Clinical study of high frequency repetitive transcranial magnetic stimulation combined with muscle electrobiofeedback in the treatment of dysphagia after stroke

doi:10.3877/cma.j.issn.2095-123X.2022.05.006

Abstract

Abstract:

Objective

To investigate the clinical efficacy of high frequency repetitive transcranial magnetic stimulation (rTMS) combined with muscle electrobiofeedback in the treatment of dysphagia after stroke.

Methods

One hundred and twenty-eight patients with dysphagia after stroke admitted by Rehabilitation Medicine Department of Hai'an Hospital Affiliated to Nantong University from July 2018 to July 2021 were selected and randomly divided into group A, group B, group C and group D, with 32 cases in each group. Group A received routine swallowing training. Group B, C and D received muscle electrobiofeedback therapy, high frequency rTMS therapy, and high frequency rTMS combined with muscle electrobiofeedback therapy on the basis of group A. The scores of standard swallowing assessment (SSA) scale, and the lingual laryngeal complex mobilities (including hyoid bone upward movement, hyoid bone forward movement, thyroid cartilage upward movement, thyroid cartilage forward movement), root meam square (RMS) of electromyographic activity of suprahyoid muscle group, the scores of swallowing quality of life (SWAL-QOL) and the clinical efficacy of the 4 groups were compared before, after treatment. Adverse reactions of patients were recorded.

Results

After treatment, the SSA scores of the 4 groups were lower than those before treatment (P<0.05). After treatment, the SSA scores of group B, C and D were lower than those of group A (P<0.05), and the SSA score of group D were lower than that of group B and C (P<0.05). After treatment, the degree of upward and forward displacement of hyoid bone and thyroid cartilage and the RMS value of suprahyoid muscle group of the 4 groups were higher than those before treatment (P<0.05). After treatment, the degree of upward and forward displacement of hyoid bone and thyroid cartilage and the RMS value of suprahyoid muscle group in group B, C and D were higher than those in group A (P<0.05), and the degree of upward and forward displacement of hyoid bone and thyroid cartilage and the RMS value of suprahyoid muscle group in group D were higher than those in group B and C (P<0.05). After treatment, the scores of SWAL-QOL in the 4 groups were higher than those before treatment (P<0.05), and the scores of SWAL-QOL in groups B, C and D were higher than those in group A (P<0.05), and the scores of SWAL-QOL in group D were higher than those in groups B and C (P<0.05). There was significant difference in the distribution of clinical efficacy among the 4 groups (P<0.05), and the total effective rate in group D was higher than that in group A (P<0.01). There were no serious adverse reactions in the 4 groups.

Conclusion

High frequency rTMS combined with muscle electrobiofeedback in the treatment of dysphagia after stroke can increase the tongue and throat muscle movement, and improve the mobility of tongue and throat complex, and improve the dysphagia, and improve the quality of life of patients.

Key words: High frequency repetitive transcranial magnetic stimulation, Muscle electrobiofeedback, Stroke, Dysphagia

Jianping Zhang, Haipeng Deng, Daiyan Jiao, Jie Zhao. Clinical study of high frequency repetitive transcranial magnetic stimulation combined with muscle electrobiofeedback in the treatment of dysphagia after stroke[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(05): 285-290.

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Figures/Tables 6

References 21

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组别	例数	性别[例（%）]		年龄（岁，Mean±SD）	病程（月，Mean±SD）	洼田饮水试验吞咽障碍分级[例（%）]
组别	例数	男	女	年龄（岁，Mean±SD）	病程（月，Mean±SD）	3级	4级	5级
A组	32	16（50.00）	16（50.00）	56.26±2.18	1.32±0.25	5（15.63）	13（40.63）	14（43.75）
B组	32	15（46.88）	17（53.13）	55.49±2.23	1.29±0.21	6（18.75）	11（34.38）	15（46.88）
C组	32	14（43.75）	18（56.25）	56.17±2.09	1.35±0.18	6（18.75）	14（43.75）	12（37.50）
D组	32	17（53.13）	15（46.88）	55.73±2.21	1.39±0.31	7（21.88）	12（37.50）	13（40.63）
χ²/F值		0.626		0.897	0.994	1.104
P值		0.891		0.445	0.398	0.981

组别	例数	性别[例（%）]		年龄（岁，Mean±SD）	病程（月，Mean±SD）	洼田饮水试验吞咽障碍分级[例（%）]
组别	例数	男	女	年龄（岁，Mean±SD）	病程（月，Mean±SD）	3级	4级	5级
A组	32	16（50.00）	16（50.00）	56.26±2.18	1.32±0.25	5（15.63）	13（40.63）	14（43.75）
B组	32	15（46.88）	17（53.13）	55.49±2.23	1.29±0.21	6（18.75）	11（34.38）	15（46.88）
C组	32	14（43.75）	18（56.25）	56.17±2.09	1.35±0.18	6（18.75）	14（43.75）	12（37.50）
D组	32	17（53.13）	15（46.88）	55.73±2.21	1.39±0.31	7（21.88）	12（37.50）	13（40.63）
χ²/F值		0.626		0.897	0.994	1.104
P值		0.891		0.445	0.398	0.981

组别	例数	治疗前	治疗后	t值	P值
A组	32	37.95±3.24	26.04±3.33	14.501	<0.001
B组	32	37.84±3.26	23.47±3.25^a	17.659	<0.001
C组	32	37.76±3.29	22.49±3.24^a	18.707	<0.001
D组	32	38.02±3.55	19.63±3.27^abc	21.554	<0.001
F值		0.038	20.959
P值		0.990	<0.001

组别	例数	治疗前	治疗后	t值	P值
A组	32	37.95±3.24	26.04±3.33	14.501	<0.001
B组	32	37.84±3.26	23.47±3.25^a	17.659	<0.001
C组	32	37.76±3.29	22.49±3.24^a	18.707	<0.001
D组	32	38.02±3.55	19.63±3.27^abc	21.554	<0.001
F值		0.038	20.959
P值		0.990	<0.001

项目		A组（n=32）	B组（n=32）	C组（n=32）	D组（n=32）	F值	P值
舌骨上移	治疗前	12.21±2.64	12.54±2.84	12.15±2.43	12.96±2.51	0.650	0.584
	治疗后	14.36±2.73	15.87±2.89^a	15.98±3.11^a	17.73±3.25^abc	6.747	<0.001
	t值	3.203	4.649	5.489	6.571
	P值	0.002	<0.001	<0.001	<0.001
舌骨前移	治疗前	4.56±1.04	4.71±1.26	4.63±1.24	4.82±1.37	0.262	0.852
	治疗后	6.12±1.56	7.03±1.54^a	7.54±1.59^a	8.68±1.62^abc	14.654	<0.001
	t值	4.707	6.596	8.164	10.292
	P值	<0.001	<0.001	<0.001	<0.001
甲状软骨上移	治疗前	14.56±3.24	14.64±3.11	14.53±3.03	15.26±3.27	0.380	0.768
	治疗后	18.42±4.31	20.68±4.28^a	21.27±4.56^a	23.71±4.68^abc	7.598	<0.001
	t值	4.050	6.458	6.964	8.372
	P值	<0.001	<0.001	<0.001	<0.001
甲状软骨前移	治疗前	4.03±1.08	4.18±1.19	4.07±1.21	4.21±1.18	0.175	0.913
	治疗后	5.56±1.34	6.28±1.38^a	6.37±1.52^a	7.14±1.58^abc	6.284	0.001
	t值	5.029	6.519	6.697	8.405
	P值	<0.001	<0.001	<0.001	<0.001

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