Wen Xin, Yang Quan, Liu Zicai, Peng Yang, Wang Jing, Liu Xuejin, Hu Hao, Liu Huiyu, Wang Minghong
Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, Guangdong, China.
School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, Jiangxi, China.
Dysphagia. 2023 Jun;38(3):912-922. doi: 10.1007/s00455-022-10515-4. Epub 2022 Sep 10.
Either effortful swallowing exercise or repetitive transcranial magnetic stimulation (rTMS) is considered as an effective method to treat dysphagia after stroke. Thus, synchronizing these two interventions may improve the efficiency of treatment. This trial intended to explore the effects of rTMS and effortful swallowing exercise on the recovery of swallowing function in patients after stroke. A total of 56 patients with post-stroke dysphagia who were able to actively cooperate with the training were analyzed in this study. We experimented with different intervention effects of rTMS synchronization with effortful swallowing training (group 1), rTMS (group 2), and traditional swallowing training alone (group 3). Every patient completed conventional swallowing training 5 days a week for 2 weeks. Patients in group 1 and group 2 underwent 10 consecutive sessions of 5 Hz rTMS over the affected mylohyoid cortical region. Fiberoptic endoscopic dysphagia severity scale (FEDSS), penetration/aspiration scale (PAS), standardized swallowing assessment (SSA), and functional oral intake scale (FOIS) were assessed and compared across the groups. No significant difference in FEDSS, PAS, SSA, or FOIS scores was found at baseline among the three groups. The mean change values of the FEDSS score, PAS score, SSA score, and FOIS score between baseline and post-intervention of the three groups (H = 16.05, P < 0.001; H = 21.70, P < 0.001; F (2, 53) = 9.68, P < 0.001; H = 18.26, P < 0.001; respectively) were statistically significant. In addition, the mean change values of FEDSS, PAS, SSA, and FOIS scores in participants in group 1 (all P < 0.001) and group 2 (P = 0.046; P = 0.045; P = 0.028; P = 0.032; respectively) were significantly higher than in group 3. Similarly, the mean change values of FEDSS, PAS, SSA, and FOIS scores were significantly higher in participants in group 1 than in group 2 (P = 0.046; P = 0.038; P = 0.042; P = 0.044; respectively). The results revealed that the conjunction of rTMS and effortful swallowing training was an effective method to facilitate the recovery of swallowing function in stroke patients. The present clinical trial provided a new treatment method for the functional restoration of swallowing in stroke patients, which may further facilitate the recovery of swallowing function in stroke patients with swallowing disorders.
用力吞咽训练和重复经颅磁刺激（rTMS）均被视为治疗中风后吞咽困难的有效方法。因此，将这两种干预措施同步进行可能会提高治疗效率。本试验旨在探讨rTMS和用力吞咽训练对中风患者吞咽功能恢复的影响。本研究共分析了56例能够积极配合训练的中风后吞咽困难患者。我们对rTMS与用力吞咽训练同步干预（第1组）、单纯rTMS（第2组）和单纯传统吞咽训练（第3组）的不同干预效果进行了实验。每位患者每周进行5天常规吞咽训练，共2周。第1组和第2组患者在受影响的下颌舌骨肌皮质区域连续接受10次5Hz的rTMS治疗。对各组进行纤维内镜吞咽困难严重程度量表（FEDSS）、渗透/误吸量表（PAS）、标准化吞咽评估（SSA）和功能性经口进食量表（FOIS）的评估和比较。三组在基线时FEDSS、PAS、SSA或FOIS评分无显著差异。三组在基线和干预后FEDSS评分、PAS评分、SSA评分和FOIS评分的平均变化值（分别为H = 16.05，P < 0.001；H = 21.70，P < 0.001；F(2, 53) = 9.68，P < 0.001；H = 18.26，P < 0.001）具有统计学意义。此外，第1组（所有P < 0.001）和第2组（分别为P = 0.046；P = 0.045；P = 0.028；P = 0.032）参与者的FEDSS、PAS、SSA和FOIS评分的平均变化值显著高于第3组。同样，第1组参与者的FEDSS、PAS、SSA和FOIS评分的平均变化值显著高于第2组（分别为P = 0.046；P = 0.038；P = 0.042；P = 0.044）。结果显示，rTMS与用力吞咽训练相结合是促进中风患者吞咽功能恢复的有效方法。本临床试验为中风患者吞咽功能恢复提供了一种新的治疗方法，可能进一步促进有吞咽障碍的中风患者吞咽功能的恢复。
