| Objective Dysphagia is one of the common dysfunction happened in patients with stroke,which could lead to prolonged hospitalization,delayed recovery and secondary complications,such as malnutrition,dehydration,aspiration pneumonia,and even life threatening.Several methods have been used in the management of dysphagia,including oral and facial sensory training,oral and pharyngeal muscle strengthening training,compensatory techniques,prosthetic devices and surgery.However,the validity and mechanism of these procedures has not been fully demonstrated.The management of patients with dysphagia after stroke is one of major topics in the field of rehabilitation medicine research.Therefore,further research on new technologies is urgently needed.Transcranial magnetism(TMS),as a safe and non-invasive new technology,has been used to change the excitability of cerebral cortex and realize the reconstruction of cortical functional areas.The aim of current study was to explore the application of high frequency(5Hz)repetitive Transcranial Magnetic Stimulation(r TMS)on contralateral hemisphere suprahyoid muscles motor cortex,and further investigate its effects in the treatment of patients with dysphagia after unilateral hemisphere stroke.Methods Forty patients who were diagnosed with dysphagia after unilateral hemisphere stroke more than two weeks were recruited in this study.The patients were randomly assigned into the experimental group(EG)or the control group(CG).Patients in both groups were treated with neurotrophic and circulatory drugs.For the patients in the experimental group,r TMS was applied along with traditional swallowing rehabilitation training(including oral-facial muscle training,respiratory training,airway protection training,pharyngeal ice stimulation training,tongue root resistance training,head and neck control training,drinking water training,etc),while the patients in the control group only received traditional swallowing rehabilitation.X-ray fluoroscopy and surface electromyography were performed before and after two-week training sessions.Standardized Swallowing Assessment(SSA),Penetration-Aspiration Scale(PAS)and Video Fluoroscopic Swallowing Study(VFSS)were used to evaluate the effectiveness of r TMS on the patients with dysphasia after unilateral hemisphere stroke.Results Before treatment,the swallowing time and maximum amplitude of s EMG as well as SSA,PAS and VFSS scores of the patients in the control group were2.22±0.63 s,0.25±0.07 m V,25.25±2.90,4.50±1.32,6.25±1.41 respectively.In the experimental group,the swallowing time and maximum amplitude of s EMG,as well as SSA,PAS and VFSS scores were 2.34±0.64 s,0.24±0.10 m V,25.15±2.52,4.70±1.76,6.20±1.24.Overall,patients in both two groups could achieve significant improvement in swallowing time of s EMG,amplitude of s MEG,SSA,PAS,and VFSS after two-week training sessions.The improvement was statistically significant(p<0.05).After treatment,the swallowing time and maximum amplitude of s EMG as well as SSA,PAS and VFSS scores of the patients in the control group were 1.80±0.57 s,0.33±0.08 m V,22.45±2.63,2.65±1.42,7.60±1.35 respectively.Compared with control group,patients in the experimental group had better performance on swallowing time(1.50±0.30),amplitude of s EMG(0.40±0.12),SSA(20.30±2.25),PAS(2.00±1.69),and VFSS(8.75±1.29)(P < 0.05).Conclusions The current study showed that the application of high frequency(5Hz)r TMS on contralateral hemisphere suprahyoid muscles motor cortex could decrease the food residue in the oral cavity,epiglottic valley and piriform recess,reduce the occurrence of aspiration,improve the muscle strength of the suprahyoid muscle group,shorten the swallowing time,and effectively improve dysphagia after unilateral hemisphere stroke.Therefore,the application of high frequency repetitive transcranial magnetic stimulation were suggested in the treatment of patients with dysphagia after unilateral hemisphere stroke. |
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