Study On Evaluating The Neuromuscular Function Based On Blood Circulation And Applications To Facial Palsy And Hemiplegia

In the past,clinical and scientific investigators used to treat nervous system diseases and blood circulation diseases separately and independently.With findings in researches involving both nervous system and blood circulation system,it has been found that the nervous system and blood circulation system are coupled both structurally and functionally.Neural function will affect blood circulation function,and blood circulation function will also affect nervous function.Since 2001,the researchment of neurovascular coupling has been increasing exponentially.However,most of the existing researches on neurovascular coupling are focused on the central nervous system,more attentions should be paid to the coupling between peripheral neuromuscular system and blood circulation system.In this study,the function of peripheral neuromuscular system was evaluated by its blood circulation information.The peripheral facial palsy and post-stroke hemiplegia were selected as objects for neuromuscular system function evaluation.For peripheral facial palsy,Laser Speckle Contrast Imaging(LSCI)technique was used for noninvasive real-time imaging of facial tissue blood flow;for hemiplegia,Near-infrared Spectroscopy(NIRS)technique was used for noninvasive real-time measurement of hemoglobin concentration variations of limb muscle.85 cases of peripheral facial palsy with different states of illness have been measured in this study.The results showed that the microcirculatory blood flow of facial tissue was related to the disablement of facial nerve.The blood flow of the affected side of face was lower than that of the healthy side in patients with facial palsy,and the blood flow of both sides of faces was almost equal on healthy man.We used Pr value(the ratio of healthy side blood flow to affected side blood flow)to indicate the degree of blood flow difference between healthy side and affected side of face.The more serious the condition was,the higher the Pr value.The correlation coefficient between Pr value and the House-Brackmann(HB)scale,which is the gold standard for evaluating facial palsy,was 0.827(P < 0.01).There also existed significant differences of Pr value among different HB groups(P < 0.01).Commonly used physical interventions for facial palsy can change the blood flow of facial tissue,for example acupuncture can decrease the Pr value by 9.31% on average,and it can improve the balance of blood flow distribution between affected and healthy sides.In summary,the feasibility of evaluating the state of facial palsy through blood flow information was verified experimentally.30 paticipents with hemiplegia post stroke have been measured in this study.It has been showed that the blood flow of affected limb muscles was similar to it of the healthy side,but there existed significant difference in blood oxygen consumption rate between the two sides of muscle(P < 0.01),whether in the experiment paradigm of blood flow obstruction,or in the experiment paradigm of muscle contraction.The blood oxygen consumption of the affected side muscle was significantly lower than that of the healthy side.However,in the affected side of limb,there was no significant correlation existed between the variations of hemoglobin concentration and the Fugl-Meyer(FM)scale,which is a commonly used scale for evaluating dyskinesia.Therefore,this study proved that the affected muscle function of hemiplegia can be assessed by its muscle oxygenation information,but the degree of dyskinesia can not be assessed completely only by muscle oxygenation information.It has been shown that the spatial distribution of blood oxygen was heterogeneous during muscle contraction,but the large size of muscle oxygen imaging equipment-Positron Emission Tomography(PET),magnetic Resonance Spectroscopy(MRS)and so on limited their application in muscle oxygenation studies.In this study,we constructed a portable multi-channel NIRS system to acquire the temporal and spatial characteristics of muscle oxygenation simultaneously.The spatio-temporal characteristics of muscle oxygenation under different rehabilitation paradigms(active,passive and imaginary exercise)were investigated.During active and passive exercise,a significant decrease has been observed in muscle oxygen hemoglobin concentration and blood flow variations(P < 0.05),and a significant increase in the heterogeneity of muscle oxygen hemoglobin concentration and blood flow distribution(P < 0.05)has also been observed during these two types of exercise.The amplitude of oxygen hemoglobin concentration and blood flow variations during passive exercise was less than that during active exercise;and the location where oxygen hemoglobin concentration changed during active exercise was correspond to the loaction of contracted muscles,while it was not correspond to the loaction of moved muscles during passive exercise.These results showed that both active and passive exercise have effects on muscles,while imagenary exercise is related to brain activity and has nearly no effect on muscles.Finally,we try to combine Surface Electromyography(sEMG)with facial blood flow imaging technology to establish a method for neuromuscular and blood circulation coupling research.Some pilot studies has been conducted in evaluating the state of facial palsy by sEMG technique,including sEMG mapping and muscle synergy analysis.It has been found that the two methods can reflect the most affected facial nerve branches and muscles precisely.Through flexible transparent electrode fabrication technology,we can integrate sEMG technology with laser speckle imaging technology,and measure EMG and blood flow signals simultaneously in the future.