Effects of Cycling Training on Sensorimotor Activation and Functional Recovery of Lower Extremity in Patients With Stroke: A Preliminary fMRI Study

踩車訓練對於中風患者感覺動作皮質活化與下肢功能恢復之影響：功能性核磁共振造影初步研究

周詣倫(Yi-Lun Chou) ； 陳綉儀(Hsiu-I Chen) ； 許妙如(Miao-Ju Hsu) ； 陳佳如(Sharon Chia-Ju Chen) ； 陳嘉炘(Chia-Hsin Chen) ； 林昭宏(Jau-Hong Lin)

《物理治療》 44卷1期 (2019/03) Pp. 9-17

https://doi.org/10.6215/FJPT.201903_44(1).0002

摘要

Background and Purposes: Leg cycling motion training is commonly used to facilitate the functional recovery of the lower extremity (LE) in patients with stroke. This study aimed to explore the relationships between the functional recovery of the LE in patients with stroke and cortical activation patterns after cycling training. Methods: Five patients with chronic stroke were recruited to undergo 30-min sessions of leg cycling training five times a week for 4 weeks. Outcome measures included the lower extremity subscale of the Fugl-Meyer Assessment (LE-FMA), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT). In addition, an ankle dorsi-flexion paradigm based on functional magnetic resonance imaging (fMRI) was performed to analyze the cortical activation patterns. The weighted Lateralization Index (wLI) in the primary sensorimotor cortex (SMC) was used to assess the activation balance between the hemispheres. Assessments were carried out at baseline (pre-training) and after the 4-week training period (post-training). Results: The LE-FMA score, 6MWT, and 10MWT respectively improved from 25.2 ± 2.9 to 29.0 ± 2.6, from 254.5 ± 50.0 to 276.7 ± 52.3 m, and from 0.78 ± 0.22 to 0.90 ± 0.19 s, respectively. The fMRI data showed that three subjects demonstrated bilateral cortical activation patterns and the other two showed contralateral activation patterns in the SMC during the affected ankle dorsi-flexion paradigm. Conclusions: This preliminary study revealed that the 4-week leg cycling training could lead to improve LE motor recovery, walking endurance, and speed for patients with chronic stroke. However, no specific relationship was found between functional improvement and activation pattern in the SMC.

關鍵字

Stroke ； Cycling training ； Motor recovery ； fMRI ； Cortical activation

並列摘要

背景與目的：踩車運動常用於促進中風患者下肢動作功能恢復的訓練。本研究目的探討中風患者接受踩車運動訓練後大腦皮質活化型態改變與下肢功能恢復之關係。方法：徵召五位慢性期中風患者接受為期四週，每週五次，每次30 min踩車運動訓練。傅格－梅爾下肢動作評估次量表及六分鐘走路測試和十公尺走路測試評估下肢動作功能恢復情況。功能性核磁共振造影分析計算受試者主動足踝背屈動作時大腦兩側感覺動作皮質區加權側化指標評估大腦間的活化程度。踩車運動訓練前和四週訓練結束後分別接受評估。結果：下肢動作功能平均分數由25.2 ± 2.9分進步至29.0 ± 2.6分；走路測試距離由254.5 ± 50.0 m進步至276.7 ± 52.3 m；走路步速測試由0.78 ± 0.22 s進步至0.90 ± 0.19 s。三位受試者患側足踝背屈動作的感覺動作皮質區呈現雙側活化，另外兩位呈現對側活化型態。結論：初步研究結果顯示慢性期中風患者接受四週踩車運動訓練後下肢動作功能、步行耐力和速度多有進步。然而，功能進步與感覺動作皮質區的活化型態並無一致關聯性。

並列關鍵字

中風 ； 踩車訓練 ； 功能恢復 ； 功能性核磁共振造影 ； 皮質活化