FMRI Research On Brain Mechanisms Of Stroke And Normal Movement Of The Hands And Feet

Objectives Human hands and feet can perform different complexity motion, motorcortical damage will lead to different degrees of motor dysfunction. BOLD-fMRI asnon-invasive imaging method, with the advantage of high spatial resolution andtemporary resolution, has been widely used in the study of brain function. Previously,more researches concentrate on motor function under single mode of motion, lessreports about multiparameter comparative study under both simple and fine motion ofthe hand and foot.The purpose of this study is to clarify the features of cerebral activation of handsand feet motion and explore the common and relatively specific neural basis of fine andsimple motion,from which we can provide theoretical basis to analyze functionreorganization of patients with cerebral infarction and help to evaluate the effect ofclinical rehabilitation training.Methods Fourteen right-handed healthy volunteers(seven male, seven female) withmean age of23years old were involved in this study. Hands movement include wristflexion-extension, fisting and tremolo movement. Feet movement include ankle flexionand extension, plantar flexion and toe movement.Real time functional magneticresonance imaging was performed with block design,, AVOVA analysis and multiplecomparative analysis were used under SPM2software.Results (1)Features of cerebral activation under hands movementThe common activated regions of simple and complex hand movements located atcontralateral SM1, SMA, bilateral prefrontal lobe and contralateral thalamus andlentiform nucleus.Compared with simple movement,the relatively specific activatedareas of on complex hand movement include that left hand movements activated SM1, bilateral premotor cortex, cingulate gyrus, superior parietal lobule (BA40), the medialprefrontal cortex (BA9), inferior parietal lobe and occipital significantly (P <0.05),right hand movements activated right superior parietal and cingulate motor areasignificantly (P <0.05), and activation effect of tremolo movement is the mostsignificant; Compared with right hand, non-dominant hand (left hand) significantlyincreased brain activation on fine movement, the area of activated regions increasedsignificantly.(2) Features of cerebral activation under foot movement taskNo clear cerebral activation was found under the task of ankle flexion and extension.Left foot plantar flexion movement activated contralateral paracentral lobule, bilateralprefrontal cortex, cingulate cortex and cerebellum, left toe movement activatedcontralateral paracentral lobule, the ipsilateral superior parietal lobule (BA7), cingulategyrus, bilateral frontal lobe, cerebellar hemisphere; the right foot plantar flexionmovement activated contralateral paracentral lobule, bilateral frontal lobe andcerebellum, right foot toe movement activated contralateral paracentral ipsilateralparietal lobe, bilateral frontal lobe, cerebellar hemisphere. Interaction analysis indicatedthat three kinds of movements of the left foot activated contralateral paracentral lobule,bilateral cingulate and prefrontal cortex significantly (P <0.05) and three kinds ofmovements of right foot activated contralateral paracentral lobule,the lateral prefrontalcortex and ipsilateral superior parietal lobule greatly(P <0.05).(3) Significantly interactive brain regions on movement of hands and feetInteractive analysis indicated that great activation in contralateral SM1and ipsilateralcerebellum was observed in the left and right hand movement and great activation in thecontralateral paracentral lobule and ipsilateral cerebellar hemisphere was found in theleft and right foot movement(P <0.05).Conclusion(1) Different neural basis were involved in hands and feet movement, distribution ofmotor function area consistent with inverted villain theory, hand movement is influenced by the contralateral SM1and ipsilateral cerebellum, and foot movement hascolsely related with paracentral lobule and ipsilateral cerebellum; Activation of primarymotor areas is consistent with classical crossover dominance theory.(2) There exsisted common and relatively specific neural neural basiss between fineand simple movement.Additional brain areas involved in fine movement compared withsimple movement; Subdominant hand motion activated more functional areas comparedto dominant hand.(3) Cerebellar hemisphere divided finely into two adjacent parts (3and4,5) incontrol of hand and foot movement. Anterior part (3) controlled the ipsilateral footmovement, while part (4,5) controlled the ipsilateral hand movements. Objective Stroke is one of the most common disease, more than about75percent ofpatients remain motor dysfunction in different degree, and serious impact on patients’quality of life. In recent years, it is proved that patient’s movement function after strokeis possible to rehabilitation and brain tissue has the ability to repair itself function. Thissocalled brain plasticity is an important foundation for clinical treatment of cerebralinjury. fMRI has become an important mean to evaluate cerebral functionalreorganization of the existing functional area surrounding brain lesions in patients withhemiplegic because of its non-invasive, high temporary, spatial resolution and wellfunction location.In this part,the differences of cerebral activation between patients withacute stroke and normal volunteer were analyzed,and the founctional injury and reorganization in patients with cerebral infarction were explored so as to guide theclinical rehabilitation.Methods Twelve patients with Acute stroke and movement disorders were involved inthia study(seven male, five female, age range42-72years, average age is55.3±2.7).All patients suffer from stroke less than a week, myodynamia≥III. Infarctionsdistributed in grey matter adjacent to unilateral lateral ventricle, basal ganglia, thalamusor pons respectively. all patients received real time functional magnetic resonanceimaging under the task of hand fist movement and foot plantar flexion motionThis withblock design, AVOVA analysis and multiple comparative analysis were used to analyzethe functional data under SPM2software.Results(1)Cerebral activation under the paretic hand movementThe left hand movement activated bilateral SM1, PMA,SMA, cingulate, prefrontalcortex, parietal lobe, occipital lobe cerebellum and the right hand movement activatedthe bilateral SM1, SMA, PMA, superior parietal lobule, inferior parietal lobe, cingulate,prefrontal cortex, occipital lobe, cerebellum.(2) Difference of the brain activation between patient with stroke and normal volunteerCompared with the normal volunteer,right hand motion of patient activated bilateralSM1area (the right obviously), bilateral SMA, parietal cortex, prefrontal cortex,cerebellar hemisphere.Left hand movement activated bilateral SM1(mainly on the leftside), SMA, premotor cortex, parietal and prefrontal cortex, left cerebellar hemisphere.The difference was statistically significant (P <0.05)(3)Cerebral activation under the paretic foot motion: the left foot movement activatedcontralateral paracentral lobule and cingulate and the right foot movement activatedcontralateral paracentral gyrus and superior parietal lobule.(4) The relatively specific activations in patients compared with normalCompared with normal, paretic foot movement activated more brain areas thannormal,but no difference was found between. left and right. Left paretic foot movement activated the right side of paracentral lobule, right side of PMA greatly (P <0.05).Right paretic foot movement activated the left superior parietal lobule, right paracentrallobule greatly(P <0.05).(5) Follow up of a case with infarction in right hemisphereThe left paretic hand movement activated bilateral SM1, SMA, premotor cortex and leftinferior parietal lobule at the acute stage,the follow-up fMRI indicated activation of theright SM1and bilateral SMA four months later.The left foot movement activatedtemporal lobe and bilateral basal ganglia, cerebellar hemisphere and vermis at the acutestage,while more activations were found at the follow-up fMRI study4months later.Conclusion(1) Founctional reorgnization was found in stroke patients with movement disordersboth in primary and secondary motor areas, paretic hand motion activated bilateralSM1, SMA, cingulate gyrus, occipital lobe and cerebellum, compared to normalvolunteer.(2) Foot movement in patients with hemiparesis after stroke has poor compensatoryfounction.The extent of activation is significantly smaller than stroke patients with handmovement disorder, which suggested that it is difficult for stroke patient with footmotion dysfunction to recover.