Clinical Study Of RESWT Combined With Routine Swallowing Rehabilitation Training On Dysphagia After Ischemic Stroke

Objective: To investigate the clinical efficacy of radial extracorporeal shock wave therapy combined with routine swallowing rehabilitation training on dysphagia after ischemic stroke.To provide a new method for the treatment of dysphagia in patients with ischemic stroke and provide a reference for clinical application.Methods: From January 2020 to December 2020,60 patients with dysphagia during oral preparation and oral phase after ischemic stroke from the outpatient and inpatient departments of Rehabilitation Medicine Department of Affiliated Hospital of Hebei University were included into this study.All patients strictly met the inclusion and exclusion criteria.Sixty patients were randomly divided into two groups: study group and control group,30 cases in each group.Both groups received standardized medical treatment(nutrition of nerve,management of blood pressure and improvement of circulation,etc.).The study group was given r ESWT and routine swallowing rehabilitation training,while the control group was given routine swallowing rehabilitation training.The radial extracorporeal shock wave was treated with the Swiss Dolor Clast therapeutic instrument produced by Swiss EMS Company,and the treatment probe with a diameter of 10 mm was selected.The treatment parameters were set as follows: shock intensity 1 bar,shock frequency 6 Hz,shock times 2000.The patients were treated once a week for 4 weeks.Routine swallowing rehabilitation training treatment schedule:30 minutes each time,once a day,5 times a week for 4 weeks.Before treatment,2 weeks after treatment and 4 weeks after treatment,the patients in the two groups were evaluated by drinking water test,standardized swallowing assessment and ingestion dysphagia assessment,and the evaluation results were statistically analyzed and compared to observe the clinical efficacy.The treatment effect of the two groups was compared by Mann Whitney U test.Friedman test was used to compare the grade data of drinking water test before treatment,2 weeks after treatment and 4 weeks after treatment in each group.If there were statistical differences,Wilcoxon test was used for pairwise comparison at different time points in the group.Mann Whitney U test was used to compare the data at the same time point between the two groups.Before treatment,2 weeks after treatment and 4 weeks after treatment,the standard swallowing score and ingestion swallowing score were compared between the two groups.2 × 3 repeated measurement ANOVA was used to analyze the main effect and interaction effect of group and time.If the interaction effect was significant,simple effect analysis was performed.P<0.05 means significant difference,P<0.01 means very significant difference.Results:(1)The therapeutic effect of r ESWT group was significantly higher than that of control group(P<0.01).(2)After 2 weeks and 4 weeks of treatment,the test grade of drinking water in the two groups was significantly improved compared with that before treatment(P<0.01).After 2weeks of treatment,the improvement of drinking water level in the r ESWT group was better than that in the control group(P=0.05).After 4 weeks of treatment,compared with the control group,the drinking water level of r ESWT group improved more significantly(P< 0.01).(3)The SSA scores of control group and r ESWT group after 2 weeks and 4 weeks of treatment were significantly lower than those before treatment(P<0.01).After 2 weeks of treatment,SSA score of r ESWT group was significantly lower than that of control group(P<0.05).After 4 weeks of treatment,SSA score of r ESWT group was still significantly lower than that of control group(P<0.01).(4)The dysphagia scores of the control group and the r ESWT group after 2 and 4 weeks of treatment were significantly lower than those before treatment.After 2 weeks of treatment,the feeding dysphagia score of r ESWT group was significantly higher than that of control group(P<0.01).After 4 weeks of treatment,the feeding dysphagia score of the r ESWT group was still significantly higher than that of the control group(P<0.01).Conclusion: 1.Routine swallowing rehabilitation training can improve the swallowing function of patients with dysphagia after ischemic stroke.2.Compared with routine swallowing rehabilitation training,the effect of r ESWT combined with routine swallowing rehabilitation training in the treatment of dysphagia after ischemic stroke is more obvious.