Rehabilitation in chronic spatial neglect strengthens resting-state connectivity
Rehabilitation in chronic spatial neglect strengthens resting-state connectivity
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DOI：
10.1111/ane.13048
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发表时间：
2019-03-01
影响因子：
3.5
通讯作者：
Malm, Jan
中科院分区：
文献类型：
--
作者：
Wahlin, Anders;Fordell, Helena;Malm, Jan
目的
慢性视觉空间忽视患者的康复研究不足，对于可用于促进康复的神经机制知之甚少。在本研究中，我们提供了慢性忽视患者在虚拟现实（VR）环境中接受训练以提高左侧意识时背侧注意网络（DAN）内静息态功能连接的数据。
方法
该研究纳入了13例右侧脑卒中后视觉空间忽视持续超过6个月的患者。患者接受了静息态功能磁共振成像（fMRI）检查。在基线时以及经过5周的强化训练后进行扫描。我们专门检查了DAN内的静息态功能连接。此外，利用空间一致性相关，我们将DAN的空间拓扑结构变化与其他网络进行了比较。
结果
我们发现训练后右侧额叶眼区和左侧顶内沟之间的半球间功能连接纵向增加（训练前：0.33±0.17[平均值±标准差]；训练后：0.45±0.13；P = 0.004）。空间一致性分析表明，训练对DAN连接的影响大于其他任何网络。
结论
在慢性脑卒中患者中，提高左侧意识的强化VR训练也增加了DAN内偶尔的半球间功能连接。具体而言，负责向左扫视眼球运动的区域与左侧后顶叶皮质的整合性更强。这些结果强调了在慢性视觉空间忽视患者训练中应利用的一种机制。
Objectives Rehabilitation of patients with chronic visuospatial neglect is underexplored, and little is known about neural mechanisms that can be exploited to promote recovery. In this study, we present data on resting-state functional connectivity within the dorsal attention network (DAN) in chronic neglect patients as they underwent training in a virtual reality (VR) environment that improved left-side awareness. Methods The study included 13 patients with visuospatial neglect persisting more than six months after a right-sided stroke. The patients underwent resting-state functional magnetic resonance imaging (fMRI). Scans were collected at baseline and after five weeks of intense training. We specifically examined resting-state functional connectivity within the DAN. In addition, using spatial concordance correlation, we compared changes in the spatial topology of the DAN with that of other networks. Results We found a longitudinal increase in interhemispheric functional connectivity between the right frontal eye field and the left intraparietal sulcus following training (before: 0.33 +/- 0.17 [mean +/- SD]; after: 0.45 +/- 0.13; P = 0.004). The spatial concordance analyses indicated that training influenced the DAN connectivity more than any of the other networks. Conclusion Intense VR training that improved left-sided awareness in chronic stroke patients also increased sporadic interhemispheric functional connectivity within the DAN. Specifically, a region responsible for saccadic eye movement to the left became more integrated with the left posterior parietal cortex. These results highlight a mechanism that should be exploited in the training of patients with chronic visuospatial neglect.