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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 湯佩芳 | |
dc.contributor.author | Yi-Hsuan Chen | en |
dc.contributor.author | 陳亦璇 | zh_TW |
dc.date.accessioned | 2021-06-16T09:37:48Z | - |
dc.date.available | 2022-03-01 | |
dc.date.copyright | 2017-03-01 | |
dc.date.issued | 2017 | |
dc.date.submitted | 2017-02-10 | |
dc.identifier.citation | Ashburner J, Friston KJ (2005): Unified segmentation. Neuroimage 26:839-51.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/59784 | - |
dc.description.abstract | 背景:中風後之動作學習以及其相關腦部神經塑性為現今腦中風復建之重要議題。過去針對次序性動作學習及其相關神經塑性之研究乃建立在使用上肢進行短期動作學習的模式上。然而,不同的大腦及小腦功能區在短期與長期腳踝動作次序性動作學習的角色仍未被完整探討。
目的:本研究之目的為探討非小腦損傷之缺血性中風病人以及年齡相當之健康成年人之大腦及小腦皮質在短期(一週)及長期(三週)之次序性動作學習後的活化改變,以及腦功能區活化改變和行為改變上之相關性。 方法:本研究使用三週之腳踝動作次序學習,收入非小腦損傷之慢性缺血性中風病人及年齡相當之健康成年人為受試者,使用非慣用腳或患側腳腳踝進行學習。於開始訓練前、開始訓練一週後及開始訓練三週後分別執行行為測試以及功能性磁振造影之掃描。原始之功能性磁振造影影像先以前處理(preprocessing)之步驟去除雜訊。接著會進行全腦分析(whole brain analysis),利用對比之設定,分析每位受試者執行重複次序時的腦部功能性活化與休息時的腦部功能性活化差異。本研究採用依解剖自動標籤模板(Anatomical Automatic Labeling template)選取之雙側前額葉、感覺動作皮質區、前運動皮質區、輔助動作皮質區、小腦小葉IV&V、VI、VII、VIII及Crus I+II等為興趣區域(regions of interest)。探討不同的興趣區在學習前、學習一週後、及學習三週後之功能性活化模式的改變,及學習後興趣區域腦部活化改變以及行為改變間的相關性。 結果:本研究納入20位健康人以及18位中風受試者進入短期學習組,12位健康人以及10位中風受試者進入長期學習組。腳踝追蹤結果顯示,經過一週及三週之學習過後,兩組受試者均在行為表現有統計上顯著之進步(p< 0.05)。影像結果顯示,健康受試者在學習前主要使用兩側之輔助動作皮質區、前運動皮質區、主要感覺動作皮質區、前額葉及小腦小葉VI執行腳踝重複次序動作(p< 0.05)。中風受試者則比健康受試者多使用動作對側小腦小葉IV&V (p< 0.05)。一週學習過後,健康受試者在動作同側大腦輔助動作皮質區、前運動皮質區、動作對側主要感覺動作皮質區與動作同側前額葉(r= 0.486~0.534, p< 0.05)及額外兩週學習過後,於大腦前動作對側運動皮質區、主要感覺動作皮質區、雙側小腦小葉IV&V、動作對側小腦小葉VI、小腦小葉Crus I&II(r= 0.404~0.453, p> 0.05)之標準化活化強度下降越多者,標準化行為進步越多。一週學習過後,中風受試者在小腦小葉動作同側VII及VIII之標準化活化強度下降越少者,行為表現進步越多(r= -0.643~-0.684, p< 0.05)。經過額外兩週的練習,中風受試者在動作對側大腦主要感覺動作皮質區、雙側前運動皮質區、雙側前額葉(r= 0.652~0.789, p> 0.05)之標準化活化強度下降越多者及小腦小葉動作對側VI,雙側VII及動作對側Crus I&II(r= -0.601~-0.803, p> 0.05)之標準化活化強度上升越多者,標準化行為進步越多。 討論及結論:本研究之結果顯示,大腦與小腦皮質在健康人及非小腦損傷中風病人之短期及長期腳踝動作次序性學習中,扮演不同之角色。健康人短期學習主要倚賴大腦活化效率之提升,其長期學習則倚賴大腦及小腦活化效率之提升。而非小腦損傷中風病人之短期及長期學習則皆主要倚賴小腦之代償性活化。 | zh_TW |
dc.description.abstract | Background: Motor learning and the associated brain plasticity after stroke are crucial topics in stroke rehabilitation nowadays. However, the evidence of the benefits of motor sequence learning was established mainly on studies using upper extremity short-term motor learning paradigms. In previous studies, the roles of the different regions in the cerebrum and the cerebellum in short- and long-term ankle motor sequence learning have not been fully explored.
Purposes: The purposes of this study were to investigate the changes of cerebral and cerebellar functional activation and their relationships with behavioral improvement after short- and long-term ankle motor sequence learning in patients with non-cerebellar ischemic stroke and age-matched healthy adults. Methods: A three-week motor sequence learning paradigm using the non-dominant or paretic ankle was used in this study. Patients with non-cerebellar ischemic stroke and age-matched healthy controls were enrolled and underwent clinical assessments, behavior testing, functional magnetic resonance imaging (fMRI) scans at baseline, Week 1, and Week 3. Raw fMRI data was preprocessed to eliminate the noise. Then, whole brain analysis (contrast of repeated sequences versus rest condition) and anatomical regions of interest (ROIs) analysis were conducted. Bilateral dorsolateral prefrontal cortex (dlPFC), sensorimotor cortex (SMC), supplementary motor area (SMA), and premotor cortex (PMC), cerebellar lobules IV&V, VI, VII, VIII, and Crus I&II, based on the Anatomical Automatic Labeling (AAL) template, were chosen as the ROIs. Results: Twenty healthy and 18 stroke subjects participated in the short-term learning study; and 12 healthy and 10 stroke subjects participated in the long-term learning study. Both groups showed significant improvement in ankle tracking errors in short- and long-term learning (p< 0.05). At baseline, healthy subjects showed primary activations in the bilateral SMA, PMC, SMC, contralateral dlPFC, and bilateral cerebellar lobules VI (p< 0.05); the stroke subjects showed additional activations in the contralateral cerebellar lobule IV&V at baseline (p< 0.05). Healthy subjects who had greater reduction of activation intensity in ipsilateral dlPFC, SMA, contralateral SMC, and bilateral PMC from baseline to Week 1 (r= 0.486~0.534, p< 0.05) and in contralateral SMC, PMC, cerebellum lobule VI, lobule Crus I&II, and bilateral cerebellum lobule IV&V from Week 1 to Week 3 (r= 0.404~0.453, p> 0.05) presented greater tracking performance improvement during the corresponding time periods. Stroke patients who had greater increases in activation intensity in ipsilateral cerebellar lobule VII and lobule VIII presented more behavior improvement from baseline to Week 1 ( r= -0.643~-0.684, p< 0.01) and those who showed greater reduction of activation intensity in contralateral SMC, bilateral dlPFC and PMC that from Week 1 to Week 3 (r= 0.652~0.789, p> 0.05) or greater increases in activation intensity in contralateral cerebellum lobule VI, lobule Crus I&II, and bilateral cerebellum lobule VII (r= -0.601~-0.803, p> 0.05) presented more behavior improvement. Discussion and Conclusions: These results suggested differential roles of the cerebral and cerebellar cortices in short- and long-term ankle motor sequence learning between healthy subjects and patients with chronic stroke with the cerebellum spared. Healthy subjects relied on the efficiency of cerebral activation for short-term learning and on that of cerebral and cerebellar activation for long-term learning. Stroke patients relied on compensatory cerebellar activation for both short- and long-term learning. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T09:37:48Z (GMT). No. of bitstreams: 1 ntu-106-R03428010-1.pdf: 6018532 bytes, checksum: d091d89cb0b167b23c70e9e089905264 (MD5) Previous issue date: 2017 | en |
dc.description.tableofcontents | 中文摘要 ii
Abstract iv Chapter 1: Introduction 12 1.1 Background 12 1.2 Knowledge gaps 17 1.3 Purposes 18 1.4 Operational definitions of terms and variables 19 1.5 Research questions and hypotheses 21 Chapter 2: Literature review 26 2.1 Definition and Stages of motor leaning 26 2.2 Classification of motor learning studies by task: visuomotor adaptation and motor sequence learning tasks 27 2.2 fMRI activation patterns while performing ankle sequence tracking tasks in healthy adults and patients with stroke 28 2.2.1 In healthy adults 29 2.2.2 In patients with stroke 32 2.3 fMRI evidence of neural correlates of motor sequence learning 34 2.3.1 Short-term learning 34 2.3.2 Long-term learning 37 2.4 Theoretical models about the role of the cerebellum in motor sequence learning 38 Chapter 3: Methods 44 3.1 Study design and procedures 44 3.2 Participants 44 3.3 Instrumentation and assessments 45 3.3.1 Clinical assessments 45 3.3.2 Ankle motor sequence tracking device and assessment 46 3.3.3 MRI 47 3.4 Ankle motor sequence tracking learning paradigm 48 3.5 Data acquisition and analysis 49 3.5.1 Clinical assessments 49 3.5.2 Ankle motor sequence tracking measures 49 3.5.3 MRI measures 49 3.5.4 Test of the awareness of the existence of the repeated sequence 53 3.6 Statistical analysis 53 Chapter 4: Results 56 4.1 Demographics and Characteristics of Participants 56 4.1.1 Short-term learning group 56 4.1.2 Long-term learning group 56 4.2 Ankle tracking performance 57 4.2.1 Short-term learning group 57 4.2.2 Long-term learning group 58 4.3 fMRI results of the short-term learning group 58 4.3.1 Whole brain analysis results 58 4.3.2 Anatomical ROI analysis results 59 4.3.3 fMRI activation-behavioral correlation analysis results 60 4.4 fMRI results of the long-term learning group 60 4.4.1 Whole brain analysis results 60 4.4.2 Anatomical ROI analysis results 61 4.4.3 fMRI activation-behavioral correlation analysis results 62 4.5 Results of non-trained healthy subjects 64 Chapter 5. Discussion 65 5.1 Ankle tracking performance 66 5.2 Brain activation pattern at baseline 67 5.3 Brain activation changes and their relationships with behavioral improvement in healthy subjects 68 5.4 Brain activation changes and their relationships with behavioral improvement in subjects with stroke 72 5.5 Ankle tracking performance in the no training healthy subjects 76 5.6 Limitations 77 5.7 Conclusions 77 References 79 Tables 95 Table 1. Demographics of healthy and stroke subjects in short-term learning group 95 Table 2. Basic information of individual patients with stroke 97 Table 3. Clusters demonstrating significant repeated sequence main effect (repeated versus rest) for the short-term learning healthy group (N=20) 99 Table 4. Clusters demonstrating significant repeated sequence main effect (repeated versus rest) for the short-term learning stroke group (N=18) 100 Table 5. Clusters demonstrating significant repeated sequence main effect (repeated versus rest) for the long-term learning healthy group (N=12) 101 Table 6. Clusters demonstrating significant repeated sequence main effect (repeated versus rest) for the long-term learning stroke group (N=10) 103 Table 7. Activation intensity at baseline and Week 1 in nine pairs of regions of interest in short-term learning group 104 Table 8. Activation intensity at baseline, Week 1 and Week 3 in nine pairs of regions of interest in long-term learning group 106 Table 9. Partial correlations between the normalized change of RMSE score and the normalized change of activation intensity within different ROIs from baseline to Week 1 of short-term ankle motor sequence learning 108 Table 10. Partial correlations between the normalized change of RMSE score and the normalized change of activation intensity within different ROIs from baseline to Week 1 of long-term learning group 110 Table 11. Partial correlations between the normalized change of RMSE score and the normalized change of activation intensity within different ROIs from Week 1 to Week 3 of long-term learning group 112 Table 12. Partial correlations between the normalized change of RMSE score and the normalized change of activation intensity within different ROIs from baseline to Week 3 of long-term learning group 114 Figures 116 Figure 1. Illustration of six-week ankle motor sequence learning paradigm 116 Figure 2. Illustration of subject’s position during ankle tracking testing and training 117 Figure 3. Repeated (upper) and random (bottom) sequences in ankle tracking tests; Red line indicates the target trajectory 118 Figure 4. Two runs of block design in fMRI scan 119 Figure 5. Illustration of quiet and noisy inside scanner ankle tracking baseline 120 Figure 6. Flow of fMRI data analysis 121 Figure 7. Different ROIs within the cerebrum based on AAL template 122 Figure 8. Different ROIs within the cerebellum based on AAL template 123 Figure 9. Tracking RMSE score of healthy and stroke subjects in short-term (A) and long-term (B) learning groups 124 Figure 10. Brain activations at Baseline (upper panel) and Week 1 (lower panel) during repeated sequence tracking (repeated – rest contrast) of healthy subjects (A) and stroke subjects (B) (p< 0.05, FWE corrected). 125 Figure 11. Brain activations at Baseline (upper panel), Week 1 (middle panel) and Week 3 (lower panel) during repeated sequence tracking (repeated – rest contrast) of healthy subjects (A) and stroke subjects (B) (p< 0.05, FWE corrected). 126 Figure 12. Activation intensity within different cerebral ROIs in the short-term learning healthy and stroke subjects 127 Figure 13. Activation intensity within different cerebellar ROIs in the short-term learning healthy and stroke subjects 128 Figure 14. Activation intensity within different cerebral ROIs in the long-term learning healthy and stroke subjects 129 Figure 15. Activation intensity within different cerebellar ROIs in the long-term learning healthy and stroke subjects 130 Figure 16. Scatterplot of normalized change of RMSE score and normalized change of activation intensity within ROIs which presented significant correlations with p< 0.05 in the short-term learning healthy subjects 131 Figure 17. Scatterplot of normalized change of RMSE score and normalized change of activation intensity with in ROIs which presented significant correlations with p< 0.05 in the short-term learning stroke subjects 132 Figure 18. Scatterplot of normalized change of RMSE score and normalized change of activation intensity with in ROIs from Week 1 to Week 3 which presented moderate correlations in the long-term learning healthy subjects 133 Figure 19. Scatterplot of normalized change of RMSE score and normalized change of activation intensity with in ROIs from Week 1 to Week 3 which presented strong correlations in the long-term learning stroke subjects 135 Figure 20. Tracking RMSE score of healthy subjects in no training (A) and the long-term learning healthy (B) group 136 Figure 21. Individual brain activations at Baseline, Week 1, and Week 3 during repeated sequence tracking (repeated – rest contrast) of no training healthy subjects (p< 0.05, FWE corrected). 137 Appendices 138 Appendix 1: IRB Approval and consent form of this study (National Taiwan University Hospital) 138 Appendix 2. Waterloo Footedness Questionnaire-revised 147 Appendix 3. Mini-Mental State Examination 148 Appendix 4. Muscle strength testing recording sheet 150 Appendix 5. Fugl-Meyer Assessment 151 Appendix 6. Modified Ashworth Scale 153 Appendix 7. Time “Up & Go” Test 154 | |
dc.language.iso | en | |
dc.title | 大腦及小腦皮質在健康成人與非小腦損傷缺血性中風病患之短期與長期腳踝動作次序學習扮演的角色: 功能性磁振造影研究 | zh_TW |
dc.title | Roles of the Cerebral and Cerebellar Cortices in Short- and Long-term Ankle Motor Sequence Learning of Healthy Adults and Patients with Non-cerebellar Ischemic Stroke: An fMRI Study | en |
dc.type | Thesis | |
dc.date.schoolyear | 105-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 曾文毅,鄭建興,吳恩賜,林千禾 | |
dc.subject.keyword | 腦中風,下肢,動作次序性學習,功能性磁振造影,大腦及小腦活化模式, | zh_TW |
dc.subject.keyword | stroke,lower extremities,motor sequence learning,functional MRI,cerebral and cerebellar activation pattern, | en |
dc.relation.page | 154 | |
dc.identifier.doi | 10.6342/NTU201700421 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2017-02-10 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 物理治療學研究所 | zh_TW |
顯示於系所單位: | 物理治療學系所 |
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