基于镜像神经元理论的动作观察疗法对卒中后吞咽障碍的作用及其神经机制研究

Dysphagia has been commonly found in post-stroke patients. The current treatment of post-stroke dysphagia has limited effectiveness. Action observation therapy (AOT) based on mirror neuron theory has been preliminarily applied in the rehabilitation of post-stroke dysphagia and achieved obvious effects, but lack of systematic and in-depth comparative study, and its neural mechanism is not yet clear. It has been confirmed that there exists common neural nodes between the mirror neuron system (MNS) and the swallowing neural network. We hypothesize that AOT may facilitate recovery of swallowing neural networks by activating the MNS especially those common neural nodes. In this study, we will use neuronavigated transcranial magnective stimulation and fMRI in post-stroke dysphagic patients after 4 weeks AOT treatment. Using these techniques together, we will detect the excitability changes of the swallowing motor conduction pathway, activation and functional connection changes of the swallowing neural network. We aim to reveal the role of common nerve nodes in the regulation of these two neural networks, and explore the underlying neural mechanism of the AOT treatment on the functional recovery of swallowing in post-stroke patients. This study has important theoretical significance on this novel therapy for post-stroke dysphagia rehabilitation.

吞咽障碍是卒中患者常见症状，目前很多治疗手段疗效欠佳。基于镜像神经元理论的运动观察疗法（AOT）已初步应用在卒中后吞咽障碍的康复并取得明显效果，但仍缺乏系统深入的对比研究，且其神经机制尚未明确。已证实，镜像神经元系统（MNS）与吞咽神经网络存在共同神经节点。因此我们假设，AOT可能通过激活包括这些共同神经节点在内的MNS促进卒中后吞咽中枢神经网络功能重组。为此，本研究采用导航经颅磁刺激运动诱发电位测定技术结合fMRI技术，评价卒中后吞咽障碍患者在接受4周AOT干预后吞咽运动传导通路兴奋性改变、吞咽脑区激活情况及吞咽神经网络功能连接变化，明确MNS与吞咽神经网络之间的连通性及共同神经节点在两个神经网络中的调控作用，揭示AOT对卒中后吞咽中枢神经网络功能重组机制，为AOT在卒中后吞咽障碍的康复提供理论依据。

卒中后吞咽障碍的康复疗法往往所需康复周期长且临床疗效欠佳。因此，探寻新型高效卒中后吞咽障碍康复技术，探讨其作用机制，突破当前卒中后吞咽障碍的康复治疗瓶颈，是亟待解决的问题。镜像神经元是人们进行动作观察和动作执行时均被直接激活的神经元，存在双侧半球多个脑区，构成镜像神经元系统。动作观察疗法是基于镜像神经元理论的新型中枢康复策略，我们在临床工作中发现动作观察疗法有利于卒中后吞咽障碍患者康复，但其具体作用及神经机制未明确。项目利用任务态功能磁共振技术研究动作观察对镜像神经元系统及吞咽脑区激活效应及激活模式差异。结果显示，吞咽神经网络与镜像神经元网络存在共同脑区（左辅助运动区BA6区和左颞中回BA21区），吞咽动作观察可以通过激活镜像神经元系统激活吞咽神经网络。利用经颅磁刺激技术研究动态动作观察与静态动作观察对吞咽运动脑区兴奋性的作用及其调控机制，证实吞咽动作动态视频观察可以有效提高非优势半球吞咽运动皮质及其下行传导通路兴奋性，并显著降低优势半球吞咽运动皮质内抑制。利用近红外脑功能成像技术研究吞咽动作观察、吞咽动作执行、吞咽动作想像对吞咽相关脑区激活模式及激活程度差异。证实左侧运动前区及辅助运动区是吞咽动作观察、吞咽动作执行及吞咽动作想像均稳定激活的脑区，吞咽动作观察对吞咽运动脑区的激活程度较吞咽动作执行或吞咽动作想像弱。在本项目的支撑下，项目组已在在Frontiers in Neurology, Frontiers in Cellular Neuroscience, Brain Stimulation等杂志上发表SCI论文5篇；本项目研究成果也多次在国际和国内学术大会上交流并获奖。本项目研究结果对优化动作观察治疗方案、促进动作观察疗法在卒中后吞咽功能康复中的临床转化具有重要意义。