运动想象治疗脑卒中患者手部运动功能的功能磁共振研究

目的：探讨运动想象（MI）治疗对脑卒中后脑功能重塑的影响。方法：将16例脑卒中患者随机分为运动想象组（MI）6例、执行运动（EM）组5例、对照组（CG）5例。3组在常规康复治疗基础上,MI组、EM组分别进行运动想象、实际动作治疗,每次30min,每周5次,为期4周。治疗前、后进行运动功能评价,并使用功能磁共振（fMRI）观察患手对指实际动作、想象时偏瘫对侧感觉运动区的激活情况,定量分析治疗前后cSMC区的激活强度t、LI变化。结果：治疗4周后,MI组及EM组FMA、STEF评分较前均有明显提高（均P＜0.05）,且MI组上述评分均更高于其它2组（均P＜0.05）。治疗后,3组MBI评分均有提高,但组内及组间差异无统计学意义。运动想象与运动执行的激活部位相似：治疗前运动想象激活区主要位于双侧SMC区、双侧SMA区,治疗后,各组双侧SMC区激活强度有增大趋势,MI组对侧SMC区激活显著（P＜0.05）,且对侧偏侧化优势较CG组显著（P＜0.05）。结论：运动想象治疗能够明显改善脑卒中后患者手功能,其机制可能与运动想象促进脑功能重塑有关。     

脑缺血性卒中患者运动功能康复的功能性磁共振成像研究

目的利用功能性磁共振成像（fMRI）技术研究急性期缺血性脑卒中患者（以下简称急性期患者）运动相关皮质的激活情况，并探讨脑卒中后脑功能重组特点及其与肢体运动功能恢复的关系。方法采用GEI．5T双梯度16通道磁共振成像系统，对9例急性期患者和9例健康志愿者行Bold—fMRI检查。fMRI检查以被动对指运动（以下简称运动）为刺激任务，所有数据采用SPM2软件包进行离线后处理。比较健康志愿者与急性期患者fMRI结果的异同点，计算脑激活区体积和单侧化指数（LI），考察急性期患者患手运动LI值与患手运动功能的关系。结果健康志愿者单手运动激活对侧感觉运动皮质（SMC）、双侧辅助运动区（SMA）。急性期患者患手运动时同侧半球脑激话增多，健手运动的fMRI结果与健康志愿者基本一致。LI值也进一步确定，急性期患者患手运动时同侧半球脑激活增多。统计学分析表明，急性期患者患手运动的LI值与患手运动功能呈正相关。结论fMRI检查能客观地反映急性期患者运动相关皮质改变，提示存在脑功能代偿与重组。急性期患者患手运动LI值与患手运动功能呈正相关，提示fMRI是研究缺血性脑卒中后肢体运动功能康复与脑功能重组之间关系的一种有效工具。     

功能性核磁共振成像在计算机辅助的上肢功能训练治疗脑梗死上肢偏瘫中的应用研究

目的:探讨计算机辅助训练上肢对脑可塑性的可能作用。方法:脑卒中上肢偏瘫患者10例,均进行计算机辅助训练,治疗前后采用偏瘫上肢功能测试-香港版(FTHUE-HK),Fulg-Meyer上肢评定(FMA)及改良Barthel指数量表(MBI)评定上肢运动功能,及患者屈伸腕关节时进行功能核磁共振扫描(fMRI)。结果:治疗6周后,10例患侧的上肢功能评定FTHUE-HK、FMA及MBI评分均较治疗前后患侧上肢功能评定变化明显提高(P0.05)。fMRI扫描示:患者健侧手运动脑功能激活区主要位于对侧初级运动皮质区(SMC)及同侧小脑,患者健手在康复训练后脑激活区增多,包括对侧SMC区及同侧小脑、部分边缘系统;患者治疗前患侧手运动激活区分布广泛,而对侧SMC激活减少,同侧SMC激活增多,另主要还见辅助运动区激活增多;治疗后可见双侧SMC及辅助运动区激活,对侧SMC激活较治疗前增多,另主要还见对侧顶上小叶激活增多。结论:计算机训练可以有效改善脑卒中患者上肢运动功能,诱发大脑皮质功能重塑是其机制的重要组成部分。     

Bold-fMRI联合DTT技术在缺血性脑卒中患者上肢功能恢复磁共振研究中的应用

目的联合Bold-fMRI及DTT技术研究皮质脊髓束（CST）在不同损伤情况下脑皮质功能重组模式及其与偏瘫上肢运动功能恢复的关联性。 方法共选取15例初次发病的急性脑梗死伴单侧严重上肢瘫患者作为研究对象。于发病1周内对患者执行偏瘫侧手指被动伸展任务(FE）下fMRI及DTT联合成像,通过Dtv.Ⅱ.R2软件计算患侧及健侧CST条目数。并于发病后1个月及3个月时行偏瘫侧手指被动FE任务下fMRI成像,通过SPM8软件观察不同时程患者脑功能区激活情况。采用简化Fugl-Meyer评分(FMA)上肢部分对入选患者患侧上肢运动功能进行跟踪评定。 结果根据重建的患侧CST条目数与健侧CST条目数的比值分为3型,Ⅰ型患者患侧纤维束根数大于健侧2/3,Ⅱ型患者患侧纤维束根数大于健侧1/3但小于2/3,Ⅲ型患者患侧纤维束根数小于健侧1/3。I型患者Bold-fMRI初期显示双侧初级感觉运动区（SMC）及患侧为主辅助运动区（SMA）激活,1个月及3个月时健侧SMC区激活逐渐减弱,患侧SMC区激活强度逐渐增强。II型患者Bold-fMRI初期表现为患侧SMC区及SMA区激活,1个月时表现为以健侧为主双侧SMC区及SMA区明显激活,3个月时患者SMC区激活增强,患侧激活减弱。Ⅲ型患者Bold-fMRI初期表现为SMA区及后顶叶皮质区(PPC)轻度激活,1个月时健侧SM1区有轻度激活,3个月时双侧SMC区及SMA区均无激活。发病1周内Ⅰ型、Ⅱ型及Ⅲ型患者上肢FM评分分别为（5.6±4.3）分、（4.8±5.0）分及（6.5±4.5）分,组间差异均无统计学意义（P>0.05）;发病1个月时Ⅰ型、Ⅱ型及Ⅲ型患者上肢FM评分分别为（48.5±5.6）分、（36.5±6.8）分及（12.3±3.4）分,组间差异均具有统计学意义（P<0.05）;发病3个月时Ⅰ型与Ⅱ型患者上肢FM评分分别为（62.8±3.2）分、（60.2±5.2）分,组间差异均无统计学意义（P>0.05）,但均显著高于Ⅲ型患者上肢FM评分［（10.2±6.0）分］（P<0.05）。 结论不同CST损伤情况下脑皮质功能重组模式各异,颅内功能重组是一个动态过程,不同脑区激活模式与患者临床预后密切相关。     

脑卒中患者强制性使用运动治疗的fMRI研究

目的研究脑卒中偏瘫患者进行强制性使用运动疗法（CIMT）治疗前后fMRI的脑功能区激活变化。方法对5例后遗症期脑卒中患者进行上肢动作研究量表评价;fMRI试验采用组块设计,使用3.0T磁共振仪进行fMRI数据采集,在CIMT治疗前后对患者进行fMRI扫描。结果CIMT治疗后,患者患侧上肢运动功能显著改善（P〈0.001）,fMRI检查显示患侧运动区手部支配区域激活范围明显局限化,激活强度增加,临近激活区域明显减少,对侧代偿激活区域范围缩小。结论CIMT可以有效改善脑卒中患者上肢运动功能,诱发大脑皮质功能重塑是其机制的重要组成部分。     

卒中早期手指被动运动的脑功能磁共振成像研究

目的应用扩散张量成像及BOLD-fMRI技术观察卒中早期手指被动运动时大脑半球相关区域血氧水平的变化情况.方法采用1.5 T MR成像系统对6名早期卒中患者进行BOLD-fMRI及扩散张量成像,采用手指被动屈伸运动作为fMRI的刺激任务.结果在锥体束中断时,卒中早期健手运动时激活双侧SMC区,患手运动可激活对侧半球后顶叶皮层及同侧SMC区;锥体束较完整时健手运动时激活对侧SMC区,患手运动激活双侧SMC区、双侧后顶叶皮层.结论卒中早期可能发生运动功能通路的重构,但锥体束不同损伤情况下运动功能恢复可能存在不同的机制.DTI与fMRI联合应用将是监测和研究脑卒中后恢复的有用工具.     

缺血性脑卒中患者患手主动运动及被动运动时的功能性磁共振研究

目的观察缺血性脑卒中患者患手执行主动及被动运动时的脑激活模式,探讨主动运动和被动运动治疗脑卒中后手功能障碍的中枢机制。 方法对5例左侧大脑皮质下脑卒中患者患手执行主动及被动抓握-释放动作,执行动作期间采用血氧水平依赖性功能性磁共振（BOLD-fMRI）进行脑扫描,利用SPM5软件对上述患者试验数据进行分析,使用XJVIEW toolbox 8.11版软件得出入选患者在上述两种运动状态下的脑激活区分布图,并对其在不同运动状态下的脑激活模式特点进行分析比较。 结果入选患者患手在执行主动运动时其脑激活部位主要位于对侧感觉运动区(SMC)、运动前区(PMC)、双侧小脑及双侧辅助运动区(SMA),另外同侧SMC及PMC区也有轻度激活;激活脑区主要位于对侧大脑及小脑半球。患手执行被动运动时的脑激活部位主要位于双侧SMC、PMC区、双侧小脑、SMA区;激活脑区平均分布于两侧大脑及小脑半球。与患手主动运动比较,患手被动运动时的脑区激活范围较广泛,激活强度也较高。 结论患手执行主动运动和被动运动均可激活脑卒中患者运动相关脑区,提示对脑卒中患者进行主动运动及被动运动均可促进其脑功能重组。     

运动想象联合常规康复训练促进脑卒中患者功能恢复的静息态功能性磁共振研究

目的 利用静息态功能性磁共振成像（fMRI）研究脑卒中患者运动想象训练（MIT）联合常规康复训练后上肢功能恢复潜在的脑重塑机制。 方法 选择10例脑卒中偏瘫患者，进行MIT，每周5次，每次约30 min，共4周，同时进行常规康复训练，每周5次，每次约40 min，共4周。另选取10例年龄和性别与MIT组相匹配的健康受试者作为健康对照组。干预前和干预4周后，应用Fugl-Meyer运动功能量表上肢部分（FMA-UE）和改良Barthel指数（MBI）评估受试者的上肢运动功能和日常活动能力。干预前、后分别对患者进行fMRI检查，统计患侧初级运动区（M1）与全脑各脑区间的功能连接，计算M1和初级感觉区（S1）的偏侧化指数（LI）。 结果 干预后，MIT组FMA-UE评分从［（23.3±14.9）分］升高到［（33.6±13.6）分］，MBI从［（58.0±15.5）分］升高到［（72.5±16.2）分］，差异均有统计学意义（P<0.01）。MIT组患者患侧M1与健侧MI、健侧S1、健侧额叶的功能连接增强，患侧M1与患侧旁中央小叶、患侧前扣带回的功能连接也增强。MIT组干预前脑卒中患者的LI在M1、S1两区均较健康对照组明显增加（干预前LIM1为0.43，LIS1为0.37，健康对照组接近于0），干预后LIM1和LIS1均有所降低，并趋向于健康人数值（干预后LIM1为0.22，干预后LIS1为0.34），LIM1显著下降（P<0.05），LIS1未显著下降（P>0.05）。 结论 MIT联合常规康复训练可改善脑卒中患者的上肢运动功能和日常活动能力，经过4周干预后患者患侧M1和健侧M1的功能连接被显著修复，和双侧多个非初级运动脑区的功能连接也增加，逐步恢复了双侧初级运动区功能连接的对称性，这些可能是运动想象联合常规康复训练改善脑卒中患者运动功能的脑重塑机制。     

健康成年人手部主动及被动运动时大脑功能区

利用血氧水平依赖性功能性磁共振成像技术探讨健康成年人手部主动、被动对掌运动时的脑激活区的特点,为运动疗法治疗脑卒中提供理论依据。9名健康成年人参加实验。以右手主动及被动对掌运动作为刺激模式,采用区块设计,利用SPM5软件进行数据处理。测量位于对侧感觉运动区及运动前区的脑激活区的中点,并统计各脑区出现激活的频数。 结果主动及被动手对掌运动时主要激活的脑区包括：对侧感觉运动皮质（SMC）区、对侧运动前皮质（PMC）区、双侧辅助运动区（SMA）及同侧小脑,其中对侧SMC区的激活频率最高;被动运动时所激活的对侧SMC和PMC区的几何中心较主动运动时偏后。主动和被动对掌运动均可引起运动相关脑区激活,两种运动模式所激活脑区在分布上无明显差别,但被动运动所激活的对侧SMC和PMC区几何中心较主动运动偏后。     

脑梗死康复治疗前、后手运动功能BOLD-fMRI定量分析

目的利用血氧水平依赖性功能磁共振成像（BOLD-fMRI）技术研究急性期脑梗死患者短期康复治疗前、后的手运动中枢激活体积的变化，比较常规治疗者和康复治疗者中枢激活体积的变化规律，探讨脑梗死患者急性期手运动功能康复的机制。 方法选择脑梗死急性期患者16例作为患者组，随机分为康复治疗组8例，常规治疗组8例，分别于入院当日及治疗第14天进行fMRI检查，并采用Fugl-Meyer运动功能评分法（FMA）评定其手运动功能，记录并比较常规治疗组和康复治疗组治疗前、后的中枢激活体积；另选10名健康志愿者行单次fMRI检查，测定相同运动任务刺激后的脑功能区位置和激活体积，并与患者组进行比较。 结果16例脑梗死患者经治疗后，对侧感觉运动皮质（SMC）激活体积及FMA评分均大于治疗前（P<0.05）；康复治疗组治疗前、后患手运动激活对侧SMC的体积以及FMA评分的变化均较常规治疗组明显（P<0.05）。 结论脑梗死急性期采取临床短期康复治疗可引起患侧SMC区的相应变化，促进患肢功能的恢复。     

Two different reorganization patterns after rehabilitative therapy: an exploratory study with fMRI and TMS

We used two complementary methods to investigate cortical reorganization in chronic stroke patients during treatment with a defined motor rehabilitation program. BOLD ("blood oxygenation level dependent") sensitive functional magnetic resonance imaging (fMRI) and intracortical inhibition (ICI) and facilitation (ICF) measured with transcranial magnetic stimulation (TMS) via paired pulse stimulation were used to investigate cortical reorganization before and after "constraint-induced movement therapy" (CI). The motor hand function improved in all subjects after CI. BOLD signal intensity changes within affected primary sensorimotor cortex (SMC) before and after CI showed a close correlation with ICI (r = 0.93) and ICF (r = 0.76) difference before and after therapy. Difference in number of voxels and ICI difference before and after CI also showed a close correlation (r = 0.92) in the affected SMC over the time period of training. A single subject analysis revealed that patients with intact hand area of M1 ("the hand knob") and its descending motor fibers (these patients revealed normal motor evoked potentials [MEP] from the affected hand) showed decreasing ipsilesional SMC activation which was paralleled by an increase in intracortical excitability. This pattern putatively reflects increasing synaptic efficiency. When M1 or its descending pyramidal tract was lesioned (MEP from the affected hand was pathologic) ipsilesional SMC activation increased, accompanied by decreased intracortical excitability. We suggest that an increase in synaptic efficiency is not possible here, which leads to reorganization with extension, shift and recruitment of additional cortical areas of the sensorimotor network. The inverse dynamic process between both complementary methods (activation in fMRI and intracortical excitability determined by TMS) over the time period of CI illustrates the value of combining methods for understanding brain reorganization.     

Cortical reorganization following modified constraint-induced movement therapy: a study of 4 patients with chronic stroke

OBJECTIVE: To determine whether cortical changes occur following participation in a program of modified constraint-induced movement therapy (mCIMT). DESIGN: Pre-post, case series. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Two men and 2 women with unilateral stroke occurring more than 1 year prior to study entry and moderate stable motor deficits. INTERVENTION: Subjects participated in mCIMT, comprised of structured, 30-minute therapy sessions emphasizing affected arm use in valued activities, which occurred 3 days a week for 10 weeks. Their unaffected arms were restrained 5 days a week for 5 hours. MAIN OUTCOME MEASURES: The Action Research Arm Test (ARAT), upper-extremity portion of the Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and functional magnetic resonance imaging (fMRI) at 4T were administered before and after mCIMT. RESULTS: Three subjects exhibited score increases on the MAL, ARAT, and FMA, representing increased affected arm use, impairment, and function. These subjects reported new ability to perform valued activities with the affected hand, such as writing. These subjects also displayed cortical reorganization on fMRI. One subject exhibited minimal affected arm use changes, modest function changes, and no cortical fMRI changes. CONCLUSIONS: Increased affected arm use during mCIMT appears to induce cortical reorganization, as measured by fMRI. In patients who responded to mCIMT, cortical reorganization was positively related to degree of increase in affected arm use and ability. Because mCIMT is more easily administered than longer duration protocols, mCIMT may be a more practicable way of studying plasticity.     

计算机辅助上肢训练对脑卒中患者与正常人脑可塑性影响的功能磁共振成像对比研究

摘要 目的：探讨计算机辅助训练上肢对脑卒中患者与正常人脑可塑性的可能作用。 方法：对5名正常志愿者（对照组）及5例脑卒中上肢偏瘫患者（实验组）进行6周的计算机辅助训练,每周训练5次,在训练前、训练后分别在受试者屈伸左右腕关节时进行功能磁共振成像（fMRI）扫描,并对实验组进行Fulg-Meyer上肢功能评定（FMA）,改良Barthel指数（MBI）量表评定。 结果：实验组与对照组相比,治疗前,运动左侧腕关节时,激活脑区主要在左额中央前回（同侧的感觉运动皮质区）;治疗后,运动左侧腕关节时,实验组与对照组相比,激活脑区在同侧感觉运动皮质区,但激活强度及体素均较治疗前有明显的降低。治疗前,运动右腕关节时,两者的激活脑区的部位相似,均在对侧的SMC区及同侧的小脑,但激活强度和体素较对照组小;治疗后,运动右腕关节时,两组之间无显著差异。 结论：计算机辅助训练可诱导出大脑皮质功能区的重组与代偿,使其趋向正常化。     

Correlated change in upper limb function and motor cortex activation after verum and sham acupuncture in patients with chronic stroke

BACKGROUND: Acupuncture may improve motor function in patients with chronic hemiparetic stroke, yet the neural mechanisms underlying such an effect are unknown. As part of a sham-controlled, randomized clinical trial testing the efficacy of a 10-week acupuncture protocol in patients with chronic hemiparetic stroke, we examined the relationship between changes in function of the affected upper limb and brain activation using functional magnetic resonance imaging (fMRI). METHODS: Seven (7) chronic hemiparetic stroke patients underwent fMRI and testing of function of the affected upper limb (spasticity and range-of-motion) before and after a 10-week period of verum (N=4) or sham (N=3) acupuncture. The correlation between changes in function of the affected upper limb and brain activation after treatment was tested across patients. RESULTS: We found a significant positive correlation between changes in function of the affected upper limb (spasticity and range of motion) and activation in a region of the ipsilesional motor cortex. Patients treated with verum acupuncture showed a trend toward a greater maximum activation change in this motor cortical area as compared to those treated with sham acupuncture. CONCLUSIONS: Acupuncture may improve function of the affected upper limb in chronic hemiparetic stroke patients by increasing activity in the ipsilesional motor cortex.     

Lesion location alters brain activation in chronically impaired stroke survivors

Recovery of motor function after stroke is associated with reorganization in central motor networks. Functional imaging has demonstrated recovery-dependent alterations in brain activation patterns when compared to healthy controls. These alterations are variable across stroke subjects. Factors identified as contributing to this variability are the degree of functional impairment, the time interval since stroke, and rehabilitative therapies. Here, the hypothesis is tested that lesion location influences the activation patterns. Using functional magnetic resonance imaging, the objective was to characterize similarities or differences in movement-related activation patterns in patients chronically disabled by cortical plus subcortical or subcortical lesions only. Brain activation was mapped during paretic and non-paretic movement in 11 patients with subcortical stroke, in nine patients with stroke involving sensorimotor cortex, and in eight healthy volunteers. Patient groups had similar average motor deficit as measured by a battery of scores and strength measures. Substantial differences between patients groups were found in activation patterns associated with paretic limb movement: whereas contralateral motor cortex, ipsilateral cerebellum (relative to moving limb), bilateral mesial (cingulate, SMA), and perisylvian regions were active in subcortical stroke, cortical patients recruited only ipsilateral postcentral mesial hemisphere regions, and areas at the rim of the stroke cavity. For both groups, activation in ipsilateral postcentral cortex correlated with motor function; in subcortical stroke, the same was found for mesial and perisylvian regions. Overall, brain activation in cortical stroke was less, while in subcortical patients, more than in healthy controls. For non-paretic movement, activation patterns were similar to control in cortical patients. In subcortical patients, however, activation patterns differed: the activation of non-paretic movement was similar to that of paretic movement (corrected for side). The data demonstrate more differences than similarities in the central control of paretic and non-paretic limb movement in patients chronically disabled by subcortical versus cortical stroke. Whereas standard motor circuitry is utilized in subcortical stroke, alternative networks are recruited after cortical stroke. This finding proposes lesion-specific mechanisms of reorganization. Optimal activation of these distinct networks may require different rehabilitative strategies.     

Motor imagery training improves upper extremity performance in stroke patients

[Purpose] The purpose of this study was to investigate whether motor imagery training has a positive influence on upper extremity performance in stroke patients. [Subjects and Methods] Twenty-four patients were randomly assigned to one of the following two groups: motor imagery (n = 12) or control (n = 12). Over the course of 4 weeks, the motor imagery group participated in 30 minutes of motor imagery training on each of the 18 tasks (9 hours total) related to their daily living activities. After the 4-week intervention period, the Fugl-Meyer Assessment-Upper Extremity outcomes and Wolf Motor Function Test outcomes were compared. [Results] The post-test score of the motor imagery group on the Fugl-Meyer Assessment-Upper Extremity outcomes was significantly higher than that of the control group. In particular, the shoulder and wrist sub-items demonstrated improvement in the motor imagery group. [Conclusion] Motor imagery training has a positive influence on upper extremity performance by improving functional mobility during stroke rehabilitation. These results suggest that motor imagery training is feasible and beneficial for improving upper extremity function in stroke patients.Key words: Stroke, Motor imagery training, Upper extremity performance     

Cortical reorganization of hand motor function to primary sensory cortex in hemiparetic patients with a primary motor cortex infarct

OBJECTIVE: To show cortical reorganization in hemiparetic patients with a primary motor cortex (M1) infarct including the precentral knob by using functional magnetic resonance imaging (fMRI). DESIGN: Case-control. SETTING: Outpatient clinics in the rehabilitation department of a university hospital. PARTICIPANTS: Two stroke patients and 20 control subjects. INTERVENTIONS: By using fMRI, we evaluated the hand motor function of 2 hemiparetic stroke patients, who had made some recovery from complete paralysis of the affected hand, and 20 control subjects. MAIN OUTCOME MEASURES: fMRI was performed by using the blood oxygen level-dependent technique at 1.5 T with a standard head coil. The motor task paradigm consisted of hand grasp-release movements. RESULTS: The contralateral primary sensorimotor cortex was activated by the hand movements of the control subjects and of the unaffected side of the 2 patients. Only the contralateral (infarct side) primary sensory cortex (S1) was activated by the movements of the affected hand of the 2 patients, a result that was not observed in the control subjects or with the unaffected hand in the stroke patients. CONCLUSIONS: The hand motor function associated with the infarcted M1 in our patients was reorganized into the S1. These results suggest cortical reorganization in patients with an M1 infarct.     

A longitudinal fMRI study: in recovering and then in clinically stable sub-cortical stroke patients

The aim of this 1-year longitudinal fMRI study was to compare hand motor activation patterns between cerebrovascular paretic patients with a subcortical infarction and healthy elderly subjects and to evaluate the changes between the subacute phase and the chronic phase of recovery. We studied eight right-handed patients with pure motor hemiparesis due to a single ischemic infarct of the corticospinal tract. Each patient underwent a first fMRI (E1) 20 +/- 9 days after stroke, a second (E2) after 4 months and a third (E3) 12 months after stroke. During each fMRI session, the patients performed an active motor task consisting of audio-paced (1 Hz) finger flexion-extension of the paretic hand and underwent a passive motor task consisting of flexion-extension of the paretic hand performed by an examiner. Data were analyzed with SPM99 (random effect analyses). Patients had recovered at E2, were stable between E2 and E3, but still experienced a hand weakness. Displacement of activation maxima coordinates in patients compared to healthy subjects suggested an early reorganization within the SMA and a secondary reorganization within the ipsilesional S1M1 at E2. The main differences between patients and healthy subjects were (1) recruitment of the posterior part of the cingulate cortex and SMA, (2) a general hyperactivation (except in the deefferented primary motor cortex) and (3) an evolution in the S1M1 activation from an early (20 days after stroke) contralesional hyperactivation to a later (4 months after stroke) ipsilesional hyperactivation concomitant to recovery. Changes in activation were confirmed by the passive task that involved no effort and little attention. Despite clinical stability, changes in brain processing seemed to occur between E2 and E3 corresponding to a normalization of ipsilesional S1M1 activation, a decrease of bilateral cerebellar activation, and a progressive increase in SII-BA 40 activity suggesting evolving compensatory networks to sustain recovery.     

基于动作分析的强化性分离运动对脑卒中患者上肢功能及日常生活活动能力的影响

目的：探讨动作分析及在此基础上的强化性分离运动对脑卒中患者上肢功能及日常生活活动能力的影响。方法：62例脑卒中偏瘫患者随机分为对照组和观察组,对照组接受常规的物理治疗和作业治疗;观察组患者在常规治疗的基础上,对每个作业活动进行动作分析,并在此基础上进行强化性分离运动训练。治疗前及治疗2个月后分别用简化Fugl-Meyer运动量表和Brunnstrom分期评定上肢功能,以及用改良的Barthel指数评定日常生活活动能力。结果：对照组和观察组治疗后上肢功能和日常生活活动能力均有改善（P〈0.05）,且观察组的均优于对照组,差异有显著性意义（P〈0.05）。结论：基于动作分析的强化性分离性运动对脑卒中偏瘫患者的上肢功能和ADL功能具有促进作用,对提高脑卒中的康复疗效具有重要意义。