Functional Near-infraed Spectroscopy Studies During Motor Imagery And Motor Execution In SCI Patients

Objective:About 13%of SCI patients have physical motor dysfunction every year^[1],which not only seriously affects patients’self-care ability in daily life,but also brings huge economic burden to patients’families and social medical system.Therefore,how to promote the recovery of patients’motor function after SCI has become one of the most important topics at present.The purpose of this study is to explore the brain region activation mode of motor imagination（MI）and motor execution（ME）in spinal cord injury（SCI）patients through near-infrared brain functional imaging technology（f NIRS）,and to provide a neuroimaging theoretical basis for MI and ME to treat limb motor dysfunction in SCI patients.The study is divided into three chapters:1.An f NIRS study during motor imagery and motor execution in healthy adults;2.An f NIRS study during active motion and passive motion in healthy adults;3.An f NIRS study during motor imagery and motor execution in spinal cord injury patients.Methods:1.Task designBlock design was used.2.Task mode and groupingChapter 1:30 healthy adults,with the MI and ME of the"flexion and extension of the right knee"action as the task mode,compared the brain area activation mode of the two task states;Chapter 2:15 healthy adults,with the active and passive movements of"flexion and extension of the right knee"as the task mode,compared the brain area activation mode of the two task states;Chapter 3:23 healthy adults as healthy group and 21 SCI patients as SCI group took MI and ME of"flexion and extension right knee"as the task mode,comparing the brain area activation mode of MI and ME between the two groups.3.Test indexOxygenation hemoglobin concentration△Hb O and activation intensity quantified indexβ1 value.4.Statistical softwarePerformed data analysis using Nirspark software and SPSS 23.0.Results:1.Lanes 2、3、4、5、7、9、19、20、21、24、25、26、27、32、33、34 were significantly activated during the ME task（P<0.05,corrected by F D R）and lanes 2、5、9、16、27、29、33、34、35 were significantly activated during the MI task（P<0.05,corrected by FDR）.According to the channel brain region registration information:The brain region activation pattern was similar during both MI and ME tasks in healthy adults,including left primary motor cortex（L-M1）,left primary sensory cortex（L-S1）,prefrontal pole,Broca triangle,and right supramarginal gyrus;Both L-M1 and left pre-motor cortex（L-PMC）were activated during MI in healthy adults,whereas dorsolateral prefrontal cortex（DLPFC）and only L-M1 of the motor region were activated during ME;2.Compared to MI,the activation intensity of left sensory and left motor cortex was significantly enhanced in ME,and that of left and right prefrontal cortex especially left and right Broca’s area（P<0.0001,corrected by FDR）were extremely significantly enhanced.3.During the active exercise task,channels 2,3,4,5,7,11,12,19,20,23,2,24,25,26,27,32,33 and 34 were activated（P<0.05 without FDR correction）;During passive motion task in the healthy adults,channels3,4,5,11,19,19,20,21,21,23,25,26,32,and 35 were activated（P<0.05,without FDR correction）.According to the channel brain area registration information,healthy adults have the similar brain region activation during active and passive flexion and extension right knee movements,including left and right Broca’s area,left and right dorsolateral prefrontal areas（L/R-DLPFC）,left sensory area（L-SA）and left motor area（L-MA）.4.The left primary sensory cortex,left motor area,supramarginal gyrus and left pars triangularis Broca’s area were coactivated during both ME and MI in healthy group as well as MI in SCI group（P<0.05,corrected for FDR）;5.Channel 24（t=2.976,P=0.016,corrected by FDR）,namely,left dorsolateral prefrontal cortex（L-DLPFC）was activated in healthy group during ME,no corresponding channel of L-DLPFC was activated during MI in both groups（t>0,p>0.050,corrected by FDR）.6.Compared to the healthy group,the activation of L-DLPFC increased in the SCI group during MI（t=1.517,P=0.034）.7.Channel 18,namely,right motor area（R-MA）was activated（t=3.033,P=0.045,FDR）in SCI group during MI,and no R-MA（t>0,p>0.05,corrected by FDR）was activated in healthy group during MI;Compared with the healthy group during MI,the activation of the right sensory area（R-SA）increased during MI in the SCI group（t=1.843,P=0.009）;After the general linear model（GLM）analysis:only 10 SCI patients had a significant activation in left primary motor cortex（L-M1）（t>0,P<0.05,without FDR correction）during ME;Compared with10-matched healthy adult,the 10 SCI patients had significantly more activation in channel 18（t=3.278,P=0.004,without FDR correction）and channel 30（t=2.098,P=0.049,without FDR correction）during ME,according to the channel registration information,there were significantly more activation in the right primary motor cortex（R-M1）and R-SA.8.Ten patients with L-M1 activation during ME,34（t=2.559,P=0.031,without FDR correction）and 30（t=2.147,P=0.047,without FDR correction）with a degree of 18 channel（t=2.103,P=0.054,without FDR correction）,the 10 patients had L-M1,R-SA and R-M1 activation during ME;The other seven patients without L-M1 activation during ME,channel 34（t=-2.011,P=0.091,without FDR correction）,18,31 channels（t<0,P>0.05,without FDR correction）,1,15,17,30（t<0,P>0.05,without FDR correction）,according to the channel brain region registration information,L-M1,R-M1,and R-SA were not activated during the ME in these seven patients.Conclusion:1.This trial proved the rationality of MI therapy based on the cortical angle of healthy adults;2.During ME in healthy adults,the L-DLPFC is involved in motor decision-making and possibly in the bidirectional feedback regulation of PMC-M1;3.Broca district,what is closely related to the motor program understanding,participates in MI and ME of healthy adults;4.Passive motion can be used instead of active motion for f NIRS studies of brain function in patients with SCI.5.MI treatment in patients with SCI can somewhat simulate the activation pattern of ME brain area in healthy people.6.Increased L-DLPFC activation during MI in SCI patients may be related to enhanced motor sequence learning.7.Sensorimotor cortex reorganization can occur during MI and ME,participating in the recovery of motor function after SCI.