| ObjectiveThe study aimed at observe the clinical effect of selective spinal massage therapy(SSMT) for cerebral ischemic stroke(CIS) survivors with hand dysfunction. And observing the influence of brain functional connectivity of patients with application of functional magnetic resonance imaging(f MRI) technology during resting-state, in order to explore the central mechanism on improving hand dysfunction with SSMT.Methods60 patients were randomly divided into the treatment group(n = 30) and the control group(n = 30). All the patients accepted routine rehabilitation, and the patients in the treatment group accepted SSMT in addition for 3 courses. Treatments were given every day for total 10 times as one course, every courses given between 2days apart, each session lasted for 30 minutes. They were assessed with manual muscle test(MMT), Fugl-Meyer assessment of motor recovery(FMA), the hand motor status scale and national institutes of health stroke scale(NIHSS) before and after treatment. In the same period, 30 patients were randomly selected from the treatment group(n = 15) and the control group(n = 15). These patients which accepted routine rehabilitation received f MRI scan before and within 1 week after the end of treatment. Observed the similarities and differences of the f MRI brain imaging between two groups, and to explore the relationship between related brain regions with motor and other function. The imaging and clinical data were collected and analyzed with statistics method.Results1. The FMA score of the treatment group before treatment was 9.90 ± 2.96,treatment of 3 courses was 22.80 ± 7.64, the total effective rate was 90%; Controlgroup before therapy was 9.23 ± 2.99, treatment of 3 courses was 17.20 ± 5.53, the total effective rate was 63.3%. Before treatment, there was no significant difference between two groups(P> 0.05). The score of FMA improved in both groups after treatment(P < 0.01), while the scores of the treatment group were significantly higher than that of control group after 3 courses treatment(P < 0.01).2. The hand motor status scale by rank sum test, before treatment, there was no significant difference between two groups(P > 0.05). The hand motor status improved in both groups after 3 courses of treatment(P < 0.01), while the scores improved more in the treatment group than in the control group after treatment(P <0.01).3. The MMT scale of wrist joints by rank sum test, before treatment, there was no significant difference between two groups(P> 0.05). The MMT scale of wrist joints improved in both groups after 3 courses of treatment(P < 0.01), while the scale improved more in the treatment group than in the control group after treatment(P <0.05).4. The NHISS score of the treatment group before treatment was 11.00 ± 4.65,treatment of 3 courses was 3.57 ± 2.46; Control group before therapy was 10.27 ±4.60, treatment of 3 courses was 5.70 ± 2.90. Before treatment, there was no significant difference between two groups(P> 0.05). The score of NIHSS improved in both groups after treatment(P < 0.01), while the scores of the treatment group were significantly higher than that of control group after 3 courses treatment(P < 0.01).5. The date of f MRI show that:There were significant differences in two groups for the leave of m ALFF(P <0.05). The treatment group showed increased and decreased brain regions in m ALFF in the resting state compared with controls. The increased m ALFF was distributed over the primary sensorimotor cortex(SMC), premotor cortex(PMC), supplementary motor area(SMA), somatosensory cortex, somatosensory association cortex, motor speech area, visual speech area, limbic system and other brain structures involved in advanced cognitive functions. The decreased Re Ho was found in motor speech area,visual speech area, auditory speech area, cerebellum(CRB), limbic system and otherbrain structures involved in advanced cognitive functions.There were significant differences in two groups for the leave of sm Re Ho(P <0.05). The treatment group showed increased and decreased brain regions in sm Re Ho in the resting state compared with controls. The increased sm Re Ho was distributed over the somatosensory association cortex, motor speech area, CRB and the prefrontal cortex. The decreased Re Ho was found in motor speech area, visual speech area,auditory speech area, CRB, limbic system and other brain structures involved in advanced cognitive functions.There were significant differences in two groups for the leave of fc MRI(P <0.05). The treatment group showed increased and decreased brain regions in fc MRI in the resting state compared with controls. The increased fc MRI was distributed over the PMC, somatosensory cortex, somatosensory association cortex, supramarginal gyrus, SMA, motor speech area, visual speech area, auditory speech area, CRB,limbic system and other brain structures involved in advanced cognitive functions.The decreased fc MRI was found in PMC, SMA, visual speech area, visual speech area, supramarginal gyrus, CRB, limbic system and other brain structures involved in advanced cognitive functions.Conclusion1. SSMT in combination with routine rehabilitation and routine rehabilitation may promote the recovery of flaccid hand and upper extremity function after CIS. The effect of SSMT in combination with routine rehabilitation is better than routine rehabilitation treatment alone. It is the embodiment of the integrated traditional and western medicine, and a therapy of systemic and local modality in combination,enriching rehabilitation therapy.2. SSMT may improve the regional function and the leave of brain functional network. It was distributed over the hand motor functional area, somesthetic area,language area and other brain structures involved in advanced cognitive functions,suggesting that it could induce brain functional reorganization and compensation. |
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