中風復健與大腦的神經可塑性變化: 縱貫性功能性磁振造影研究;Neuroplasticity Following Stroke Rehabilitation: A Longitudinal FMRI Study

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Title:	中風復健與大腦的神經可塑性變化: 縱貫性功能性磁振造影研究;Neuroplasticity Following Stroke Rehabilitation: A Longitudinal FMRI Study
Authors:	林柏廷;Lin,Po-Ting
Contributors:	生物醫學工程研究所
Keywords:	中風復健;神經可塑性;功能性磁振造影;靜息態功能性連結;strokerehabilitation;functional connectivity;neuroplasticity;fMRI
Date:	2016-01-27
Issue Date:	2016-03-17 19:44:55 (UTC+8)
Publisher:	國立中央大學
Abstract:	台灣近年來已逐漸步入高齡化的社會，中老年族群的健康問題中，腦中風高居台灣主要死因的第二位，在中老年族群的中風率及復發率逐年攀升，因此提昇中風病患的認知功能與生活品質之復健工作日益重要。過去研究指出，隨著復健過程持續接受刺激會使大腦網路重組，歷經功能與結構上的改變，重新建立起新的聯結以回復特定認知功能，此現象亦稱為神經可塑性。然而現階段復健療效之可塑性評估仍囿限於以行為量表與主觀認知為主，目前仍未能有系統地針對復健療效進行客觀神經生理指標評量，因此本研究嘗試使用功能性磁振造影來探討長期追蹤中風病患腦部可塑性之改變。本研究一共收錄了 15位中風病患以及12個健康受試者作為控制組，其中病患被隨機分配到虛擬實境復健組以及傳統治療組，並於復健前、復健後、以及復健一個月後追蹤這三個時間點進行磁振造影與行為量表之評估。任務導向的功能性磁振造影結果顯現在復健後執行握拳測驗時，感覺運動皮層區從復健前的雙側活化現象變為接近控制組的單側活化；而靜息態功能性磁振造影的結果則顯示在復健前由原本的單側連結在復健後轉變為接近控制組的雙側連結。此外，復健後的預設模式網路與感覺運動皮層區間亦呈現顯著增強的跨網路連結，此結果暗示著預設模式網路也可能在神經可塑性上扮演著重要的角色。在分組比較上，虛擬實境遊戲之復健方式似乎對於靜息態的功能性網路聯結較有助益。;As the Taiwanese population structure converts into an aged society, stroke has become the second place among the highest medical causes of death. Following the stroke onset, continuous physical practice or exercise in the rehabilitation procedure stimulates the brain to re-organize its neural network, re-establishing the new functional connectivity to replace the injured neural assembly, known as the neural plasticity. However, the major assessment of neural plasticity now is based on subjective behavioral scores without objective neurophysiological quantitation. To better evaluate the efficacy of stroke rehabilitation, this study adopted clinical assessments and the functional magnetic imaging (fMRI) approaches to evaluate the brain plasticity alternation of stroke patients. We recruited a total of 12 healthy control and 15 stroke patients, among which 9 patients were assigned to the virtual reality rehabilitation (VRR) group and 6 for the traditional rehabilitation (TR) group. Both groups underwent the rehabilitation methods for a total of 24 hours, respectively, and they were assessed before rehabilitation, after rehabilitation and one-month follow-up after rehabilitation. For the fMRI, we focused on six major areas of the brain network associated with stroke. (1) ipsilesional primary motor cortex (iM1) (2) contralesional primary motor cortex network (cM1N); (3) ipsilesional attention network (iAN); (4) contralesional attention network (cAN); (5) default mode network (DMN); (6) supplementary motor area (SMA) network. Results showed a trend from abnormal bilateral M1 activation turning into unilateral activation after rehabilitation, while the patients grasped their affected hand. Meanwhile, the resting-state fMRI results showed that a unilateral M1 connectivity before rehabilitation turned into a bilateral M1 connectivity after rehabilitation. The DMN showed an enhanced connectivity with M1 after rehabilitation, implying that the DMN might play an important role in neuroplasticity following stroke. At last, the VRR group showed better recovery of resting-state functional connectivity along the stroke rehabilitation process, in contrast to the TR group.
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