Service de physiologie digestive, urinaire, respiratoire et sportive, CHU de Rouen, 1 rue de Germont, 76031, Rouen Cedex, France.
Dysphagia. 2010 Dec;25(4):291-7. doi: 10.1007/s00455-009-9259-3. Epub 2009 Oct 24.
Oropharyngeal dysphagia is frequent in stroke patients and increases mortality, mainly because of pulmonary complications. We hypothesized that sensitive transcutaneous electrical stimulation applied submentally during swallowing could help rehabilitate post-stroke oropharyngeal dysphagia by improving cortical sensory motor circuits. Eleven patients were recruited for the study (5 females, 68 ± 11 years). They all suffered from recent oropharyngeal dysphagia (>eight weeks) induced by a hemispheric (n = 7) or brainstem (n = 4) stroke, with pharyngeal residue and/or laryngeal aspiration diagnosed by videofluoroscopy. Submental electrical stimulations were performed for 1 h every day for 5 days (electrical trains: 5 s every minute, 80 Hz, under motor threshold). During the electrical stimulations, the patients were asked to swallow one teaspoon of paste or liquid. Swallowing was evaluated before and after the week of stimulations using a dysphagia handicap index questionnaire, videofluoroscopy, and cortical mapping of pharyngeal muscles. The results of the questionnaire showed that oropharyngeal dysphagia symptoms had improved (p < 0.05), while the videofluoroscopy measurements showed that laryngeal aspiration (p < 0.05) and pharyngeal residue (p < 0.05) had decreased and that swallowing reaction time (p < 0.05) had improved. In addition, oropharyngeal transit time, pharyngeal transit time, laryngeal closure duration, and cortical pharyngeal muscle mapping after the task had not changed. These results indicated that sensitive submental electrical stimulations during swallowing tasks could help to rehabilitate post-stroke swallowing dysphagia by improving swallowing coordination. Plasticity of the sensory swallowing cortex is suspected.
口咽吞咽困难在脑卒中患者中很常见，并且会增加死亡率，主要是因为肺部并发症。我们假设在吞咽过程中颏下敏感经皮电刺激可以通过改善皮质感觉运动回路来帮助脑卒中后口咽吞咽困难的康复。11 名患者入组研究（5 名女性，68±11 岁）。他们都患有近期口咽吞咽困难（>8 周），由半球性（n=7）或脑干性（n=4）脑卒中引起，通过视频透视诊断为咽后残留和/或喉咽吸入。颏下电刺激每天进行 1 小时，共 5 天（电刺激：每分钟 5 秒，80Hz，在运动阈下）。在电刺激期间，要求患者吞咽一茶匙糊剂或液体。在电刺激前和电刺激后一周使用吞咽障碍 handicap 指数问卷、视频透视和咽肌皮质映射评估吞咽。问卷结果显示口咽吞咽困难症状改善（p<0.05），而视频透视测量显示喉咽吸入（p<0.05）和咽后残留（p<0.05）减少，吞咽反应时间（p<0.05）改善。此外，任务后的口咽通过时间、咽通过时间、喉闭合时间和皮质咽肌映射没有变化。这些结果表明，吞咽过程中的颏下敏感电刺激可以通过改善吞咽协调性来帮助脑卒中后吞咽困难的康复。怀疑感觉吞咽皮质的可塑性。
