The Study Of Acupuncture Kinesitherapy Treatment For Dysphagia Caused By Pseudobulbar Paralysis After Stroke

Objective This study was to observe the clinical efficacy and mechanism of the acupuncture kinesitherapy on supranuclear paralysis dysphagia following stroke.Methods Total of90supranuclear paralysis dysphagia patients were collected and divided into3groups stratified randomly as control group, acupuncture group and treatment group consisting of30patients each group. All patients were received conventional therapy and deglutition function training. Besides, patients in acupuncture group received regular acupuncture therapy, and patients in treatment group received acupuncture plus moving therapy in forehead middle line, lian quan and jia lian quan points. The patients’deglutition function improvement was assessed by brainstem auditory evoked potentials (BAEP), video fluoroscopic swallowing study (VFSS) and Kubota-Chiari’s swallowing functional classification before the therapy, three weeks’therapy later and six weeks’therapy later, and tested the amount of NO and SOD in plasma.Results (1) The acupuncture kinesitherapy can obviously improve the supranuclear paralysis dysphagia patients’deglutition function. The efficacy of acupuncture group is superior than that of control group.(2) The acupuncture kinesitherapy can efficiently shorten the time of the supranuclear paralysis dysphagia patients’peak latency and interpeak latency of BAEP.(3) As time goes on, the VFSS scores of treament group are higher than that of acupuncture group. This therapy can obviously shorten the time of food passing pharyngeal, reduce or dislodge aspiration, improve deglutition function and promote recovery.(4) The acupuncture kinesitherapy can obviously decrease level of NO and increase level of SOD in plasma.Conclusions The acupuncture kinesitherapy is confirmed efficacy on supranuclear paralysis dysphagia following stroke, and its possible functional mechanism includes three aspects.(1) This therapy directly stimulates the suprahyoid muscle group (genioglossus, stylohyoid etc.), palatopharyngeus and constrictor naris, relieves muscle spasm, promotes muscle force recovery, raises pharyngeal muscle compliance and excites glossopharyngeal nerve, vagus nerve and hypoglossal nerve, recovers pharyngeal innervation, improves local muscle weakness and strengthens the correct model connecting swallowing act, thus improves deglutition function. Second, this therapy promotes the cerebral cortex’s function recovery by decreasing NO and increasing SOD amount. And acupuncture can activate the posterior insular lobe cortex. Maybe it promotes the deglutition function recovery through various ways as facilitating swallowing act trigger and improving pharyngeal somesthesia and taste sense etc. Third, this therapy promotes the brainstem’s function recovery, it promotes the swallowing reflex completion for the reflex arc, excites the glossopharyngeal nerve and vagus nerve etc. under the points, transmits excitement information, makes synapsis remolding and rebuilds the damaged nerve reflex arc. The strengthening of the voluntary movement induced by acupuncture and the motor pattern adjusted by acupuncture, makes the cerebral cortex motor area movement qualitative, thereby it recovers the cerebral cortex’s function of adjusting corticonuclear tract, upper motor neuron and lower motor neuron. It promotes the rebuilding of damaged reflex arc or recovers that part completing just through medulla oblongata, makes the brainstem function recovery, improves and rebuilds the deglutition function, as a result, it promotes the dysphagia recovery.