Brain activity changes associated with treadmill training after stroke.
Brain activity changes associated with treadmill training after stroke.
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DOI：
10.1161/strokeaha.109.550053
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发表时间：
2009-07
期刊：
影响因子：
8.3
通讯作者：
Matthews PM
中科院分区：
文献类型：
--
作者：
Enzinger C;Dawes H;Johansen-Berg H;Wade D;Bogdanovic M;Collett J;Guy C;Kischka U;Ropele S;Fazekas F;Matthews PM
中风后运动恢复的机制尚未完全清楚。一些研究纵向使用功能性MRI将大脑活动变化与治疗后上肢的性能增益联系起来，但到目前为止，对训练诱导的下肢功能恢复的研究相对被忽视。我们调查了18名慢性患者在4周的跑步机训练和部分体重支持后的功能重组（平均年龄，59.9±13.5岁），轻度至中度轻瘫（受累腿的运动指数：77.7± 10.5;范围：9 - 99）和步态障碍（功能性截肢分类：4.4±0.6;范围：3 - 5），使用重复3.0-T功能性MRI和踝关节背屈范例，由于单一皮质下缺血性卒中。训练后步行耐力改善（2分钟计时步行距离：121.5±39.0 vs训练前：105.1 ±38.1 m; P=0.0001）。对于麻痹足的主动运动与休息，更大的步行耐力与双侧初级感觉运动皮层，扣带运动区，尾状核双侧和丘脑的受影响的半球的大脑活动增加。尽管皮质下对步态控制有很大的贡献，但康复相关的行走改善与皮质激活变化有关。这与上肢康复中的发现相似，但在所涉及的皮层区域中存在一些差异。我们观察到双侧半球的激活增加，更大的恢复都在皮层和皮层下区域的运动麻痹脚。然而，虽然背侧运动前皮质似乎在手部运动的恢复中起着重要作用，但没有发现该区域参与下肢恢复的证据。
The mechanisms underlying motor recovery after stroke are not fully understood. Several studies used functional MRI longitudinally to relate brain activity changes with performance gains of the upper limb after therapy, but research into training-induced recovery of lower limb function has been relatively neglected thus far. We investigated functional reorganization after 4 weeks of treadmill training with partial body weight support in 18 chronic patients (mean age, 59.9±13.5 years) with mild to moderate paresis (Motricity Index affected leg: 77.7± 10.5; range, 9 to 99) and gait impairment (Functional Ambulation Category: 4.4±0.6; range, 3 to 5) due to a single subcortical ischemic stroke using repeated 3.0-T functional MRI and an ankle-dorsiflexion paradigm. Walking endurance improved after training (2-minute timed walking distance: 121.5±39.0 versus pre: 105.1 ±38.1 m; P=0.0001). For active movement of the paretic foot versus rest, greater walking endurance correlated with increased brain activity in the bilateral primary sensorimotor cortices, the cingulate motor areas, and the caudate nuclei bilaterally and in the thalamus of the affected hemisphere. Despite the strong subcortical contributions to gait control, rehabilitation-associated walking improvements are associated with cortical activation changes. This is similar to findings in upper limb rehabilitation with some differences in the involved cortical areas. We observed bihemispheric activation increases with greater recovery both in cortical and subcortical regions with movement of the paretic foot. However, although the dorsal premotor cortex appears to play an important role in recovery of hand movements, evidence for the involvement of this region in lower extremity recovery was not found.