Huang Yu-Chi, Hsu Tun-Wei, Leong Chau-Peng, Hsieh Han-Chin, Lin Wei-Che
Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Diagnostic Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Front Neurosci. 2018 Jul 20;12:488. doi: 10.3389/fnins.2018.00488. eCollection 2018.
Early detection and intervention for post-stroke dysphagia could reduce the incidence of pulmonary complications and mortality. The aims of this study were to investigate the benefits of swallowing therapy in swallowing function and brain neuro-plasticity and to explore the relationship between swallowing function recovery and neuroplasticity after swallowing therapy in cerebral and brainstem stroke patients with dysphagia. We collected 17 subacute stroke patients with dysphagia (11 cerebral stroke patients with a median age of 76 years and 6 brainstem stroke patients with a median age of 70 years). Each patient received swallowing therapies during hospitalization. For each patient, functional oral intake scale (FOIS), functional dysphagia scale (FDS) and 8-point penetration-aspiration scale (PAS) in videofluoroscopy swallowing study (VFSS), and brain functional magnetic resonance imaging (fMRI) were evaluated before and after treatment. FOIS ( = 0.003 in hemispheric group and = 0.039 in brainstem group) and FDS ( = 0.006 in hemispheric group and = 0.028 in brainstem group) were both significantly improved after treatment in hemispheric and brainstem stroke patients. In hemispheric stroke patients, changes in FOIS were related to changes of functional brain connectivity in the ventral default mode network (vDMN) of the precuneus in brain functional MRI (fMRI). In brainstem stroke patients, changes in FOIS were related to changes of functional brain connectivity in the left sensorimotor network (LSMN) of the left postcentral region characterized by brain fMRI. Both hemispheric and brainstem stroke patients with different swallowing difficulties showed improvements after swallowing training. For these two dysphagic stroke groups with corresponding etiologies, swallowing therapy could contribute to different functional neuroplasticity.
早期发现并干预脑卒中后吞咽困难可降低肺部并发症的发生率和死亡率。本研究的目的是探讨吞咽治疗对吞咽功能和脑可塑性的益处，并探讨吞咽治疗后大脑和脑干脑卒中吞咽困难患者吞咽功能恢复与可塑性之间的关系。我们收集了17例亚急性脑卒中吞咽困难患者（11例脑卒患者，中位年龄76岁；6例脑干卒患者，中位年龄70岁）。每位患者在住院期间接受吞咽治疗。对每位患者，在治疗前后评估了视频透视吞咽研究（VFSS）中的功能性经口摄食量表（FOIS）、功能性吞咽困难量表（FDS）和8分渗透-误吸量表（PAS），以及脑功能磁共振成像（fMRI）。半球组和脑干组治疗后FOIS（半球组=0.003，脑干组=0.039）和FDS（半球组=0.006，脑干组=0.028）均显著改善。在半球性脑卒中患者中，FOIS的变化与脑功能MRI（fMRI）中楔前叶腹侧默认模式网络（vDMN）的功能脑连接变化有关。在脑干脑卒中患者中，FOIS的变化与以脑fMRI为特征的左中央后区左感觉运动网络（LSMN）的功能脑连接变化有关。半球性和脑干性脑卒中吞咽困难患者在吞咽训练后均有改善。对于这两组具有相应病因的吞咽困难脑卒中患者，吞咽治疗可导致不同的功能性神经可塑性。
