现代仪器与医疗

基于fNIRS探索代偿模型的不同靶区刺激对严重脑卒中后上肢功能障碍患者的影响

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杨雅雯 ¹^,² , 乔勇军 ² , 潘文秀 ¹^,² , 赵丹 ¹^,² , 谢青 ¹^,²^,^*

现代仪器与医疗 | 专栏 2025,31(5): 37-42

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现代仪器与医疗 |专栏 2025 , 31 (5) : 37 -42

基于fNIRS探索代偿模型的不同靶区刺激对严重脑卒中后上肢功能障碍患者的影响

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杨雅雯¹^,², 乔勇军², 潘文秀¹^,², 赵丹¹^,², 谢青¹^,²^,^*

作者信息

^1.上海市瑞金康复医院康复医学科，上海　200023

^2.上海交通大学医学院附属瑞金医院康复医学科，上海　200025

通讯作者:

谢青，女，硕士研究生，主任医师，研究方向：神经调控

作者简介:

杨雅雯，女，硕士研究生，主治医师，研究方向：神经调控

Investigating the effects of stimulating different target regions within the compensation model on upper limb dysfunction in patients with severe stroke using fNIRS

Yawen Yang¹^,², Yongjun Qiao², Wenxiu Pan¹^,², Dan Zhao¹^,², Qing Xie¹^,²^,^*

Affiliations

^1.Department of Rehabilitation and Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai 200023, China

^2.Department of Rehabilitation and Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

出版时间: 2025-10-10 doi: 10.11876/mimt202505005

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摘要

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目的

探索基于代偿模型理论的健侧初级运动皮层（contralesional primary motor cortex，cM1）或健侧背外侧前运动皮层（contralesional dorsal premotor cortex，cPMd）高频重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）治疗方案对严重脑卒中患者上肢运动功能的影响及其机制，通过近红外脑功能成像（functional near infrared spectroscopy，fNIRS）技术分析脑网络重塑特征。

方法

本研究招募病程3～12月首次脑卒中患者23例，进行随机单盲对照实验。受试者随机分为cM1组、cPMd组和对照组（假刺激组）。cM1组刺激参数为5 Hz，cM1，100%RMT，1 000脉冲/次。cPMd组刺激参数为5 Hz，cPMd，100%RMT，1 000脉冲/次。治疗时间均为每天1次，每周5天，共2周。受试者在干预前后进行Fugl-Meyer上肢功能评定（Fugl-Meyer assessment-upper extremity，FMA-UE）和静息态fNIRS检测。fNIRS感兴趣脑区（region of interest，ROI）定位在左右两侧的BA4与BA6，静息态fNIRS关注于各ROI之间的功能连接（functional connection，FC）变化。

结果

3组患者的FMA-UE评分在基线水平差异无统计学意义（P>0.05）。干预2周后的结果显示，与干预前相比，cM1组、cPMd组的FMA-UE评分显著提高（P<0.05）；组间对照结果显示，与对照组相比，cM1组干预前后FMA-UE评分变化值差异具有统计学意义（P=0.007）。静息态fNIRS结果显示，cM1组的左侧BA4与右侧BA4之间（LBA4-RBA4）的FC显著大于cPMd组（P=0.046)，对照组的左侧BA4与右侧BA4之间（LBA4-RBA4）的FC显著大于cPMd组（P=0.011)。除此之外，并未发现其他显著差异。

结论

基于代偿模型理论的cM1、cPMd靶区刺激均可改善严重脑卒中后上肢运动障碍患者的上肢运动功能，具有临床可行性及安全性。靶向cM1区的高频rTMS治疗方案通过增强半球间运动皮层的功能连接，显著改善严重脑卒中患者上肢运动功能，同时，cM1较cPMd在促进严重脑卒中上肢运动功能障碍患者的功能恢复上更具优势。

关键词

重复经颅磁刺激 / 脑卒中 / 上肢运动功能 / 代偿模型 / 近红外脑功能成像技术

Abstract

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Objective

To explore the effects and mechanisms of high-frequency repetitive transcranial magnetic stimulation (rTMS) targeting the contralesional primary motor cortex (cM1) or the contralesional dorsal premotor cortex (cPMd) on upper limb motor function in patients with severe stroke, based on the compensation model theory. The study utilized functional near infrared spectroscopy (fNIRS) to analyze the characteristics of brain network reorganization.

Methods

This study recruited 23 patients with first-onset stroke within a disease course of 3～12 months and conducted a randomized single-blind controlled experiment. Participants were randomly assigned to the cM1 group, cPMd group, and the control group (sham stimulation group). The cM1 group received stimulation at 5 Hz, 100% resting motor threshold (rMT), with 1 000 pulses per session. The cPMd group received stimulation at 5 Hz, 100% rMT, with 1 000 pulses per session. The treatment was administered once daily, five days per week, for a total of two weeks. Participants underwent Fugl-Meyer assessment of upper extremity function (FMA-UE) and resting-state fNIRS detection before and after the intervention. The regions of interest (ROIs) for fNIRS were located in the bilateral Brodmann areas 4 (BA4) and 6 (BA6), with the resting-state fNIRS focusing on the changes in functional connectivities (FC) between these ROIs.

Results

There were no significant statistical differences in the baseline FMA-UE scores among the three groups (P>0.05). Compared with pre-intervention, the results after two weeks of intervention showed that the FMA-UE scores in the cM1 group and the cPMd group significantly increased (P<0.05). The intergroup comparison revealed that the change in FMA-UE scores in the cM1 group was significantly different from that in the control group (P=0.007). For the resting-state fNIRS results, the FC between the left BA4 and right BA4 (LBA4-RBA4) in the cM1 group was significantly greater than that in the cPMd group (P=0.046), and the FC between LBA4 and RBA4 in the control group was significantly greater than that in the cPMd group (P=0.011). No other significant differences were found.

Conclusion

High-frequency rTMS targeting cM1 and cPMd based on the compensation model theory can improve upper limb motor function in patients with upper limb motor dysfunction after severe stroke, with clinical feasibility and safety. The rTMS treatment targeting the cM1 area significantly enhances the interhemispheric functional connectivity of the motor cortex, thereby improving upper limb motor function in patients with severe stroke. Moreover, cM1 appears to be more advantageous than cPMd in promoting functional recovery in patients with upper limb motor dysfunction after severe stroke.

Key words

Repetitive transcranial magnetic stimulation / Stroke / Upper limb motor function / Compensation model / Functional near-infrared spectroscopy

引用本文

杨雅雯, 乔勇军, 潘文秀, 赵丹, 谢青. 基于fNIRS探索代偿模型的不同靶区刺激对严重脑卒中后上肢功能障碍患者的影响. 现代仪器与医疗, 2025 , 31 (5) : 37 -42 . DOI: 10.11876/mimt202505005

Yawen Yang, Yongjun Qiao, Wenxiu Pan, Dan Zhao, Qing Xie. Investigating the effects of stimulating different target regions within the compensation model on upper limb dysfunction in patients with severe stroke using fNIRS[J]. Modern Instruments & Medical Treatment, 2025 , 31 (5) : 37 -42 . DOI: 10.11876/mimt202505005

基金

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上海市黄浦区卫健委青年项目(HLQ202107)

参考文献

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2025年第31卷第5期

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文章信息

doi: 10.11876/mimt202505005

首发时间：2026-10-23
出版时间：2025-10-10

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基金

上海市黄浦区卫健委青年项目(HLQ202107)

作者信息

^1.上海市瑞金康复医院康复医学科，上海　200023

^2.上海交通大学医学院附属瑞金医院康复医学科，上海　200025

通讯作者:

谢青，女，硕士研究生，主任医师，研究方向：神经调控

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2种不同金属材料的力学参数

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