Tarameshlu Maryam, Ansari Noureddin N, Ghelichi Leila, Jalaei Shohreh
Departments of Speech Therapy.
Physiotherapy, School of Rehabilitation.
Int J Rehabil Res. 2019 Jun;42(2):133-138. doi: 10.1097/MRR.0000000000000336.
Dysphagia following stroke is common and can lead to severe complications such as aspiration pneumonia, but there is inconclusive evidence on how poststroke dysphagia should be treated. This study aimed to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with the traditional dysphagia therapy on the swallowing function in patients with poststroke dysphagia. In this pilot double-blind randomized clinical trial, 18 patients with poststroke dysphagia were allocated randomly to three groups: (i) traditional dysphagia therapy, (ii) rTMS, and (iii) combined intervention. Patients received traditional dysphagia therapy for 18 treatment sessions three times per week. The inhibitory rTMS was applied to the intact cerebral hemisphere at 1 Hz with a train of 1200 for 5 consecutive days. The patients in the combined intervention group received traditional dysphagia therapy and rTMS simultaneously. The Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale were performed before treatment, after the end of the fifth session, after the end of the 10th session, after the end of the 15th session, and after the end of the 18th session. All groups had improved on MASA and Functional Oral Intake Scale scores over time (P<0.01). The improvements achieved in all outcomes were significantly greater in the combined intervention group than those of the traditional dysphagia therapy and rTMS groups. The large effect sizes were found for the MASA score in all groups: traditional dysphagia therapy group (d = 3.57), rTMS group (d = 2.67), and combined intervention group (d = 3.87). This pilot randomized-controlled trial showed that the combination of rTMS and traditional dysphagia therapy significantly improved swallowing function in patients with poststroke dysphagia.
中风后吞咽困难很常见，可能导致严重并发症，如吸入性肺炎，但关于中风后吞咽困难应如何治疗，证据尚无定论。本研究旨在探讨重复经颅磁刺激（rTMS）联合传统吞咽困难治疗对中风后吞咽困难患者吞咽功能的影响。在这项前瞻性双盲随机临床试验中，18例中风后吞咽困难患者被随机分为三组：（i）传统吞咽困难治疗组，（ii）rTMS组，（iii）联合干预组。患者每周接受三次传统吞咽困难治疗，共18个疗程。抑制性rTMS以1Hz的频率应用于完整的大脑半球，每次连续1200次，共5天。联合干预组的患者同时接受传统吞咽困难治疗和rTMS。在治疗前、第5次疗程结束后、第10次疗程结束后、第15次疗程结束后和第18次疗程结束后进行吞咽能力曼恩评估（MASA）和功能性经口进食量表评估。随着时间的推移，所有组的MASA和功能性经口进食量表评分均有所改善（P<0.01）。联合干预组在所有结果上取得的改善均显著大于传统吞咽困难治疗组和rTMS组。所有组的MASA评分均发现较大的效应量：传统吞咽困难治疗组（d = 3.57）、rTMS组（d = 2.67）和联合干预组（d = 3.87）。这项前瞻性随机对照试验表明，rTMS与传统吞咽困难治疗相结合可显著改善中风后吞咽困难患者的吞咽功能。
