本文選題：腦卒中 + 腦機接口��； 參考：《中國人民解放軍醫(yī)學院》2014年碩士論文

【摘要】：目的：1.驗證腦機接口結(jié)合功能性電刺激（BCI-FES）在慢性期腦卒中康復中的可行性；2.研究腦機交互的中樞神經(jīng)康復機制。 方法：將4名符合納入標準的受試者分入BCI-FES訓練組或單純FES訓練組，其中1名受試者在接受完第I階段的BCI-FES訓練后經(jīng)過20周的洗脫期再次接受了第II階段的單純FES訓練。每一階段訓練持續(xù)4周，40分鐘/次，共20次。每階段訓練前、訓練后各進行一次上肢運動功能評價，功能性磁共振成像（fMRI）檢測及彌散張量成像（DTI）檢測，訓練結(jié)束后4周再進行一次隨訪上肢運動功能評價。上肢運動功能評價包括患側(cè)手最快抓握速度、Fugl-Meyer上肢運動功能評價、上肢主要肌群徒手肌力檢查（MMT）、九孔柱測試、BoxBlock測試、Jebson-Taylor測試。fMRI檢測包含“運動”、“想象”及“休息”刺激組塊，對采集到的圖像進行分析，繪制腦激活圖，，計算激活體積及偏側(cè)系數(shù)（LI）。對DTI掃描數(shù)據(jù)進行感興趣區(qū)（ROI）的纖維走行描繪、各向異性分數(shù)（FA）值、FA指數(shù)及表觀彌散系數(shù)（ADC）值計算。 結(jié)果：1.MMT兩組受試者訓練后均無顯著改善，患手最快抓握速度FES組平均值在訓練后略下降，BCI-FES組平均值訓練后升高，其余上肢功能檢測兩組受試者在訓練后平均值均較訓練前提高，且BCI-FES組各項平均提高值均高于FES組；2.BCI-FES組全部上肢運動功能評價項目的平均值在隨訪點也均表現(xiàn)出較訓練前提高，除九孔柱測試外，其他評價項目的平均值均低于訓練后測試值；3.全部受試者在患手真實運動及運動想象時大腦激活模式與正常人不同，表現(xiàn)為同側(cè)初級運動區(qū)（M1）激活的增多，對側(cè)M1激活的減少，以及更多次級運動區(qū)的參與；4.BCI-FES訓練后受試者執(zhí)行患手真實運動和運動想象時較訓練前出現(xiàn)更多腦區(qū)的參與。單純FES訓練后則無明顯的激活腦區(qū)增加；5.比較真實運動，運動想象有更多次級運動區(qū)的參與，而對于初級運動區(qū)的激發(fā)不如真實運動明顯；6.BCI-FES訓練及單純FES訓練均可在一定程度上增加腦激活體積，而BCI-FES訓練的增加程度要明顯高于單純FES訓練；7.經(jīng)過BCI-FES訓練，慢性期腦卒中患者在執(zhí)行癱瘓手任務（真實運動或運動想象）時，平均LI值提高，大腦激活平衡向損傷側(cè)半球轉(zhuǎn)移。而單純FES訓練后大腦激活平衡向損傷對側(cè)半球輕度轉(zhuǎn)移，平均LI值下降；8.全部受試者病灶周圍區(qū)域白質(zhì)纖維數(shù)量低于對側(cè)半球相應區(qū)域，損傷側(cè)半球內(nèi)囊后肢區(qū)域白質(zhì)纖維數(shù)量也低于對側(cè)半球內(nèi)囊后肢；9.BCI-FES訓練后病灶周圍區(qū)域及損傷半球內(nèi)囊后肢區(qū)域白質(zhì)纖維數(shù)量及完整性均較訓練前提高，單純FES訓練則無此效應；10.全部BCI-FES組受試者病灶周圍區(qū)域FA值及FA指數(shù)、病灶側(cè)內(nèi)囊后肢區(qū)域FA值及FA指數(shù)均在訓練后有所提高，F(xiàn)ES組受試者病灶周圍區(qū)域FA值、FA指數(shù)訓練后平均升高，但升高幅度低于BCI-FES組，病損側(cè)內(nèi)囊后肢FA值、FA指數(shù)則均下降；11.BCI-FES組病灶周圍區(qū)域及損傷半球內(nèi)囊后肢區(qū)域ADC值在訓練后平均下降，單純FES組則平均升高。12.訓練前后，患手真實運動時的fMRI-LI的改變與病灶周圍區(qū)域的FA值的改變（P=0.017，r=0.9412）及病灶側(cè)半球內(nèi)囊后肢區(qū)域FA值的改變（P=0.034，r=0.9065）呈顯著線性正相關。 結(jié)論：1.BCI-FES應用于存在腦損傷的腦卒中患者的康復訓練是可行的；2.BCI-FES康復訓練新技術可促進慢性期腦卒中患者上肢運動功能的改善，其改善要優(yōu)于單純FES治療，且這種改善至少可以在訓練結(jié)束后1個月仍有體現(xiàn)；3.BCI-FES技術可促進慢性期腦卒中患者中樞神經(jīng)系統(tǒng)重塑，這種重塑在皮層水平和皮層下水平均有體現(xiàn)，且其可塑性的改善要明顯優(yōu)于單純FES治療。
[Abstract]:Objective : 1 . To verify the feasibility of brain - computer interface combined with functional electrical stimulation ( BCI - fes ) in the rehabilitation of cerebral apoplexy .
2 . To study the central nervous rehabilitation mechanism of brain - machine interaction .

Methods : Four subjects who met the inclusion criteria were divided into the training group of the BCI - fes training group or the simple fes training group . One of the subjects was trained in Phase II only by 20 - week washout period after the training of BCI - fes in Phase I . The functional evaluation of upper limb exercise included the fastest grasping speed of the affected side , the function of Fugl - Meyer upper limb movement , and the Jebson - Taylor test . The functional evaluation of the upper limb included " motion " , " imagination " and " rest " stimulation group . The functional evaluation of the upper limb included " motion " , " imagination " and " rest " stimulation group . The functional evaluation of the upper limb was performed by plotting the active volume and the partial coefficient ( LI ) . The fiber trace drawing , the anisotropy fraction ( FA ) value , FA index and the apparent diffusion coefficient ( ADC ) value of the region of interest ( ROI ) were calculated for DTI scan data .

Results : 1 . There was no significant improvement after the training of 1 . MMT in both groups . The average value of the fastest grasping speed was slightly decreased after the training , and the average value of the group was increased after the training , while the rest of the upper limb function test showed that the average values of the two groups were higher before the training , and the average increase of the average values of the BCI - fes group was higher than that of the group ' s group ;
2 . The average value of all upper limb exercise functional evaluation items of BCI - fes group was higher than that before training before training , except for nine - hole column test , and the average value of other evaluation items was lower than that of post - training test value ;
3 . In all the subjects , the brain activation pattern is different from that of the normal person in the event of the real movement of the hand and the movement of the hand , showing the increase of the activation of the ipsilateral primary motion region ( M1 ) , the reduction of the activation of the contralateral M1 , and the participation of the more stages of the motion region ;
4 . After training , the subjects were involved in more brain areas than before training .
5 . Compared with the real motion , the motion picture has more involvement of the motion region , but the excitation of the primary motion region is not as obvious as the real motion ;
6 . The training of BCI - fes and the training of simple fes can increase the brain activation volume to a certain extent , while the degree of increase of BCI - fes training is much higher than that of simple fes training ;
7 . The average LI value was increased and the cerebral activation balance was transferred to the injured lateral hemisphere during the exercise of the paralyzed hand task ( real motion or exercise imagination ) .
8 . The number of white matter fibers in the area around the lesion was lower than that in the contralateral hemisphere , and the number of white fibers in the posterior limb region of the injured lateral hemisphere was lower than that of the contralateral hemisphere .
9 . The quantity and integrity of white matter in the area around the lesion and in the posterior limb region of the injured hemisphere were higher than before training .
10 . The FA value and FA index of the lesion were increased after the training , FA value and FA index of the lesion were increased after the training , but the FA value and FA index increased after the training , but the increase was lower than that of the BCI - fes group . The FA value and FA index of the lesion were decreased .
12 . Before and after the training , the changes of the F - LI and FA values in the area around the lesion ( P = 0.034 , r = 0.9065 ) were positively correlated with the changes of FA value in the area around the lesion ( P = 0.034 , r = 0.9065 ) .

Conclusion : 1 . BCI - fes can be used in rehabilitation training of stroke patients with brain injury .
2 . The new technique can promote the improvement of the upper limb movement function of stroke patients in the chronic stage , and the improvement is superior to that of the simple fes treatment , and the improvement can be embodied at least 1 month after the end of the training ;
3 . BCI - fes can promote the remodeling of the central nervous system in the patients with chronic stroke . This remodeling is reflected in the cortical level and the subcortical water , and the improvement of plasticity is much better than that of the simple fes treatment .
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R493;R743.3

【參考文獻】

相關期刊論文 前2條

1 鄧小湘;蔣雯;王君;湯啟宇;黃瑞旺;張玉梅;艾林;戴建平;;利用靜息態(tài)功能磁共振成像研究缺血性腦卒中患者康復治療后運動功能網(wǎng)絡連接的變化[J];磁共振成像;2010年01期

2 羅珊;張旭;;血氧水平依賴功能磁共振成像的基本原理及方法學應用[J];國際生物醫(yī)學工程雜志;2007年06期

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