基于功能性近红外光谱技术观察缺血性脑卒中患者患侧上肢屈肘任务下的皮质激活特征OA

Objective To observe the cortical activation characteristics in patients with ischemic stroke during the elbow flex-ion task of the affected upper limb based on functional near-infrared spectroscopy(fNIRS).Methods A total of 80 inpatients with ischemic stroke admitted to Beijing Rehabilitation Hospital Affiliated to Capital Medical University from January 2023 to June 2024 were enrolled,including 40 cases with left hemiplegia and 40 cases with right hemiplegia.According to Fugl-Meyer Assessment-Up-per Extremity(FMA-UE),patients with FMA-UE score>43 were assigned to the mild group,and those with FMA-UE score≤43 were assigned to the severe group.Among them,there were 20 cases in both the mild and severe subgroups of left hemiplegia,as well as 20 cases in both the mild and severe subgroups of right hemiplegia.Meanwhile,20 healthy subjects were included as the con-trol group.Referring to the Brodmann cortical areas,14 regions of interest(ROIs)were defined bilaterally,including the dorsolateral prefrontal cortex(DLPFC),frontal polar area(FPA),primary motor cortex(M1),supplementary motor area(SMA),premotor cortex(PMC),somatosensory cortex(SMC),and Broca's area.The fNIRS data of patients during the elbow flexion task of the affected up-per limb were collected using an fNIRS device with a sampling frequency of 20 Hz and a block design,and the total task duration was set at 180 s.Oxyhemoglobin(HbO₂)was used to identify the activated channels,and the activation rate was calculated.The lat-erality index(LI)was adopted to evaluate the dominance of activation between the left and right cerebral hemispheres during the spe-cific task.Results Compared with the control group,the mild left hemiplegia group had higher activation rates in all SMA&PMC channels(P<0.05),while the severe left hemiplegia group showed elevated activation rates in global brain channels,all SMA&PMC channels and the right hemisphere channels(P<0.05);the severe left hemiplegia group also presented higher activation in global brain channels,all SMA&PMC channels and the right hemisphere channels than the mild left hemiplegia group(P<0.05).The mild right hemiplegia group exhibited higher activation in the right hemisphere channels of DLPFC(P<0.05)compared with the control group,whereas the severe right hemiplegia group had higher activation in global brain channels,all SMA&PMC channels,all DLP-FC channels and the right hemisphere channels(P<0.05);the severe right hemiplegia group also showed higher activation in global brain channels,all SMA&PMC channels,the left hemisphere channels,all DLPFC channels and the right hemisphere channels than the mild right hemiplegia group(P<0.05).Both mild and severe left hemiplegia groups had stronger right hemisphere activation than the control group;the severe left hemiplegia group presented stronger M1 and PMC activation in the right hemisphere than the mild left hemiplegia group,while the latter had stronger DLPFC and SMA activation in the right hemisphere than the former.Both mild and severe right hemiplegia groups showed relatively balanced bilateral DLPFC and SMA activation compared to the control group;the severe right hemiplegia group had stronger left M1 activation than the mild right hemiplegia group,while the mild hemiplegia group exhibited stronger left PMC activation than the severe right hemiplegia group.The LI of each brain region in the right mild hemiplegia group tended to approximate that of the control group.Conclusion When patients with ischemic stroke performing the elbow flexion task with the affected upper limb,severe patients have higher activation rates in SMA&PMC and DLPFC,while mild patients have LI values closer to those of healthy controls.The differences in cerebral cortical activation are associated with the severity of motor dysfunction and the damaged hemisphere.