由三種功能性神經造影看中風患者之動作恢復機制

偏癱是中風後最常見的症狀，影響了80%的急性期病人的功能及大於40%慢性期的病人。我們對中風發生後的恢復機制仍然不是完全了解。以往我們都是經由經驗觀察、評估量表、步態分析及肌電圖來得知病人動作障礙的表現及動作單元的活化。近十年來發展的神經造影技術，則把我們對中風的了解推向一個新的領域。我們關心的不只是動作的表現，還包括大腦的活化模式及神經機制。本文首先介紹三種功能性神經造影技術，包括功能性磁振造影(functional MRI)、正子斷層攝影(PET scan)、穿顱磁刺激(TMS)。功能性磁振造影相對於其他兩種工具具有比較好的空間解析度、且不須使用放射線介質而重覆性較高，穿顱磁刺激的解析度雖可高達數十毫秒，但相對而言空間解析度不如功能性磁振造影，然而價位也較低。因此三種功能性神經造影技術各具優缺點，能夠分別促進我們對於腦中風後神經系統重塑以及功能恢復機制之了解。其次介紹中風後的可塑性現象（自發性重組、遠端區域的徵募、特殊區域的延伸、增加未受傷區域的活化）及三種造影技術在中風的研究成果。本文最後結合大腦重組和功能恢復的關係，期望能提供神經物理治療策略的參考。

關鍵字

中風；功能性神經造影；可塑性；物理治療

並列摘要

Hemiparesis is the most common symptom involving 80% of acute patients and more than 40% of chronic patients. Motor recovery after stroke is an important issue for clinician and family and the predictive factor of prognosis after stroke is also important. Historically, we learn about the motor recovery after stroke through experiences, clinical observations, evaluation scales, gait analysis, and EMG findings. Last decade, improvement of functional neuroimaging techniques advanced our knowledge about the recovery mechanism significantly. In this paper, we introduce three functional neuroimaging techniques. The fMRI is better than PET in both temporal and spatial resolution. The TMS is cheaper than fMRI and temporal resolution is 10 ms better, however the spatial resolution was worse. The PET requires the use of radioactive agents, thus lacks repeatability. Plasticity such as spontaneous reorganization, recruitment of remote area, extension of specialized areas and increased activity in nonspared areas after stoke has been shown with the functional neuroimaging techniques. It is recommended that bilateral activities, forced-use technique, and techniques to enhance proprioceptive feedback (such as passive ranges of motion exercises and proprioceptive neuromuscular facilitation) be used to enhance the motor recovery after stroke.

並列關鍵字

Stroke ； Functional neuroimaging ； Plasticity ； Physical therapy

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由三種功能性神經造影看中風患者之動作恢復機制

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