Article(id=1211302344281690942, tenantId=1146029695717560320, journalId=1146031591421210625, issueId=1211302341744137007, articleNumber=null, orderNo=23, doi=10.3981/j.issn.1000-7857.2024.10.01475, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1728230400000, receivedDateStr=2024-10-07, revisedDate=1752595200000, revisedDateStr=2025-07-16, acceptedDate=1764086400000, acceptedDateStr=2025-11-26, onlineDate=1766726583786, onlineDateStr=2025-12-26, pubDate=1765555200000, pubDateStr=2025-12-13, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1767456000000, onlineIssueDateStr=2026-01-04, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766726583786, creator=13701087609, updateTime=1774080405602, updator=sys-migrate, issue=Issue{id=1211302341744137007, tenantId=1146029695717560320, journalId=1146031591421210625, year='2025', volume='43', issue='23', pageStart='1', pageEnd='112', issueExtLink='null', onlineDate='null', pubDate='1765555200000', pubDateStr='2025-12-13', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1766726583181, creator='13701087609', updateTime=1774330548003, updator='13041195026', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1243195681876328676, tenantId=1146029695717560320, journalId=1146031591421210625, issueId=1211302341744137007, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1243195681876328677, tenantId=1146029695717560320, journalId=1146031591421210625, issueId=1211302341744137007, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=91, endPage=98, ext={EN=ArticleExt(id=1211302345015694168, articleId=1211302344281690942, tenantId=1146029695717560320, journalId=1146031591421210625, language=EN, title=Research of fNIRS neurofeedback for post−stroke rehabilitation training, columnId=1150494644690366681, journalTitle=Science & Technology Review, columnName=Papers, runingTitle=null, highlight=null, articleAbstract=

Functional near−infrared spectroscopy (fNIRS) neurofeedback technology is an emerging non−invasive brain function modulation technique. This article reviews the relevant studies on fNIRS neurofeedback in improving post−stroke dyskinesia, cognitive impairment, and emotional disorders, analyzes the feasibility and effectiveness of fNIRS neurofeedback in post−stroke rehabilitation training, then discusses the problems in the development of this field, and finally summarizes the future research trend of fNIRS neurofeedback in post−stroke rehabilitation training, to provide a reference for follow−up research.

, authors=null, authorsList=Jiaxin DING, Di WU, Deyu LI, Huiting QIAO, Yizhu TIAN, Daifa WANG, Meiyun XIA, authorCompany=null, correspAuthors=Meiyun XIA, authorNote=null, correspAuthorsNote=null, copyrightStatement=All rights reserved. Unauthorized reproduction is prohibited., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1211302346198487971, articleId=1211302344281690942, tenantId=1146029695717560320, journalId=1146031591421210625, language=CN, title=基于功能近红外光谱的神经反馈研究, columnId=1146540929516700224, journalTitle=科技导报, columnName=研究论文, runingTitle=null, highlight=null, articleAbstract=

功能近红外光谱神经反馈是一种新兴的无创脑功能调控技术。综述了fNIRS神经反馈在改善卒中后运动障碍、认知障碍及情绪障碍中的相关研究,研究表明,基于多模态和多感官反馈的运动想象神经反馈训练模式被开发用于卒中运动功能障碍患者;卒中后认知障碍的发生与卒中病变的特征(如大小或关键区域)、阿尔茨海默病病理和大脑可塑性密切相关;fNIRS神经反馈用于情绪调节也已在不同人群中得到了验证。分析了fNIRS神经反馈用于卒中后康复训练的可行性、有效性,探讨了该领域发展存在的问题,最后总结了未来近红外神经反馈用于卒中后康复训练的研究趋势,建议未来的研究者对研究方案进行更加详实的报告,包括患者类型、神经反馈信号的反馈形式、呈现方式、呈现时间以及对照组的设计等。

, authors=

丁佳新,硕士研究生,研究方向为卒中神经反馈,电子信箱:

武迪(共同第一作者),博士研究生,研究方向为近红外脑功能评价,电子信箱:

, authorsList=丁佳新, 武迪, 李德玉, 乔惠婷, 田一竹, 汪待发, 夏美云, authorCompany=null, correspAuthors=夏美云, authorNote=null, correspAuthorsNote=
夏美云(通信作者),副研究员,研究方向为脑功能评价和神经反馈,电子信箱:
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类型 反馈参数 空间
分辨率/cm
时间
分辨率/Hz
抗运动性 抗电磁性 应用人群 疾病训练
周期/次
可操作性 成本
EEG神经反馈 单一/多个频段 6~9 >1000 无限制 ≥5 静态/动态任务
fMRI神经反馈 激活/功能连接 0.03 0~2 禁金属植入 ≤5 静态任务
fNIRS神经反馈 激活/功能连接 2~3 0~10 无限制 ≤5 静态/动态任务
), ArticleFig(id=1242146522289218306, tenantId=1146029695717560320, journalId=1146031591421210625, articleId=1211302344281690942, language=CN, label=表1, caption=

不同类型神经反馈方法的对比

, figureFileSmall=null, figureFileBig=null, tableContent=
类型 反馈参数 空间
分辨率/cm
时间
分辨率/Hz
抗运动性 抗电磁性 应用人群 疾病训练
周期/次
可操作性 成本
EEG神经反馈 单一/多个频段 6~9 >1000 无限制 ≥5 静态/动态任务
fMRI神经反馈 激活/功能连接 0.03 0~2 禁金属植入 ≤5 静态任务
fNIRS神经反馈 激活/功能连接 2~3 0~10 无限制 ≤5 静态/动态任务
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基于功能近红外光谱的神经反馈研究
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丁佳新 1 , 武迪 1 , 李德玉 1 , 乔惠婷 1 , 田一竹 1 , 汪待发 1 , 夏美云 2, *
科技导报 | 研究论文 2025,43(23): 91-98
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科技导报 |研究论文 2025 , 43 (23) : 91 -98
基于功能近红外光谱的神经反馈研究
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丁佳新1 , 武迪1 , 李德玉1, 乔惠婷1, 田一竹1, 汪待发1, 夏美云2, *
作者信息
  • 1北京航空航天大学生物与医学工程学院,北京 100083
  • 2北京航空航天大学杭州创新研究院(北京航空航天大学国际创新学院)医工交叉科创中心,杭州 311115
通讯作者:
夏美云(通信作者),副研究员,研究方向为脑功能评价和神经反馈,电子信箱:
Research of fNIRS neurofeedback for post−stroke rehabilitation training
Jiaxin DING1 , Di WU1 , Deyu LI1, Huiting QIAO1, Yizhu TIAN1, Daifa WANG1, Meiyun XIA2, *
Affiliations
  • 1School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
  • 2Medical Engineering & Engineering Medicine Innovation Center, Hangzhou Innovation Institute, Beihang University, Hangzhou 311115, China
出版时间: 2025-12-13 doi: 10.3981/j.issn.1000-7857.2024.10.01475
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功能近红外光谱神经反馈是一种新兴的无创脑功能调控技术。综述了fNIRS神经反馈在改善卒中后运动障碍、认知障碍及情绪障碍中的相关研究,研究表明,基于多模态和多感官反馈的运动想象神经反馈训练模式被开发用于卒中运动功能障碍患者;卒中后认知障碍的发生与卒中病变的特征(如大小或关键区域)、阿尔茨海默病病理和大脑可塑性密切相关;fNIRS神经反馈用于情绪调节也已在不同人群中得到了验证。分析了fNIRS神经反馈用于卒中后康复训练的可行性、有效性,探讨了该领域发展存在的问题,最后总结了未来近红外神经反馈用于卒中后康复训练的研究趋势,建议未来的研究者对研究方案进行更加详实的报告,包括患者类型、神经反馈信号的反馈形式、呈现方式、呈现时间以及对照组的设计等。

卒中  /  神经反馈  /  功能性近红外光谱  /  康复训练

Functional near−infrared spectroscopy (fNIRS) neurofeedback technology is an emerging non−invasive brain function modulation technique. This article reviews the relevant studies on fNIRS neurofeedback in improving post−stroke dyskinesia, cognitive impairment, and emotional disorders, analyzes the feasibility and effectiveness of fNIRS neurofeedback in post−stroke rehabilitation training, then discusses the problems in the development of this field, and finally summarizes the future research trend of fNIRS neurofeedback in post−stroke rehabilitation training, to provide a reference for follow−up research.

stroke  /  neurofeedback  /  functional near−infrared spectroscopy  /  rehabilitation
丁佳新, 武迪, 李德玉, 乔惠婷, 田一竹, 汪待发, 夏美云. 基于功能近红外光谱的神经反馈研究. 科技导报, 2025 , 43 (23) : 91 -98 . DOI: 10.3981/j.issn.1000-7857.2024.10.01475
Jiaxin DING, Di WU, Deyu LI, Huiting QIAO, Yizhu TIAN, Daifa WANG, Meiyun XIA. Research of fNIRS neurofeedback for post−stroke rehabilitation training[J]. Science & Technology Review, 2025 , 43 (23) : 91 -98 . DOI: 10.3981/j.issn.1000-7857.2024.10.01475
卒中是世界范围内常见的脑血管疾病之一,具有发病率高、致残率高、死亡率高、复发率高的特点,并呈年轻化趋势[1]。中风是全球第2大死亡原因,也是第3大致残原因。约70%~80%的卒中幸存者遗留不同程度的功能障碍,如运动障碍、认知障碍、情感障碍等[25],且功能恢复速度慢,难度大,预后差,已成为康复治疗中的重点和难点。
神经可塑性是脑神经康复的根本基础。神经可塑性是指大脑依赖经验修正编码与学习新行为的过程,通过增加或改变原有的神经突触来适应环境或修正行为[6]。成人的大脑皮层功能也具有高度的动态可塑性,当外界环境变化不断刺激大脑时,大脑可依据受刺激经验通过皮层神经网络重组来适应外部变化。神经可塑性是学习和适应环境的基础,也是脑神经受损后的运动学习和功能恢复的重要基础。
神经反馈是一种基于神经可塑性原理的新兴脑功能康复疗法。神经反馈作为一种直接训练大脑机能的主动式干预手段,通过实时获取受试者的神经信号,借助先进的信息处理技术完成大脑信息的快速解码,匹配以视觉、听觉、触觉等多种感官刺激方式,构成脑−机交互训练通路,实现大脑工作状态与运行性能的闭环训练[78]。神经反馈利用内源性生理信号引导受试者调节与行为相关的脑活动或功能网络,且对脑活动或功能网络产生长期性的影响,从而增强或恢复其功能。传统康复疗法,如运动训练,缺乏反馈信息的有效、及时且准确的输出,不利于受试者调整脑活动状态,训练周期长,康复速度慢。神经反馈使神经康复训练过程可观察、可量化、可自我调节,在科学研究和临床应用方面表现出巨大的技术优势和应用前景,获得研究者及临床医师的广泛关注,并在提高或改善受试者的行为和认知能力,干预神经或精神疾病及卒中后康复等方面取得良好应用效果[910]
功能近红外光谱(functional near−infrared spectroscopy,fNIRS)是一种基于光学原理的无创神经活动成像技术,具有时间和空间分辨率适中、抗电磁干扰和运动干扰能力强、应用人群广泛、应用场景无限制等优点。相对于脑电(electroencephalogram,EEG),fNIRS能够精确定位和调节相关脑区,受试者可以更快地学会调节血流动力学信号。这使得fNIRS神经反馈训练成为一种有吸引力的工具,为高层次(如认知−行为)大脑功能和神经可塑性提供了基础。与功能磁共振成像(functional magnetic resonance imaging,fMRI)相比,fNIRS更适合大样本量、长周期、多中心研究,有效避免了统计检验中检验能力不足导致的低统计功效问题,提升了研究结果的可靠性和有效性。fNIRS神经反馈通过调节目标脑区的血流动力学活动间接地调节神经元活动,使目标脑区发生可塑性变化从而改善功能和行为。fNIRS神经反馈原理如图图1所示。例如通过fNIRS神经反馈调节运动相关皮层活动,诱发运动相关神经网络的可塑性变化,从而促进运动功能恢复。同时也可以调节与认知、情绪等障碍相关的皮层活动以改善症状[11]。fNIRS因其独特的技术优势在神经反馈领域崭露头角。表1展示了不同类型神经反馈方法的对比情况。
应用fNIRS神经反馈调节与功能受损脑区的神经活动来改善卒中引起的功能障碍的研究已初步证明了fNIRS神经反馈在卒中康复领域的重要价值。本文将针对fNIRS神经反馈在卒中后运动障碍、认知障碍以及情感障碍康复训练中的应用进行系统性综述,分析其可行性、有效性,探讨该领域发展存在的问题,并总结未来fNIRS神经反馈用于卒中后康复训练的研究趋势。
运动功能障碍是卒中后最常见的功能损伤,约70%的卒中患者患有上肢功能障碍[12],约63%的卒中患者患有下肢运动障碍[13]。卒中患者常因其闭环神经环路受损而难以执行特定的运动,对于上肢运动障碍患者常表现为运动模式异常、肌肉激活改变等特征。而卒中后下肢步态障碍的患者,其行走障碍体现在时空特征偏差、行走时能量消耗增多。传统运动康复疗法常采用渐进式抗阻训练、强制性运动疗法、电刺激等方式,但存在个体差异性大、疗法单一、被动等局限性,往往不能调动患者自身的能动性。为此,相关研究开始利用运动想象(motor imagery,MI)疗法来代替运动执行。所谓MI,是指大脑反复想象执行运动任务,但不发生任何实际动作,是运动行为在大脑中的预演。研究表明,MI与运动执行具有相似的脑区激活[14]。MI神经反馈训练主要通过肢体运动想象诱发促进病灶区域的神经组织产生有益的可塑性变化,进而促进肢体运动功能康复。
MI神经反馈用于卒中后运动康复训练已得到初步验证和应用[3]。Mihara等[15]对卒中偏瘫患者进行了基于fNIRS的MI神经反馈训练。该研究纳入了20名处于稳定恢复期的运动性偏瘫患者。研究使用改良Fugl−Meyer评估运动量表对肢体运动障碍的严重程度进行评估,以确保纳入的患者存在一定程度的肢体运动障碍(量表得分在27~60之间)。实验过程中采用双盲随机假对照方案将受试者随机分组以接受康复训练。与对照组相比,实验组额外接受6次持续10 min的上肢远端MI训练。结果显示,实验组患者Fugl−Meyer评估中的手/手指分量表评分显著优于对照组,实验组患者运动前区与运动想象相关的皮层激活也明显大于对照组。研究结果表明,基于fNIRS的MI神经反馈有助于卒中后偏瘫患者运动功能的恢复。对于卒中后步态和平衡功能障碍,尽管大部分患者经过自主康复可以恢复部分行走能力,但往往做不到安全、长时间地行走。2021年,Mihara等[16]再次使用基于fNIRS的MI神经反馈进行卒中后步态和平衡相关研究。研究共招募了54名慢性期卒中偏瘫步态障碍患者,采用双盲随机假对照方案对受试者进行分组。除常规治疗外,实验组额外接受6次、每次5 min的下肢MI训练。结果显示,该神经反馈训练改善了实验组患者的起立−行走任务能力,提升了下肢步态能力。此外,对fNIRS的分析表明,实验组患者与想象相关的辅助运动区激活显著增加,以及辅助运动区和腹外侧前运动区之间静息态连接性增强,进一步说明了该神经反馈训练方案的有效性。
基于多模态和多感官反馈的MI神经反馈训练模式也被开发用于卒中运动功能障碍患者。2020年,Rieke等[17]开发了一种联合顺序实时fMRI和fNIRS任务的神经反馈系统,旨在提高卒中后患者的运动学习能力。该研究进行了3次实时fMRI神经反馈训练,在进行手腕伸展训练的同时接受病变运动皮层活动的反馈。随后进行10次fNIRS神经反馈训练并接受神经触发的功能性电刺激。训练结束后,患者手臂协调性和手腕主动伸展能力得到了显著改善。结果验证了fMRI−fNIRS混合神经反馈运动训练的可行性。2022年,Wang等[18]采用EEG和fNIRS联合监测,在常规康复训练的基础上,对7名卒中患者进行了12次、每次15 min的MI神经反馈训练。该研究以电刺激作为实时触觉反馈,引导受试者适当调整想象策略,尽可能地达到神经反馈的目标。训练结果显示,卒中患者的上肢肌力评价均随着运动康复训练时间的增加而提高,EEG监测的事件相关去同步化和大脑血氧响应明显增强,生活活动能力也有所增强。EEG和fNIRS联合神经反馈在改善卒中患者运动功能和诱导神经可塑性康复方面的有效性被证实。
尽管基于fNIRS的MI神经反馈在卒中运动康复方面取得了重要进展,但需要注意的是:MI神经反馈训练成效严重依赖受试者的MI能力[19]。因此,对受试者MI能力的评估至关重要。目前常用的评估方法有:(1) 问卷调查法或国际量表。MI能力的2个关键特征是生动性和可控性,MI能力问卷调查量表主要围绕这2个关键特征进行评估。如针对健康个体的运动想象问卷调查;针对运动残疾患者的动觉和视觉想象问卷调查;针对MI的可控性量表运动想象的可控性测试;针对MI的生动性量表运动想象生动性问卷调查。(2) 心理测时法。受试者执行MI的持续时间与相应实际运动的持续时间越接近,表明该被试的MI能力越强。(3) 脑功能成像。例如,采用fMRI评估MI期间大脑激活的分布特征,以具有较强MI能力受试者的fMRI成像特征作为参考进行比较,如果具有可比性,则认为具有较强的MI能力。(4) 心理旋转法等。其中,视觉运动想象要求被试者在心里可视化特定动作,如在脑海中回忆某个情景,仅需要少量的训练,甚至不需要训练,受试者可以熟练地、自由地操控该心理活动。而动觉运动想象要求受试者以第一人称视角在心里感觉或排演特定运动过程但不发生实际运动,是一种矛盾的对抗过程,不易执行和控制,往往需要大量的训练(20~40 min)[2021],且存在较严重的运动想象盲区[19]。此外,MI神经反馈治疗卒中后运动功能障碍的具体恢复机制尚不明确,其影响康复训练效果的因素,如卒中损伤类型、病程、神经反馈训练强度、训练周期等都有待进一步研究。
卒中后认知障碍(post−stroke cognitive impairment,PSCI)是卒中患者普遍存在的残留症状,其发病率仅次于卒中后运动障碍。2022年的一项综述显示,高达57%的缺血性卒中患者在发病后6个月出现不同程度的认知障碍[22]。PSCI患者的死亡率明显高于无认知障碍的患者[23]。除此之外,PSCI的致残率增加,照料压力显著增大,患者心理健康状况显著下降[24]。PSCI通常涉及多个方面,例如记忆、注意力、执行功能和语言等[22]。PSCI治疗的主要目的是延缓认知障碍的进一步下降、提高认识水平、改善精神行为症状和提高日常生活能力。神经反馈训练已被证实可改善神经退行性疾病患者的认知功能。相对于由外界能量输入改善患者认知状态的被动式训练方法,如经颅磁刺激,将神经反馈推广应用到PSCI患者[25],这一主动康复训练方式对于患者的认知改善具有重要意义[26]
fNIRS神经反馈改善认知功能已被初步验证和应用。Barth等[27]在13名健康受试者中进行了8次基于fNIRS的额叶皮质区域活动的神经反馈训练。研究人员用平均氧合血红蛋白浓度评估受试者在训练过程中以及n−back任务期间的认知表现。结果显示12名受试者能够实现额叶血流动力学反应的自主调节。与训练前相比,受试者的工作记忆表现更好,这表明fNIRS神经反馈诱导特定大脑激活可有效改善受试者的认知功能。Acevedo等[28]对86名健康人进行为期4周的fNIRS认知神经反馈训练。训练后,受试者的记忆、言语记忆和复合认知功能显著提高。Xia等[29]将fNIRS神经反馈从局部脑区迁移至脑网络层面,证实了基于fNIRS的功能连接神经反馈对认知功能的调控作用。该研究以健康人群为研究目标,额叶−顶叶功能连接作为反馈信号,工作记忆作为调控的靶向认知功能,通过对10名健康受试者进行3次、每次约15 min的功能连接神经反馈训练,发现受试者的额叶−顶叶功能连接显著升高,且工作记忆能力显著改善。该研究表明,可以通过fNIRS神经反馈调节皮层间的功能连接改善相关认知功能。以上研究结果表明,基于激活或功能连接的fNIRS神经反馈训练均可有效改善健康人群的认知能力。
Tetsuka等[30]验证了急性期卒中的短期fNIRS神经反馈训练诱导前额叶活动对工作记忆的积极效果。该研究采用了双盲随机假反馈对照的研究方法,将30名急性期卒中患者随机分为真反馈组(20人)和假反馈组(10人),分别接受双侧背外侧前额叶皮层/额极皮层的脑活动和其他受试者的脑活动信息的反馈,训练时长约20 min,并对比了训练前后2组受试者的工作记忆能力差异。研究发现,与基线相比,真反馈组在训练期间表现出更高任务相关右前额叶活动中,并帮助维持认知能力,该研究结果为临床医生对急性期卒中患者制定神经康复计划提供了新选择。
尽管针对健康受试者的认知神经反馈已取得良好进展,但针对PSCI患者的神经反馈训练方案还需进一步研究。PSCI的发生与卒中病变的特征(如大小或关键区域)、阿尔茨海默病病理和大脑可塑性密切相关[31]。PSCI的干预应该考虑卒中的发生时间、认知障碍的严重程度、是否存在合并症及患者和照顾者的需求等。然而,目前尚缺乏针对PSCI的大型、随机、双盲、对照临床试验。因此,针对不同亚型的PSCI患者的个性化fNIRS神经反馈训练方案需进一步细化和优化,以证明其干预的实用性、有效性和持续性。
情绪障碍是缺血性脑卒中患者较为常见的并发症之一,以卒中后抑郁症(post−stroke depression,PSD)和卒中后焦虑(post−stroke anxiety,PSA)最为常见[32]。约有33%的卒中幸存者患有卒中后抑郁[33],约有14%~27%的卒中后患者可出现卒中后焦虑[34]。临床上,卒中后康复通常集中在运动能力恢复上,而很少关注情绪状态。然而,卒中后情绪障碍不仅影响患者功能恢复,还会增加致残率和致死率。目前针对情绪障碍的治疗以药物治疗为主,且副作用明显。神经反馈内源性闭环调控为卒中诱发的情绪功能障碍提供了潜在有效的治疗方法[35]
神经反馈改善情绪障碍已被验证和应用。张菁等[36]利用EEG神经反馈对70例PSA患者进行研究。患者被随机分为神经反馈组和对照组,神经反馈组患者接受药物治疗并进行神经反馈训练,而对照组仅进行药物治疗。结果发现,在反馈训练结束后及训练后4周和8周分别发现,神经反馈组患者的汉密尔顿焦虑量表评分及焦虑症状减轻程度均优于对照组。Cannon等[37]招募一名女性卒中患者,并对其进行52次基于EEG的神经反馈训练,有效改善了该患者的抑郁情绪。Zhao等[38]利用fMRI功能连接神经反馈对26名高度焦虑的患者进行反馈训练,发现患者杏仁核−前额叶的功能连接显著增加,且焦虑水平降低。以上研究均证明了神经反馈训练对卒中后情绪调节的重要作用。
fNIRS神经反馈用于情绪调节已在不同人群中得到验证。针对健康人群的情绪识别[39]和互动神经反馈模式已被开发。Yu等[40]招募了30名健康受试者进行了fNIRS神经反馈训练,并将受试者随机分为实验组和对照组。训练期间,实验组被要求根据自身的fNIRS神经反馈信号上调右侧背外侧前额叶的皮质活动,而对照组则被反馈来自实验组的假反馈信号。研究发现,训练过程中实验组的情绪调节网络内以及该网络与左侧杏仁核之间的静息态功能连接显著增强,而对照组无此变化。这表明,神经反馈训练显著提高了实验组受试者的情绪调节能力。该研究证实了fNIRS神经反馈训练在情绪调节中的可行性,为疾病的临床应用奠定了基础。Kimmig等[41]将fNIRS神经反馈用于改善社交焦虑症(social anxiety disorder,SAD)并取得积极效果。该研究显示,12名SAD患者经过为期6~8周的背外侧前额叶激活反馈训练,对威胁相关刺激的注意偏倚有所改善,并且SAD症状严重程度也有所降低。个体神经反馈表现的提高和个体SAD症状严重程度的降低与大脑注意系统对社会威胁信号的反应降低相关。这项研究不仅表明fNIRS神经反馈在SAD患者中的可行性,为进一步揭示背外侧前额叶在SAD注意力偏倚中的重要作用,为未来SAD的治疗提供新思路。此外,fNIRS神经反馈在增强自闭症谱系障碍儿童的面部识别[42]、调节饮食行为[43]等方面均有良好的应用。因此,尽管到目前为止,尚未见fNIRS神经反馈在卒中后情绪障碍患者中的应用案例,但其表现出了巨大的应用潜力和空间。
卒中后运动障碍、认知障碍和情感障碍存在复杂的作用关系,如图2所示,单一功能障碍的恢复有望改善其他脑功能[26]。卒中后运动功能与认知功能之间存在相互作用关系[44]。相关研究表明,有氧运动引起的脑血流量增强可以增强记忆检索和认知任务表现[44];同样,注意力等认知功能的改善也可促进运动能力的恢复[3]。卒中后运动功能与情绪状况有密切联系,例如,与未接受PSD治疗的患者相比,接受PSD治疗的患者往往有更好的运动康复效果;良好的运动康复也与卒中后患者的动机和情绪状态紧密相关[45]。参与情绪调节的大脑区域与认知控制过程有关[36],改善前额叶认知控制区域的功能有助于治疗和预防情绪失调[36],反之亦然,增强认知控制区域的功能可以直接改善情绪调节[46]。研究发现,音乐对提升接受运动和认知康复的脑卒中患者的情绪状况具有积极影响[47]。相对于无音乐伴随的治疗,基于音乐的治疗使受试者情绪状况得到改善,且运动和认知康复效果更好。Xia等[29]将fNIRS额顶功能连接神经反馈用于健康成年受试者,通过3次、每次约20 min工作记忆训练显著改善了受试者的工作记忆能力。此外,研究发现,训练后,受试者注意力显著提高,证实了fNIRS神经反馈对非靶向训练认知功能的迁移作用。由于fNIRS神经反馈相对于EEG神经反馈起步晚,现有研究更多地关注于单一功能障碍的改善效果,或者不同认知功能之间的迁移改善效果。鉴于运动、认知和情绪障碍单一功能恢复对其他功能的积极影响,未来康复训练方案应综合考虑大脑不同脑区、不同功能间的相互作用。针对不同类型的卒中后患者,进行多维度的训练治疗将更有助于患者的全面康复。
尽管fNIRS神经反馈在卒中后运动、认知和情绪障碍方面取得了积极的研究结果,值得注意的是:大部分研究采用了小样本,其研究结果迁移至临床应用的可靠性值得进一步深入验证;存在混杂偏倚,患者的基础健康状况、合并症、治疗依从性等因素在研究中需要充分控制或考虑,以减少可能对研究结果产生的潜在影响;测量偏倚,某些评估方法,例如量表、行为学等,不同研究中的准确性和一致性难以统一;干预参数,如训练周期、时长和强度尚无统一标准。综合来看,fNIRS神经反馈在未来的研究中,需要进一步规范实验设计,扩大样本量,提高样本的代表性,确保数据的可靠性。同时,要充分考虑并控制可能的偏倚因素,合理设定干预参数,以获得更准确、可靠和具有普遍指导意义的研究结论,为卒中后患者的康复治疗提供更坚实的科学依据。
神经反馈通过对大脑活动的内源性控制改善功能缺陷,相比药物治疗,具有更高的特异性和更少的副作用。然而,fNIRS神经反馈在卒中康复领域仍然相对较新。在这里进行了系统综述,评估了fNIRS神经反馈在卒中后运动、认知和情绪障碍康复中的潜力。由于该领域还处于早期阶段,主要由可行性、试点或概念验证研究组成。因此,本文可能有助于推动fNIRS神经反馈在卒中康复领域的进一步尝试。
神经反馈领域最近达成的共识中[4849],鼓励神经反馈研究采用更严格的实验设计和更全面的研究报告,以提高研究的可重复性和可比性[50]。为了在未来获得可比的结果变量,将研究方案迁移推广至临床,进一步制定研究方案标准和协议至关重要。因此,建议研究者对研究方案进行更加详实的报告,包括患者类型(疾病阶段、亚型等)、神经反馈信号的反馈形式(听觉、视觉、本体感觉等)、呈现方式(原始大脑活动或衍生信号)、呈现时间(连续或间歇)、训练强度(训练次数、训练时长、随访周期等)以及对照组的设计(无反馈、假反馈和治疗对照)等。
总之,fNIRS神经反馈作为一种安全有效的康复训练手段,在卒中康复中显示出巨大的应用前景。未来,随着神经科学和神经反馈技术的进一步发展,fNIRS神经反馈技术将越来越广泛地应用于各类疾病,造福人类健康。
  • 北京航空航天大学杭州创新研究院研究基金(2024KQ098)
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2025年第43卷第23期
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doi: 10.3981/j.issn.1000-7857.2024.10.01475
  • 接收时间:2024-10-07
  • 首发时间:2025-12-26
  • 出版时间:2025-12-13
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  • 收稿日期:2024-10-07
  • 修回日期:2025-07-16
  • 录用日期:2025-11-26
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北京航空航天大学杭州创新研究院研究基金(2024KQ098)
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    1北京航空航天大学生物与医学工程学院,北京 100083
    2北京航空航天大学杭州创新研究院(北京航空航天大学国际创新学院)医工交叉科创中心,杭州 311115

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夏美云(通信作者),副研究员,研究方向为脑功能评价和神经反馈,电子信箱:
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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