Ortega Omar, Palomeras Ernest, Clavé Pere
Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital Universitari de Mataró, Universitat Autònoma de Barcelona, Carretera de Cirera 230, 08304, Mataró, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
Sci Rep. 2025 Jul 10;15(1):24903. doi: 10.1038/s41598-025-07961-z.
Oropharyngeal dysphagia in chronic post-stroke (PS-OD) patients is associated with impaired oropharyngeal sensory/motor function. We aimed to evaluate the effect of transcutaneous electrical stimulation (TES) on the biomechanics and kinetics of swallowing in PS-OD patients in a randomized controlled clinical trial with 1-year follow-up. 71 PS-OD patients with impaired safety of swallow (ISS) were randomized into 2 groups, (1) 26 with compensatory treatment (CT): thickeners and texture-modified diets, and (2) 45 with active treatment (TES + CT) with 2 cycles of TES (VitalStim; Enovis, USA), at baseline and 6 months. Each TES cycle consisted of 15 1-hour sessions over 2 weeks. Its effect was assessed by videofluoroscopy (baseline, post-treatment 1, 6 months, post-treatment 2, 12 months). Both groups were homogeneous, patients had 74.41 ± 11.28 years (31.00% women), functional decline (Barthel 72 ± 31), comorbidities (Charlson 3.00 ± 1.57), nutritional risk (MNA-sf 10.29 ± 2.59) and moderate stroke (NIHSS 3.35 ± 4.01). All had ISS (penetration-aspiration scale [PAS] 4.61 ± 1.67, only 9.86% could swallow thin liquid safely) and biomechanical delay (time to laryngeal vestibular closure [LVC] 402.82 ± 111.98ms). Swallowing parameters improved significantly between baseline and 12 months in the TES group (ISS, p < 0.001; PAS, safe thin liquid hydration, LVC, p < 0.0001; bolus kinematics, p < 0.05). No changes were observed in hyoid bone movement or timing. The CT group did not show any significant biomechanical changes. No relevant adverse events were associated with TES. TES is a safe and effective therapy for PS-OD. After 1 year of follow up, it improved ISS, time to LVC, bolus kinetics, and reduced the need for thickening agents.
慢性卒中后口咽吞咽困难（PS-OD）患者的口咽吞咽困难与口咽感觉/运动功能受损有关。我们旨在通过一项为期1年随访的随机对照临床试验，评估经皮电刺激（TES）对PS-OD患者吞咽生物力学和动力学的影响。71例吞咽安全性受损（ISS）的PS-OD患者被随机分为两组，（1）26例接受代偿性治疗（CT）：增稠剂和质地改良饮食，（2）45例接受积极治疗（TES+CT），采用2个周期的TES（VitalStim；美国Enovis公司），分别在基线和6个月时进行。每个TES周期包括在2周内进行15次1小时的治疗。通过视频荧光吞咽造影（基线、治疗后1个月、6个月、治疗后2个月、12个月）评估其效果。两组患者情况相似，患者年龄为74.41±11.28岁（女性占31.00%），功能下降（Barthel指数72±31），合并症（Charlson指数3.00±1.57），营养风险（微型营养评定简表MNA-sf 10.29±2.59），且为中度卒中（美国国立卫生研究院卒中量表NIHSS 3.35±4.01）。所有患者均有ISS（渗透-误吸量表[PAS]4.61±1.67，只有9.86%的患者能够安全吞咽稀液体）和生物力学延迟（喉前庭关闭时间[LVC]402.82±111.98毫秒）。在TES组中，基线和12个月之间吞咽参数有显著改善（ISS，p<0.001；PAS、安全稀液体吞咽、LVC，p<0.0001；食团动力学，p<0.05）。舌骨运动或时间未观察到变化。CT组未显示任何显著的生物力学变化。未发现与TES相关的相关不良事件。TES是一种治疗PS-OD安全有效的疗法。经过1年的随访，它改善了ISS、LVC时间、食团动力学，并减少了增稠剂的使用需求。
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