Effect of Low-Frequency rTMS and NMES on Subacute Unilateral Hemispheric Stroke With Dysphagia.
Effect of Low-Frequency rTMS and NMES on Subacute Unilateral Hemispheric Stroke With Dysphagia.
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DOI：
10.5535/arm.2014.38.5.592
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Kwon YG
中科院分区：
文献类型：
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作者：
Lim KB;Lee HJ;Yoo J;Kwon YG
探讨低频重复经颅磁刺激(RTMS)和神经肌肉电刺激(NMES)对卒中后吞咽困难的影响。亚急性(3个月)单侧半球卒中吞咽困难患者随机分为常规吞咽困难治疗(CDT)组、rTMS组或NMES组。RTMS组采用100%静息运动阈值，频率1 Hz，每次20min(每周5天，共2周)。NMES组：电刺激颈前部30min/次(每周5天，共2周)。三组患者均接受常规吞咽困难治疗，疗程4周。分别于治疗前、治疗2周、治疗4周后进行功能性吞咽困难评分(FDS)、咽通过时间(PTT)、穿透吸入量表(PAS)和美国言语-语言听力协会全国预后评估系统(ASHA-NOMS)吞咽评分。47名患者完成了这项研究；CDT组15名，rTMS组14名，NMES组18名。RTMS组和NMES组前2周液体FDS和PAS的平均变化显著高于CDT组，但rTMS组和NMES组之间无显著差异。三组间半固态、PTT和Asha Nom的FDS和PAS的平均变化无显著差异。这些结果表明，低频rTMS和NMES都能促进吞咽困难的早期恢复，因此，它们都可以作为吞咽困难卒中患者的有效治疗选择。
To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on post-stroke dysphagia. Subacute (<3 months), unilateral hemispheric stroke patients with dysphagia were randomly assigned to the conventional dysphagia therapy (CDT), rTMS, or NMES groups. In rTMS group, rTMS was performed at 100% resting motor threshold with 1 Hz frequency for 20 minutes per session (5 days per week for 2 weeks). In NMES group, electrical stimulation was applied to the anterior neck for 30 minutes per session (5 days per week for 2 weeks). All three groups were given conventional dysphagia therapy for 4 weeks. We evaluated the functional dysphagia scale (FDS), pharyngeal transit time (PTT), the penetration-aspiration scale (PAS), and the American Speech-Language Hearing Association National Outcomes Measurement System (ASHA NOMS) swallowing scale at baseline, after 2 weeks, and after 4 weeks. Forty-seven patients completed the study; 15 in the CDT group, 14 in the rTMS group, and 18 in the NMES group. Mean changes in FDS and PAS for liquid during first 2 weeks in the rTMS and NMES groups were significantly higher than those in the CDT group, but no significant differences were found between the rTMS and NMES group. No significant difference in mean changes of FDS and PAS for semi-solid, PTT, and ASHA NOMS was observed among the three groups. These results indicated that both low-frequency rTMS and NMES could induce early recovery from dysphagia; therefore, they both could be useful therapeutic options for dysphagic stroke patients.