Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan.
Neurorehabil Neural Repair. 2013 May;27(4):363-9. doi: 10.1177/1545968312474116. Epub 2013 Feb 7.
BACKGROUND: Poststroke dysphagia can persist, leading to many complications. OBJECTIVE: We investigated whether noninvasive brain stimulation to the pharyngeal motor cortex combined with intensive swallowing therapy can improve dysphagia. METHODS: A total of 20 patients who had dysphagia for at least 1 month after stroke were randomly assigned to receive 10 sessions lasting 20 minutes each of either 1-mA anodal transcranial direct current stimulation (tDCS) or a sham procedure to the ipsilesional pharyngeal motor cortex, along with simultaneous conventional swallowing therapies. We evaluated swallowing function with the dysphagia outcome and severity scale (DOSS) before, immediately after, and 1 month after the last session. RESULTS: Anodal tDCS resulted in an improvement of 1.4 points in DOSS (P = .006) immediately after the last session and 2.8 points (P = .004) 1 month after the last session. The sham tDCS group improved 0.5 points (P = .059) after the last session and 1.2 points (P = .026) 1 month after the final session. The improvements in the anodal tDCS group were significantly greater than those in the sham tDCS group (P = .029 after the last session, and P = .007 1 month after the last session). CONCLUSIONS: Anodal tDCS to the ipsilesional hemisphere and simultaneous peripheral sensorimotor activities significantly improved swallowing function as assessed by the DOSS.
背景:脑卒中后吞咽障碍可能持续存在,导致许多并发症。
目的:我们研究了经颅直流电刺激(tDCS)联合强化吞咽治疗是否可以改善脑卒中后吞咽障碍。
方法:共纳入 20 例脑卒中后至少 1 个月存在吞咽障碍的患者,随机分为两组,每组 10 例,分别接受 1 次 20 分钟 1 mA 阳极 tDCS 或假刺激治疗同侧咽运动皮质,同时进行常规吞咽治疗。在治疗前、治疗结束即刻及末次治疗后 1 个月,使用吞咽障碍结局和严重程度量表(DOSS)评估吞咽功能。
结果:治疗结束即刻,阳极 tDCS 组 DOSS 评分改善 1.4 分(P =.006),末次治疗后 1 个月时改善 2.8 分(P =.004);假刺激组治疗结束即刻改善 0.5 分(P =.059),末次治疗后 1 个月时改善 1.2 分(P =.026)。阳极 tDCS 组的改善明显优于假刺激组(治疗结束即刻,P =.029;末次治疗后 1 个月,P =.007)。
结论:同侧半球阳极 tDCS 联合外周感觉运动刺激可显著改善吞咽功能,DOSS 评估结果提示这一改善具有临床意义。
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