From "hand-brain perception" to "hand-brain movement"
The main mechanisms of brain injury rehabilitation are neuroplasticity and functional reorganization. It can be seen from anatomy that the hand mapping brain area occupies a large area of projection in the precentral gyrus and postcentral gyrus. Therefore, stroke lesions often involve the hand cortex control area, leading to hand dysfunction.
Abnormal sensation and reduced motor function of the hands will lead to a decrease in the quality and efficiency of completing tasks with both hands, and have a negative impact on patients' daily life activities, social participation ability, self-confidence and quality of life.
In the past, hand function rehabilitation mainly focused on motor function, and less attention was paid to the harm caused by impaired sensory function. However, practical applications have found that focusing only on motor function often leads to a "bottleneck" in the patient's recovery process, suggesting the need to restore sensory function. importance.
Current research status of hand-brain perception and hand-brain movement
1) Summary of clinical work shows: About 65% of patients after stroke have upper limb motor dysfunction; 50%-80% of patients in the acute phase, and about 40% of patients in the chronic phase have varying degrees of hand motor dysfunction; among these patients More than 80% also have hand tactile impairment, and more than 69% have proprioceptive impairment.2) In fact, the probability of impaired hand sensory function may be much higher than that of hypokinesia, but still few people pay attention to the harm caused by impaired hand sensory function. Compared with the research on hand motor function and brain plasticity, the clinical research and mechanism of hand sensory function are still in a relatively unclear stage, and the relationship between hand sensory recovery and brain neural mechanism needs to be further clarified. The team of Professor Jia Jie from Huashan Hospital Affiliated to Fudan University once put forward three theories about hand function rehabilitation, namely, the "central-peripheral-central" closed-loop theory, the overall rehabilitation of "integration of upper and lower limbs", and "left-right check and balance" of hands and brain, " The further proposal of the concept of "hand-brain perception" aims to call on rehabilitation physicians and rehabilitation therapists to pay more attention to the recovery of sensory function of upper limbs and hands in clinical practice.
Related concepts
"Hand Brain Perception"
It means that under the stimulation of the external environment, all kinds of sensory information of the hand is transmitted up to the specific central brain area through the corresponding conduction pathway. The way the muscles and bones move is shown.
"hand and brain exercise"
The final manifestation of hand-brain perception is based on brain plasticity and neural regulation mechanisms. Clinically, peripheral intervention and central intervention are used to promote the remodeling of the central nervous system to speed up the recovery of hand motor function.
"Hand and Brain Sensing the Environment"
In the process of hand function rehabilitation, using stimulation tools or accessible rehabilitation techniques, auditory environment, visualized or masked visual environment, a large number of different types of sensory neurons in the brain analyze the sensory environment and signals, and then selectively execute the hand function. sensory and motor tasks.
The relationship between hand-brain perception and hand-brain movement
Multisensory integration and motor function
In addition to bodily sensation, sensory function also includes vision, hearing, balance, smell and taste, etc. These different senses do not exist independently. Senses from different senses are often complementary. Multi-channel perceptual training can improve the speed of perception and recognition of external stimuli. Clinical practice has shown that visual cortex activity increases when tactile stimuli and visual stimuli are on the same side of the hand.
Progress from "hand-brain perception" to "hand-brain movement"
Multiple hand sensory signals are the basis for the hand to actively identify objects and realize motor functions. After a stroke, the sensory conduction pathway from the center to the periphery is impaired, the synaptic connection efficiency between the hand-brain perception area and the hand-brain motor area decreases, and there is a lack of sensory feedback from the central nervous system. Sensory and motor deficits further aggravated. Therefore, the problem of hand-brain perception should be solved as much as possible before hand-brain movement resumes.
A new strategy for "central-peripheral-central" closed-loop intervention based on the hand-brain perception theory
The hand-brain perception theory is closely related to the closed-loop rehabilitation theory. Advocating "rehabilitation of hand function after stroke" utilizes the integration of all interventions that can promote the recovery of hand function after stroke. It runs through clinical treatment, functional assessment, rehabilitation training, family social support, etc. Then to the complete closed-loop transmission process of central perception. All content related to hand function rehabilitation in post-stroke physical therapy, occupational therapy, rehabilitation engineering and prosthetic orthopedics can be attributed to the core concept under the framework of "hand function rehabilitation after stroke" - under the theory of hand-brain perception The "central-peripheral-central" closed-loop intervention model.Hand-brain perception training under multi-sensory integration
Based on the principle of sensory integration, multi-sensory provides more sensory signals to the central nervous system. The sensory signals activate the activity of nerve cells through the ascending conduction pathway, promote the establishment of synapses and the formation of neural circuits, activate specific brain regions, and pass through brain regions. After the perceptual processing of the signal, it is transmitted downward to the periphery, further improving the body's ability to cope with complex environments.
hand-brain strategy
In the rehabilitation research of hand movement and brain plasticity, the main research content is physical therapy, occupational therapy, physical factor therapy and other intervention methods. Hand movement intervention can promote brain function reorganization.
Start the task state of "hand-brain movement" with "hand-brain perception"
Based on the theory of multisensory integration and hand-brain perception, different forms of sensory stimulation can promote the occurrence and execution of motor behaviors. When designing occupational therapy activities, the therapist will combine listening, speaking, reading, writing, touching, and discrimination training, which not only improves the patient's ability to participate in daily life, but also helps the recovery of brain cognitive functions.
