| Objective: Cerebral infarction is known to be a frequently occurringdisease in clinical practice. About60%～80%patients left motor dysfunctionafter the disease, and finally10%of them left severely disabled. Thecombination therapy of acupuncture and rehabilitation treatment is one of thehot spots in research of exercise rehabilitation therapy for stroke patients.Acupuncture, especially scalp cluster acupuncture will help to establishcollateral circulation, so as to promote blood reperfusion of infarction area.Constraint-induced movement therapy (CIMT) is a promising rehabilitationtreatment, and it’s clinical curative effect is significantly better than traditionalrehabilitation methods. However, few research for the combination therapy ofscalp cluster acupuncture and CIMT has been reported, and it’s curative effectis yet uncertain.Nowadays, the development of blood oxygenation level dependentfunctional magnetic resonance imaging (BOLD-fMRI) provide a better way toobserve and analysis dynamic changes of the compensation of brain functionand the functional recovery in motor cortex after cerebral infarction. Thepurpose of this study was to compare the curative effect of the combinationtherapy of scalp cluster acupuncture and CIMT with that of conventional bodyacupuncture and rehabilitation therapy on hand movement disorders inpatients with cerebral infarction using BOLD-fMRI, in order to optimize thetreatment planning for acute cerebral infarction and provide theoretical basisfor clinical application of the combination therapy of scalp cluster acupunctureand CIMT. Methods:30acute cerebral infarction patients with hemiplegia whosedisease course was less than3days and muscle strength of the affected upperlimb was less than grade III were involved into the treatment study. They wererandomly divided into two treatment groups, with15of them administeredscalp cluster acupuncture and CIMT as the test treatment group, while theother15patients received routine body acupuncture and rehabilitationtreatment as the control treatment group. Before and after a two-weektreatment, all patients had a passive digital opposition movement BOLD-fMRIperformed on a GE Discovery MR7503.0T MR scanner, and the Fugl-Meyerassessment (FMA) was evaluated at the same time. Fifteen healthyright-handedness volunteers with a comparative age and gender to thetreatment groups performed BOLD-fMRI with the same task for both hands.The position, volume and intensity of the activated areas were compared.Result: Obvious activation in the contralateral matosensory motor cortex(SMC) and the ipsilateral cerebellum can be detected in all the15healthyvolunteers. The number of activated brain areas in the30patients increasedobviously with a more scattered distribution. For convenience, thecontralateral SMC was selected as the region of interest (ROI) for thecomparison of the activation under the passive digital opposition movementtasks in different groups.The activated volume (459.5±50.8for left hand task, and436.0±51.1forright hand task, t=0.219, P=1.258) and intensity of the contralateral SMC(7.45±0.51for left hand task,7.41±0.56for right hand task, t=0.535, P=0.627)had no significant difference between left and right hand tasks in healthyvolunteers. Compared with healthy volunteers group, the activated volume andintensity of the contralateral SMC decreased significantly for all the treatmentgroups both before and after treatment (P<0.05). Before treatment, theactivated volume and intensity of the contralateral SMC, and the FMA had nosignificant difference between the two treatment groups. After the treatmentincreasing of activated intensity and volume in contralateral SMC wasobserved in both of the two treatment groups, so was the FMA. The differenceof the activated volume [108(110) for the test treatment group，and38(62)for the control treatment group, Z=2.386, P=0.017] and intensity [2.28(1.80) forthe test treatment group, and1.53(0.73) for the control treatment group,Z=2.365,P=0.018]of the contralateral SMC, and the FMA [48(23) for the testtreatment group, and31(13) for the control treatment group, Z=3.237,P=0.001] before and after treatment in test treatment group was larger thanthose of the control treatment group significantly.Conclusion: Compared with conventional method, the combinationtherapy of scalp cluster acupuncture and CIMT can achieve a betterimprovement of the contralateral SMC functional recovery in patients withacute cerebral infarction. BOLD-fMRI can observe the functional recoveryintuitively and quantitatively, and is valuable in evaluation of the curativeeffect of rehabilitation treatment on acute cerebral infarction. |
PDF Full Text Request