本文選題：腦卒中 + 腦機(jī)接口　； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：1.驗(yàn)證腦機(jī)接口結(jié)合功能性電刺激（BCI-FES）在慢性期腦卒中康復(fù)中的可行性；2.研究腦機(jī)交互的中樞神經(jīng)康復(fù)機(jī)制。 方法：將4名符合納入標(biāo)準(zhǔn)的受試者分入BCI-FES訓(xùn)練組或單純FES訓(xùn)練組，其中1名受試者在接受完第I階段的BCI-FES訓(xùn)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(xùn)練。每一階段訓(xùn)練持續(xù)4周，40分鐘/次，共20次。每階段訓(xùn)練前、訓(xùn)練后各進(jìn)行一次上肢運(yùn)動(dòng)功能評(píng)價(jià)，功能性磁共振成像（fMRI）檢測(cè)及彌散張量成像（DTI）檢測(cè)，訓(xùn)練結(jié)束后4周再進(jìn)行一次隨訪上肢運(yùn)動(dòng)功能評(píng)價(jià)。上肢運(yùn)動(dòng)功能評(píng)價(jià)包括患側(cè)手最快抓握速度、Fugl-Meyer上肢運(yùn)動(dòng)功能評(píng)價(jià)、上肢主要肌群徒手肌力檢查（MMT）、九孔柱測(cè)試、BoxBlock測(cè)試、Jebson-Taylor測(cè)試。fMRI檢測(cè)包含“運(yùn)動(dòng)”、“想象”及“休息”刺激組塊，對(duì)采集到的圖像進(jìn)行分析，繪制腦激活圖，，計(jì)算激活體積及偏側(cè)系數(shù)（LI）。對(duì)DTI掃描數(shù)據(jù)進(jìn)行感興趣區(qū)（ROI）的纖維走行描繪、各向異性分?jǐn)?shù)（FA）值、FA指數(shù)及表觀彌散系數(shù)（ADC）值計(jì)算。 結(jié)果：1.MMT兩組受試者訓(xùn)練后均無(wú)顯著改善，患手最快抓握速度FES組平均值在訓(xùn)練后略下降，BCI-FES組平均值訓(xùn)練后升高，其余上肢功能檢測(cè)兩組受試者在訓(xùn)練后平均值均較訓(xùn)練前提高，且BCI-FES組各項(xiàng)平均提高值均高于FES組；2.BCI-FES組全部上肢運(yùn)動(dòng)功能評(píng)價(jià)項(xiàng)目的平均值在隨訪點(diǎn)也均表現(xiàn)出較訓(xùn)練前提高，除九孔柱測(cè)試外，其他評(píng)價(jià)項(xiàng)目的平均值均低于訓(xùn)練后測(cè)試值；3.全部受試者在患手真實(shí)運(yùn)動(dòng)及運(yùn)動(dòng)想象時(shí)大腦激活模式與正常人不同，表現(xiàn)為同側(cè)初級(jí)運(yùn)動(dòng)區(qū)（M1）激活的增多，對(duì)側(cè)M1激活的減少，以及更多次級(jí)運(yùn)動(dòng)區(qū)的參與；4.BCI-FES訓(xùn)練后受試者執(zhí)行患手真實(shí)運(yùn)動(dòng)和運(yùn)動(dòng)想象時(shí)較訓(xùn)練前出現(xiàn)更多腦區(qū)的參與。單純FES訓(xùn)練后則無(wú)明顯的激活腦區(qū)增加；5.比較真實(shí)運(yùn)動(dòng)，運(yùn)動(dòng)想象有更多次級(jí)運(yùn)動(dòng)區(qū)的參與，而對(duì)于初級(jí)運(yùn)動(dòng)區(qū)的激發(fā)不如真實(shí)運(yùn)動(dòng)明顯；6.BCI-FES訓(xùn)練及單純FES訓(xùn)練均可在一定程度上增加腦激活體積，而BCI-FES訓(xùn)練的增加程度要明顯高于單純FES訓(xùn)練；7.經(jīng)過BCI-FES訓(xùn)練，慢性期腦卒中患者在執(zhí)行癱瘓手任務(wù)（真實(shí)運(yùn)動(dòng)或運(yùn)動(dòng)想象）時(shí)，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(xùn)練后大腦激活平衡向損傷對(duì)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(duì)側(cè)半球相應(yīng)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(duì)側(cè)半球內(nèi)囊后肢；9.BCI-FES訓(xùn)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(xùn)練前提高，單純FES訓(xùn)練則無(wú)此效應(yīng)；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(xùn)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(xùn)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(xùn)練后平均下降，單純FES組則平均升高。12.訓(xùn)練前后，患手真實(shí)運(yùn)動(dòng)時(shí)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(guān)。 結(jié)論：1.BCI-FES應(yīng)用于存在腦損傷的腦卒中患者的康復(fù)訓(xùn)練是可行的；2.BCI-FES康復(fù)訓(xùn)練新技術(shù)可促進(jìn)慢性期腦卒中患者上肢運(yùn)動(dòng)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(xùn)練結(jié)束后1個(gè)月仍有體現(xiàn)；3.BCI-FES技術(shù)可促進(jìn)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(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R493;R743.3

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