基于运动想象的脑机交互康复训练新技术对脑卒中大脑可塑性影响

目的:验证脑机接口结合功能性电刺激(BCI-FES)在中枢神经康复中的可行性及其机制.方法:对1例40岁男性脑卒中后左侧上肢重度瘫痪患者进行4周的基于运动想象的BCI-FES训练,训练前后各进行一次系统上肢功能评价及包含“运动”及“想象”组块的fMRI检测,进行功能激活图的绘制.结果:经过为期1个月的训练后左手最快抓握速度提高24.7％,左手抓握运动时功能性磁共振成像(fMRI)激活表现为出现病灶同侧主要运动区(M1)及辅助运动区(SMA)的激活,病灶对侧M1区及运动前区(PMC)激活较训练前减弱.左手运动想象任务时出现了双侧SMA及病灶同侧右后顶叶的激活.结论:脑机交互技术可促进脑卒中患者的中枢神经重塑.BCI-FES应用于存在脑损伤的脑卒中患者的康复训练是可行的.

A new technique of rehabilitation training based on motor imagine using brain computer interface-functional electric stimulation system and it's effect on plasticity of brain of a stroke patient

Abstract Objective: To study the feasibility of brain computer interface combined with functional electric stimulation (BCI-FES) applied to a patient with stroke as a new rehabilitation training system and to explore its mechanism. Method: The participant was a 40 years old man with severe left-hand paralysis after stroke. He received 4 weeks training with BCI-FES system based on motor imagine. The motor function of upper limb was assessed and fMRI examination was conducted pre- and after training. Result: Maximum grasp-relax speed of affected hand increased by 24.7% after training. When motion task was executed the activations in primary motor area(M1) and supplement motor area(SMA) of ipsilateral hemisphere were observed with fMRI after training, and contralateral activations in M1 and premotor cortex(PMC) decreased in addition. When motor imagine task was executed, the activations transferred to bilateral SMA and ipsilateral posterior parietal after BCI training. Conclusion: BCI-FES was a kind of feasible rehabilitation therapy for stroke survivor. The mechanism of functional recovery by using BCI-FES was to promote the plasticity of central nervous system.