Peng Jihai, Huang Siyu, Zhang Wenlin, Chen Ke Er, Chen Xiaoman, Ding Qian, Xu Guangqing
Department of Rehabilitation Medicine, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106, Zhongshan Road II, Guangzhou, 510080, China.
Dysphagia. 2025 Jun 17. doi: 10.1007/s00455-025-10847-x.
To simultaneously perform dual stimulation (DS) through repetitive transcranial magnetic stimulation (rTMS) and resistance training of the target muscle group (submental muscles) using chin-tuck against resistance (CTAR), with the aim of observing via functional near-infrared spectroscopy (fNIRS) and surface electromyography studies whether rTMS and CTAR dual stimulation can maximize cerebral blood oxygenation and brain connectivity changes, as well as submental muscle contraction function, thus enhancing swallowing function and providing a new treatment method to reduce clinical swallowing disorder patients' risk of aspiration. Forty age-matched healthy participants were enrolled and assigned to four groups: the first group received no intervention, the second group received 5-Hz single stimulation via rTMS on the dominant hemisphere M1; the third group received simultaneous 5-Hz rTMS on the dominant hemisphere M1 with active resistance movement DS of the submental muscles; the last group received single stimulation via CTAR; all participants were assessed before and after stimulation through fNIRS to measure cerebral hemodynamics for evaluating differences in brain area activation and functional connectivity during resting and task states. Differences in the root mean square amplitude (RMS) of the submental muscle group among the four groups were also analyzed. DS group channels 24 and 51 showed higher cortical activation; also increased connectivity from the left frontal lobe to the right parietal lobe. In bilateral submental muscle groups, RMS after intervention was significantly reduced in DS group and CTAR group, while there was no significant difference between TMS group and control group. In conclusion, dual stimulation of rTMS combined with CTAR can significantly activate the cerebral cortex, increase brain connectivity and reduce RMS in the rehabilitation of dysphagia, which is a promising treatment method and provides a basis for non-invasive research of fNIRS.
通过重复经颅磁刺激（rTMS）和使用抗阻颏舌肌训练（CTAR）对目标肌肉群（颏下肌肉）进行抗阻训练来同时进行双重刺激（DS），目的是通过功能近红外光谱（fNIRS）和表面肌电图研究观察rTMS和CTAR双重刺激是否能使脑血氧合和脑连接变化以及颏下肌肉收缩功能最大化，从而增强吞咽功能，并提供一种新的治疗方法以降低临床吞咽障碍患者的误吸风险。招募了40名年龄匹配的健康参与者并将其分为四组：第一组不接受干预，第二组通过rTMS在优势半球M1上接受5赫兹单刺激；第三组在优势半球M1上同时接受5赫兹rTMS和颏下肌肉的主动抗阻运动双重刺激；最后一组通过CTAR接受单刺激；所有参与者在刺激前后通过fNIRS进行评估，以测量脑血流动力学，评估静息和任务状态下脑区激活和功能连接的差异。还分析了四组中颏下肌肉群的均方根振幅（RMS）差异。双重刺激组的24和51通道显示出更高的皮质激活；从左额叶到右顶叶的连接也增加。在双侧颏下肌肉群中，双重刺激组和CTAR组干预后的RMS显著降低，而TMS组和对照组之间无显著差异。总之，rTMS与CTAR的双重刺激在吞咽困难康复中可显著激活大脑皮层、增加脑连接并降低RMS，这是一种有前景的治疗方法，并为fNIRS的非侵入性研究提供了依据。
