参与者：随机选择中风后中度上肢轻偏瘫的3名男性和1名女性。干预措施：2名患者接受心理练习和CIMT，1名患者仅接受心理练习，1名患者仅接受CIMT。主要结果测量：Wolf运动功能测试（WMFT），运动活动日志（MAL），Sirigu中断测试，运动想象量表修订版和运动想象生动度问卷。结果：单独的心理练习干预导致某些功能和心理意象测量（Sirigu，MAL，WMFT）略有改善，但没有导致具有临床意义的改善，干预前不存在显著的右小脑半球激活。CIMT后，只有一名患者表现出临床意义上的改善，他的影响手表现为减少时间的MAL和WMFT。患者在执行手指屈曲和伸展任务时，运动区和运动前区的双侧皮质激活增加。相反，在第二个任务，这是一个想象的屈曲和伸展任务，电机，枕叶，顶叶激活主要是在对侧半球进行了观察。经过2周的CIMT加心理练习，一个病人的病变局限于顶叶皮层表现出很少的改善上肢功能和心理意象的患者相比，非顶叶区的损害，谁表现出临床意义的改善。在非顶叶损伤的患者中，CIMT加心理练习2周后的激活模式在执行自愿屈曲和伸展任务时导致初级运动皮层中更多的对侧激活。病例系列表明，对于这些中风后患有慢性、中度上肢损伤的患者，2周的CIMT或CIMT加心理练习的治疗方案（1例）导致了适度的变化，表现为损伤减少，功能改善。单独的心理练习并没有导致上肢损伤的临床有意义的改善。我们描述了这些干预措施如何引起大脑的“可塑性”变化。进一步的调查，以确定适当的交付和剂量的身体和精神的做法，以及确定是否精神的做法引起的变化正相关的不同模式的皮层激活，应进行之前，他们的使用的疗效可以确定患者的局限性与这些参与者。
Objectives: To measure the efficacy of a program combining mental and physical practice with the efficacy of a program composed of only constraint-induced movement therapy (CIMT) or only mental practice on stroke patients' levels of upper-extremity impairment and upper-extremity functional outcomes and to establish the relationship between changes in blood-oxygen-level dependent (BOLD) functional magnetic resonance imaging response during a specific motor or imagery task and improvement in motor function between intervention groups.Design: Case series.Setting: Licensed, 56-bed, freestanding, university-affiliated rehabilitation hospital.Participants: Three men and 1 woman with moderate upper-limb hemiparesis after stroke were randomized.Interventions: Two patients received mental practice and CIMT, 1 patient received only mental practice, and 1 received only CIMT.Main Outcome Measures: Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), Sirigu break test, Movement Imagery Questionnaire-Revised, and Vividness of Movement Imagery Questionnaire.Results: The mental practice intervention alone led to slight improvement in certain functional and mental imagery measures (Sirigu, MAL, WMFT) but did not result in a clinically meaningful improvement with notable right cerebellar hemisphere activation that was not present before intervention. After CIMT, only the single patient showed clinically meaningful improvement of his affected hand as exhibited by decreased times on the MAL and WMFT. The patient showed increased bilateral cortical activation in both the motor and premotor areas during execution of a finger flexion and extension task. In contrast, during a second task, which was an imagined flexion and extension task, motor, occipital, and inferior parietal activation mainly in the contralateral hemisphere were observed. After 2 weeks of CIMT plus mental practice a patient with a lesion restricted to the parietal cortex showed little improvement in upper-extremity function and mental imagery in comparison with the patient with damage to nonparietal areas, who showed clinically meaningful improvement. The pattern of activation after 2 weeks of CIMT plus mental practice in the patient with nonparietal damage led to more focal contralateral activation in primary motor cortex when executing a voluntary flexion and extension task.Conclusions: The case series indicates that for these patients with chronic, moderate upper-extremity impairment after stroke, a 2-week regimen of CIMT or CUMT plus mental practice only (in 1 case) resulted in modest changes occurring as a decrease in impairment, with functional improvement. Mental practice alone did not result in a clinically meaningful improvement in upper-limb impairment. We describe how these interventions may elicit "plastic" changes in the brain. Further investigations to determine the appropriate delivery and dosing of both physical and mental practice, as well as to determine whether mental practice-induced changes positively correlate with distinct patterns of cortical activation, should be undertaken before the efficacy of their use can be ascertained among patients with limitations comparable with these participants.