Analysis Of Brain Functional Connectivity Characteristics And The Effect Mechanism Of Acupuncture Comprehensive Intervention In Post-stroke Subcortical Aphasi

Objective:Based on resting state functional connectivity method,this main aim of the study was to analyze the characteristics of cerebral functional connectivity in patients with subcortical aphasia after stroke,and to explore the natural and the acupuncture comprehensive therapy-induced recovery mechanism of language function in post-stroke subcortical aphasic patients.Methods:In part-one section,24 patients with post-stroke subcortical aphasia in their recovery period were selected,whose disease duration was 65.46±39.45 days,and who didn’t have language rehabilitation treatment before enrollment.12 healthy subjects with age,sex,and hand matching were included as the control group for cross-sectional analysis.On the day of enrollment,demographic data,Boston Diagnostic Aphasia Examination,Chinese Rehabilitation Research Center Standard Aphasia Examination or Western Aphasia Examination were collected,and resting state functional magnetic resonance scans were performed.After the score of the unified linguistics scale(formula:conversion score=sum of CRRCAE sub-items/item of maximum item × highest score of WAB sub-item),the left and right Brodamann’areas 44 and 45 districts of patients and healthy subjects were extracted as the region of interest,then the Broca’s areas were analyzed for functional connectivity with the whole brain.SPM12 and Conn were used for statistical analysis.The two-sample T-test was used to compare brain regions with different functional connectivity between groups and to extract each patient.The average functional connectivity values of the differences in brain regions and ROIs were analyzed by Pearson correlation with language assessment scales.In part-two section,14 subcortical aphasic patients who agreed to be treated with acupuncture comprehensive program were used as research objects.Using the self-control study method to conduct analysis,the Western Aphasia Test and Boston’s Diagnostic Aphasia Examination were used to assess the efficacy before and after intervention.Then the bilateral Broca’s region was also used as the ROI to perform functional connectivity analysis with the whole brain.Paired T-test was used to find brain regions with functional differences between the pre-treatment and ROI,followed by 14 acupuncture treatments for 1 month.The Pearson correlation analysis was performed on the difference between the difference in brain area and ROI before and after treatment in patients with aphasia,and the difference between before and after treatment in clinical language assessment scales.Results:In part-one section,the functional connectivity of the right Broca’s area to the left TPJ Lower was greater than that of healthy subjects and was positively correlated with Boston’s diagnostic aphasia score(r=0.48);In,in terms of linguistic assessment,the information volume,fluency,comprehension,retelling,naming,and aphasia changes in the diagnostic aphasia in Boston and the Western aphasia scale were statistically significant(P<0.05).At the level of brain functional connectivity changes,the functional connectivity between the left Broca’s area and the left occipital lobe and the left central frontal gyrus was enhanced.The functional connectivity between the left Broca’s area and the left occipital pole was positively correlated with changes in the paraphrase score(r=0.54),The functional connectivity between the right Broca area and the upper TPJ Upper is enhanced;the functional connectivity between the right Broca area and the medial prefrontal cortex/cingulate cortex(mPFC/acc)is reduced,and changes are associated with Boston’s aphasia.There was a negative correlation between changes in the BDAE test(r=0.66).Conclusion:This study found that there were specific changes in brain functional connectivity in patients with subcortical aphasia after stroke compared with healthy subjects.It was speculated that the mechanism of language function recovery in the subcortical aphasia under natural conditions was related to the enhanced connectivity between Broca’s area and left TPJ lower,which supports the functional plasticity of the right hemisphere during the recovery of aphasia.The intervention of acupuncture comprehensive treatment program promotes the recovery of subcortical aphasia by enhancing the functional connectivity in the dominant hemisphere,in which the left occipital lobe and the left central anterior gyrus play a certain function of reorganization and compensation during the rehabilitation process.While the function connectivity of the left hemisphere increases,right hemispheric functional activity is again inhibited.This result has consistency in contrast with the current mainstream research that the right hemisphere activation is decreased,and the activation site re-transition to the dominant hemisphere lesion is the general recovery of aphasia after intervention.Highlight of innovation:For the first time,our research used the resting state functional connectivity method to make a meaningful exploration of the recovery mechanism of post-stroke subcortical aphasia under the intervention of acupuncture comprehensive program based on integration of the body and the spirit theory,and provided evidence support for the mechanism of acupuncture comprehensive treatment of aphasia.