脑卒中康复中的心理模拟实践重组大脑连接：系统综述

摘要(中文译文)

中风是导致残疾的主要原因，与运动功能和大脑连接受损有关。心理模拟实践（MSP），包括运动想象、镜像疗法和动作观察疗法，已被提出作为能够调节神经网络的神经康复策略。本综述旨在通过fMRI阐明MSP对大脑连接的影响。进行了一项基于PRISMA的综述，并在PROSPERO（CRD420251086743）中进行了注册。PubMed、Scopus和Web of Science检索了2015年至2025年间发表的随机对照试验，评估了卒中患者基于MSP的康复与常规康复。如果研究评估了治疗前后基于fMRI的连接性变化，则将其纳入研究。由于连接性指标和神经影像学方法的异质性，没有进行荟萃分析。使用Cochrane RoB 2工具评估偏倚风险，显示风险较低或存在一些问题。在467份已确定的记录中，8项随机对照试验涉及249名中风患者，符合纳入标准。大多数研究调查了基于运动图像的干预措施，而两项研究评估了镜像疗法。在所有研究中，与单独进行常规康复相比，多发性硬化持续与上肢运动改善相关，并伴有大脑网络的显著重组。神经影像学结果显示，感觉运动区域内的连通性增强，包括初级运动皮层、中央后回和下顶叶，同时皮质脊髓和大脑半球间通路受到调节。几项研究还报告了适应不良激活模式的正常化、过度感觉运动连接的减少以及运动和认知网络之间更强的相互作用，这些变化与临床运动恢复相关。额外的重组涉及注意力、视觉和认知系统，表明网络水平的神经可塑性适应。鉴于心理模拟实践在调节大脑连接方面的潜在作用，它可能是标准中风康复计划中有前景的辅助干预措施。

Abstract

Stroke is a leading cause of disability, associated with impaired motor function and brain connectivity. Mental Simulation Practices (MSP), including Motor Imagery, Mirror Therapy and Action Observation Therapy, have been proposed as neurorehabilitation strategies capable of modulating neural networks. This review aimed to clarify the effects of MSP on brain connectivity using fMRI. A PRISMA-based review was conducted and registered in PROSPERO (CRD420251086743). PubMed, Scopus and Web of Science were searched for randomized controlled trials published between 2015 and 2025 evaluating MSP-based rehabilitation versus conventional rehabilitation in stroke patients. Studies were included if they assessed fMRI-based connectivity changes before and after treatment. Meta-analysis was not performed because of heterogeneity in connectivity metrics and neuroimaging methodologies. Risk of bias was assessed using the Cochrane RoB 2 tool, showing low risk or some concerns. Of 467 identified records, 8 randomized controlled trials involving 249 stroke patients met inclusion criteria. Most studies investigated Motor Imagery-based interventions, while two evaluated Mirror Therapy. Across studies, MSPs were consistently associated with upper limb motor improvement compared with conventional rehabilitation alone, accompanied by significant reorganization of brain networks. Neuroimaging findings demonstrated enhanced connectivity within sensorimotor regions, including the primary motor cortex, postcentral gyrus and inferior parietal lobule, together with modulation of corticospinal and interhemispheric pathways. Several studies also reported normalization of maladaptive activation patterns, reduced excessive sensorimotor connectivity and stronger interactions between motor and cognitive networks, changes correlated with clinical motor recovery. Additional reorganization involved attentional, visual and cognitive systems, suggesting network-level neuroplastic adaptations. Mental simulation practices may represent promising adjunctive interventions in standard stroke rehabilitation programs, given their potential role in modulating brain connectivity.

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