Cortical plasticity following motor skill learning during mental practice in stroke.
Cortical plasticity following motor skill learning during mental practice in stroke.
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DOI：
10.1177/1545968308326427
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发表时间：
2009-05
影响因子：
4.2
通讯作者：
Cramer SC
中科院分区：
文献类型：
--
作者：
Page SJ;Szaflarski JP;Eliassen JC;Pan H;Cramer SC
心理练习（MP），涉及身体动作的认知排练，是一种非侵入性的，廉价的方法，使重复的，特定任务的实践（RTP）。最近的随机对照数据表明，MP与RTP治疗方案相结合时，与仅RTP相比，显著增加了受影响手臂的使用和功能。作为下一步，该10例受试者病例系列研究了皮质可塑性是MP与RTP联合治疗效果的潜在机制的可能性。10例表现出稳定、中度运动缺陷的慢性卒中患者（平均= 36.7个月）在其受累手臂接受了半小时的治疗，每周3天，持续10周，并强调了有价值的日常生活活动（ADL）。治疗后，受试者立即接受30分钟的MP治疗，这需要在治疗期间进行ADL的MP。采用行动研究手臂测试（ARAT）和Fugl-Meyer评估（FM）对行为结局进行盲法评估。在干预前后进行功能性磁共振成像（fMRI）以评估皮质变化。干预前，受试者表现出稳定的运动缺陷。干预后，受试者表现出明显的ARAT和FM评分增加（分别为+5.3和+4.2），以及具有临床意义的进行有价值的ADL的新能力。干预后的功能磁共振成像显示显着增加激活腕关节屈曲和伸展的受影响的手在前运动区和初级运动皮层同侧和对侧的受影响的手，和上级顶叶皮层同侧的受影响的手。在患手同侧半球的顶叶皮层中观察到激活减少。这些变化与通过ARAT和FM观察到行为变化的解剖区域相关。MP是一种易于使用、具有成本效益的策略，再次证明可改善卒中后受影响手臂的结局。这是第一个研究表明，在皮层地图的改变作为一个可能的MP机制，为受影响的手臂。
Mental practice (MP), which involves cognitive rehearsal of physical movements, is a non-invasive, inexpensive method of enabling repetitive, task specific practice (RTP). Recent, randomized controlled data suggest that MP, when combined with a RTP therapy program, increases affected arm use and function significantly more than RTP only. As a next step, this 10-subject case series examined the possibility that cortical plasticity is a mechanism underlying the treatment effect of MP when combined with RTP. 10 chronic stroke patients (mean = 36.7 months) exhibiting stable, moderate motor deficits received ½ hour therapy sessions for their affected arms, occurring 3 days/week for 10 weeks, and emphasizing valued activities of daily living (ADLs). Directly after therapy, subjects received 30-minute MP sessions, which required MP of the ADLs performed during therapy. Behavioral outcomes were blindly evaluated using the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FM). Functional magnetic resonance imaging (fMRI) was administered before and after intervention to assess cortical changes. Before intervention, subjects exhibited stable motor deficits. After intervention, subjects exhibited marked ARAT and FM score increases (+ 5.3 and + 4.2, respectively), and clinically significant, new abilities to perform valued ADLs. Post-intervention fMRI revealed significant increases in activation to wrist flexion and extension of the affected hand in the premotor area and primary motor cortex ipsi- and contralaterally to the affected hand, and superior parietal cortex ipsilateral to the affected hand. Decreased activations were noted in parietal cortex of the hemisphere ipsilateral to the affected hand. These changes correlated with anatomical regions in which behavioral changes were observed via the ARAT and FM. MP is an easy to use, cost effective strategy that was again shown to improve affected arm outcomes after stroke. This is the first study suggesting alteration in the cortical map as a possible MP mechanism for the affected arm.
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DOI：
10.1097/00004356-198112000-00001
发表时间：
1981-01-01
影响因子：
1.7
作者：
LYLE, RC
通讯作者：
LYLE, RC
影响因子：
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作者：
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影响因子：
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影响因子：
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通讯作者：
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DOI：
10.1682/jrrd.2005.04.0075
发表时间：
2006-05-01
影响因子：
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作者：
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