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2021年5月25日 ;96 (21) 文章 开放获取

Neurofeedback便利化对卒中后的影响步态和平衡的复苏

随机对照试验

Masahito历经甲级,藤本总裁中西宏明,服部平,Hironori Otomune,29岁Kajiyama,Kuni Konaka,Yoshiyuki渡边,祐一一品”,山Sunada,一郎Miyai,秀树Mochizuki
第一次出版2021年4月20日, DOI: https://doi.org/10.1212/WNL.0000000000011989
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  • Study Protocol and Setting of the Functional Near Infrared Spectroscopy (fNIRS) Neurofeedback Session (A)Schematic illustration of the protocol for this study. Patients were randomly allocated to 2 groups, real feedback and sham feedback, and were subjected to 6 sessions of neurofeedback training combined with motor imagery. In the real group, the patients were provided with actual cortical activation during the motor imagery task, so they could learn how to regulate their cortical activation. In contrast, patients in the sham group were provided irrelevant information (other patients' recorded data) and therefore could not learn how to regulate their cortical activation. In the neurofeedback training sessions, patients were asked to practice the first-person motor imagery of the gait and balance task using videos. After practicing, the participants were requested to perform the motor imagery task without the video but with visual feedback of the vertical bar as a measure of appropriate supplementary motor area (SMA) activation. Neurofeedback practice was provided 3 times per week for 2 weeks, and clinical measures were evaluated before intervention (pre), just after intervention (post1), and 2 weeks postintervention (post2). (B) During neurofeedback sessions, participants' cortical activation was measured using fNIRS. fNIRS signals from the channels covering the fronto-parietal scalp and suspected to cover the SMA (channels 21, 22, 28, and 29) were used for real-time processing and calculation of the feedback signal. (C) Illustration depicts the experiment setup wherein a participant is sitting on a chair and performing a gait and balance–related motor imagery task. rsfMRI = resting-state functional MRI.
    " data-icon-position="" data-hide-link-title="0">图2
    图2 研究方案和设置的功能性近红外光谱(fNIRS) Neurofeedback会话

    (一)示意图说明为本研究的协议。患者被随机分配到两组,真实的反馈和虚假的反馈,受到6会话neurofeedback训练结合运动图像。在现实,实际提供的患者大脑皮层激活在运动图像的任务,这样他们就可以学习如何控制自己的大脑皮层激活。相比之下,虚假的组中的患者提供无关信息(其他病人的记录数据),因此无法学习如何控制自己的大脑皮层激活。neurofeedback训练,病人被要求练习第一人称运动步态和平衡任务的图像使用视频。练习后,参与者被要求执行运动图像视觉反馈的任务没有视频但是竖线作为衡量适当的辅助运动区(SMA)激活。Neurofeedback实践提供了每周3次2周,和临床前评估干预措施(前),干预(post1)后,2周postintervention (post2)。(B) neurofeedback会话期间,参与者的大脑皮层激活用fNIRS测量。fNIRS信号从渠道覆盖顶头皮和可疑的SMA(频道21日,22日,28日和29日)被用于反馈信号的实时处理和计算。(C)插图描绘了实验设置其中一个参与者正坐在椅子上,执行一个步态和balance-related汽车图像的任务。 rsfMRI = resting-state functional MRI.

  • Lesion Overlap and Longitudinal Changes in Gait-Related Clinical Measures in Both Groups (A) Overlapped lesion maps reveal corticospinal tract involvement at the level of the corona radiata, internal capsule, and brainstem. (B, C) Three-meter Timed Up and Go (TUG) test time was significantly improved in the real feedback group but not in the sham feedback group, with significant interaction between time course and intervention. (D, E) Berg Balance Scale (BBS) score improved only in the real feedback group with significant interaction between time course and intervention.
    " data-icon-position="" data-hide-link-title="0">图3
    图3 病变重叠和纵向变化Gait-Related两组临床措施

    (A)重叠病变地图揭示皮质脊髓束的参与水平的放射冠,内囊和脑干。(B, C) 3米的,(拉)测试时间显著提高在真实反馈组而不是虚假的反馈组,有显著的时间进程和干预之间的相互作用。(D, E) Berg资产规模(BBS)得分只有在真正的反馈组显著改善时间进程之间的交互和干预。

  • Changes in Gait Imagery–Related Cortical Activation and Resting-State Connectivity From the Supplementary Motor Area (SMA) After Neurofeedback (A) There was a significant group difference in cortical activation changes after neurofeedback intervention. Functional near infrared spectroscopy neurofeedback intervention facilitated gait imagery–related SMA activation. (B) Clinical improvement of balance ability correlated significantly with the individual gait-related cortical activation changes, suggesting an effect of SMA facilitation on balance ability. (C) Resting-state fMRI analysis revealed that SMA facilitation by neurofeedback enhances functional connectivity between the SMA and several motor-related cortical areas, including the affected anterior cingulate gyrus and the unaffected inferior frontal gyrus (IFG). (D) Resting-state functional connectivity changes between the SMA and the unaffected IFG significantly correlated with individual balance improvement. BA = Brodmann area; BBS = Berg Balance Scale; Ch = channels in functional near infrared spectroscopy recording; FDR = false discovery rate; MNI = Montreal Neurologic Institute.
    " data-icon-position="" data-hide-link-title="0">图4
    图4 步态的变化传递从补充运动区皮质激活和静止状态连接Neurofeedback后(SMA)

    (一)有显著组不同皮质激活neurofeedback干预后的变化。功能近红外光谱neurofeedback干预促进步态传递SMA激活。(B)的临床改善平衡能力与个人gait-related皮质激活变化显著相关,表明SMA便利化对平衡能力的影响。(C)静息状态功能磁共振成像分析表明,SMA便利化neurofeedback增强功能连通性之间的SMA和几个motor-related皮质区域,包括影响前扣带回和额下回(IFG)的影响。(D)之间的静息状态的功能连通性变化显著相关,SMA和影响空腹血糖异常与单个资产的改进。英航= Brodmann区域;BBS = Berg资产规模;Ch =渠道功能近红外光谱记录;罗斯福=错误发现率;MNI =蒙特利尔神经学研究所。

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