Efficacy and Neural Mechanisms of Robotic-Assisted Therapy in Upper Extremity Rehabilitation for Stroke Survivors: A Resting-State fMRI Study.

IF 5.2 2区 医学 Q2 ENGINEERING, BIOMEDICAL
Yingnan Lin, Hewei Wang, Li Ding, Qingming Qu, Jianghong Fu, Yifang Lin, Jie Gu, Wenyu Wang, Xueli Shan, Sujing Xu, Jie Jia, Yanyan Huang
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Abstract

Robotic-assisted therapy (RAT) represents a promising adjunctive rehabilitation technology, however, its underlying neuroplastic mechanisms remain incompletely characterized. We aimed to elucidate the neuroplastic reorganization induced by RAT that mediates motor functional improvements in stroke survivors. Thirteen stroke survivors in the RAT group and 13 demographically/clinically matched in the conventional rehabilitation therapy (CRT) group underwent a 4-week rehabilitation intervention. Motor function was assessed using the Fugl-Meyer Assessment upper and lower extremity subscale (FMA-UE, FMA-LE) and modified Barthel Index (MBI) at pre- and post-intervention timepoints. Concurrently, resting-state functional MRI (rs-fMRI) data were acquired for amplitude of low-frequency fluctuation (ALFF) computation and seed-based functional connectivity (FC) analysis. Repeated measures ANOVA showed significant Group × Time interactions for both FMA-UE and FMA-LE (F(1,24) = 4.913, p<0.05; F(1,24) = 4.778, p< 0.05). All motor outcomes displayed strong main effects of Time (all p < 0.001). Post hoc simple effects tests revealed significant within group gains in FMA UE for both RAT and CRT and in FMA LE for RAT only, with no between group differences at any single time point. Neuroimaging showed that increases in ALFF within the ipsilesional precentral gyrus correlated with improvements in both FMA-UE and FMA-LE. Compared with CRT, RAT strengthened interhemispheric functional connectivity between the precentral and postcentral gyri and between the precentral and supramarginal gyri. Together, these findings indicate that RAT promotes motor recovery by up regulating activity in the ipsilesional motor cortex and enhancing cross hemispheric sensorimotor integration, providing the direct evidence for mechanism of post stroke neural restitution.

机器人辅助治疗在中风幸存者上肢康复中的疗效和神经机制:一项静息状态fMRI研究。
机器人辅助治疗(RAT)是一种很有前途的辅助康复技术,然而,其潜在的神经可塑性机制尚未完全确定。我们的目的是阐明大鼠诱导的神经可塑性重组介导中风幸存者的运动功能改善。RAT组的13名中风幸存者和传统康复治疗组的13名人口统计学/临床匹配的中风幸存者接受了为期4周的康复干预。采用Fugl-Meyer上肢和下肢量表(FMA-UE, FMA-LE)和改良Barthel指数(MBI)在干预前后时间点对运动功能进行评估。同时,获取静息状态功能MRI (rs-fMRI)数据进行低频波动幅度(ALFF)计算和基于种子的功能连通性(FC)分析。重复测量方差分析显示,FMA-UE和FMA-LE组×时间交互作用显著(F(1,24) = 4.913, p<0.05;F(1,24) = 4.778, p< 0.05)。所有运动结果均显示时间的主要影响(均p < 0.001)。事后简单效应试验显示,大鼠和CRT的FMA UE组内显著增加,而大鼠的FMA LE组内显著增加,在任何单一时间点组间无差异。神经影像学显示,同侧中央前回内ALFF的增加与FMA-UE和FMA-LE的改善相关。与CRT相比,RAT增强了中央前回和中央后回之间以及中央前回和边缘上回之间的半球间功能连通性。综上所述,大鼠通过上调同侧运动皮层的活动和增强跨半球感觉运动整合来促进运动恢复,为脑卒中后神经恢复的机制提供了直接证据。
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来源期刊
CiteScore
8.60
自引率
8.20%
发文量
479
审稿时长
6-12 weeks
期刊介绍: Rehabilitative and neural aspects of biomedical engineering, including functional electrical stimulation, acoustic dynamics, human performance measurement and analysis, nerve stimulation, electromyography, motor control and stimulation; and hardware and software applications for rehabilitation engineering and assistive devices.
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