Momosaki Ryo, Abo Masahiro, Watanabe Shu, Kakuda Wataru, Yamada Naoki, Kinoshita Shoji
Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
Neuromodulation. 2015 Oct;18(7):630-4; discussion 634-5. doi: 10.1111/ner.12308. Epub 2015 May 6.
The purpose of this pilot study was to determine the safety and feasibility of a six-day protocol of in-hospital repetitive peripheral magnetic stimulation combined with intensive swallowing rehabilitation (rPMS-ISR) for poststroke dysphagia.
The subjects were eight patients with dysphagia caused by bilateral cerebral infarction (age: 62-70; time from onset of stroke: 27-39 months). rPMS was applied to the suprahyoid muscles, at strength set at 90% of the minimal intensity that elicited pain with a parabolic coil. One train of stimuli comprised 20 Hz for 3 sec followed by 27-sec rest. A single session included delivery of repetitive 20 trains of stimuli over 10 min, followed by 20 min of swallowing rehabilitation. Each patient received this combination treatment twice daily, morning and afternoon, over six consecutive days. Swallowing function was evaluated before and after intervention.
rPMS-ISR induced significant improvement in swallowing ability, laryngeal elevation delay time, penetration aspiration scale, and swallowing quality of life (p < 0.01), but had no significant effect on the functional oral intake scale.
The six-day in-hospital RPMS-ISR protocol seems safe and feasible for poststroke patients with dysphagia. The combination protocol improved swallowing function. Further larger studies are needed to confirm its efficacy.
本初步研究旨在确定住院期间为期六天的重复经颅磁刺激联合强化吞咽康复（rPMS-ISR）方案治疗脑卒中后吞咽困难的安全性和可行性。
研究对象为8例双侧脑梗死所致吞咽困难患者（年龄62 - 70岁；卒中发病时间27 - 39个月）。使用抛物线线圈，将rPMS应用于舌骨上肌群，强度设定为引起疼痛的最小强度的90%。一组刺激包括20Hz持续3秒，随后休息27秒。单次治疗包括在10分钟内重复给予20组刺激，然后进行20分钟的吞咽康复训练。每位患者连续六天每天上午和下午各接受一次这种联合治疗。在干预前后评估吞咽功能。
rPMS-ISR显著改善了吞咽能力、喉提升延迟时间、渗透误吸量表及吞咽生活质量（p < 0.01），但对功能性经口进食量表无显著影响。
对于脑卒中后吞咽困难患者，为期六天的住院rPMS-ISR方案似乎是安全可行的。该联合方案改善了吞咽功能。需要进一步开展更大规模的研究来证实其疗效。
