J. Biomed. Eng. Res : 139-147, 2007
1
2,3
태기식, 송성재 , 김영호
,
1
,3 (Received October 9, 2006. Accepted November 9, 2006) 2
Activations of Cerebral and Cerebellar Cortex Induced by Repetitive Bilateral Motor Excercise Ki-Sik.Tae, Sung-Jae Song1, Young-Ho Kim2,3 Dept. of Biomedical Engineering, Konyang University Dept. of Mechanical Engineering, Wonju National College 2 Department of Biomedical Engineering, Yonsei University 3 Research Institute for Medical Engineering, Yonsei University 1
The aim of this study was to evaluate effects of short-term repetitive-bilateral excercise on the activation of motor network using functional magnetic resonance imaging (fMRI). The training program was performed at 1 hr/day, 5 days/week during 6 weeks. Fugl-Meyer Assessments (FMA) were performed every two weeks during the training. We compared cerebral and cerebellar cortical activations in two different tasks before and after the training program: (1) the only unaffected hand movement (Task 1); and (2) passive movements of affected hand by the active movement of unaffected hand (Task 2). fMRI was performed at 3T with wrist flexion-extension movement at 1 during the motor tasks. All patients showed significant improvements of FMA scores in their paretic limbs after training. fMRI studies in Task 1 showed that cortical activations decreased in ipsilateral sensorimotor cortex but increased in contralateral sensorimotor cortex and ipsilateral cerebellum. Task 2 showed cortical reorganizations in bilateral sensorimotor cortex, premotor area, supplemetary motor area and cerebellum. Therefore, this study demonstrated that plastic changes of motor network occurred as a neural basis of the improvement subsequent to repetitive-bilateral excercise using the symmetrical upper-limb arm motion trainer. cerebellum, cerebrum, cortical activation, FMA, fMRI, repetitive-bilateral exercise, reorganization
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본 연구는 산업자원부 지정 연세대학교 의용계측 및 재활공학 연구센터(RRC)의 지원에 의한 것임. Corresponding Author : 김영호 강원 원주시 흥업면 연세대학교 의공학부 Tel : +82-33-760-2492 / Fax : +82-33-760-2859 E-mail :
[email protected]
. Krebs (feedback)
[5]
MIT-MANUS Motor Status Score(MSS) [6]
Fugl-Meyer(FM), . Reinkensmeyer
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February, 2007 139
Activations of Cerebral and Cerebellar Cortex Induced by Repetitive Bilateral Motor Excercise
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140
J. Biomed. Eng. Res.
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Ki-Sik.Tae, Sung-Jae Song, Young-Ho Kim
(a)
(b)
그림 1. 기구의 고정 방향에 따른 두 가지 운동 (a) 손목 굴곡/신전운동, (b) 전완 회내/회외운동
Fig. 1. Two motions in position of system (a) Wrist flexion/extension, (b) Forearm pronation/supination
6 ( 4 , 2 , 32±6 , 64±10 kg, 169.1±5 cm) 2 (35.5±16.6 ) (spasticity) Modified Ashworth 2 Scale(MAS) 4 ( 40.8±7.1 , 65±4 168.2±3 cm) . kg, 3 , 1 , 2 , 2 ( 1). / / 1 , 5 , 6 .
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표 1. 환자군의 특성 Table 1. Demographics and pathology of 4 patients with stroke 환자
나이
성
병변부위
마비측
발병 후 경과일 (월)
1
44
남
ICH in Rt. thalamus, BG, IVH
좌
38
경련성 점수* 1
2
37
남
Cerebral multiple contusion
좌
58
1
3
49
남
ICH in Lt. BG, IVH
우
24
2
4
33
남
IVH in Lt, BG
우
22
2
BG=basal ganglia, ICH=Intracerebral hemorrhage, IVH=Intraventicular hemorrhage(뇌실 출혈) *손목 굴곡/신전에 대한 도수근력검사 점수
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February, 2007 141
Activations of Cerebral and Cerebellar Cortex Induced by Repetitive Bilateral Motor Excercise
(a)
(b)
그림 2. FMA 운동지수 변화 (a) 2주 간격의 FMA변화 (b) 6주간의 훈련 전후 FMA변화
Fig. 2. Change in clinical score of FMA on the affected upper-limb of patients
SPM99 (Wellcome Department of CogNatick, MA.) nitive Neurology, UK.) (realignment)
.
6 2
(coregister)
.
template image(Mon(normalization) treal Neurologic Institute) . (sensorimotor (premotor area, PMA), (SM1) cortex, SMC), (supplementary motor area, SMA) (vermis) (medial), . t p .001 . , cluster 5
Ⅲ. 결 과 A. ,
2 ,
, Fugl-Meyer .
6
6
B. 3
Fig. 3. Cortical activations in control group J. Biomed. Eng. Res.
2
(p=0.05).
그림 3. 두 과제에 대한 대조군의 대뇌 및 소뇌 피질의 활성화
142
.
.
Ki-Sik.Tae, Sung-Jae Song, Young-Ho Kim
그림 4. 각 환자의 두 과제에 대한 훈련 전후 뇌 활성화 변화 (p
