| Objective:To observe the improvement effect of transcranial direct current stimulation(tDCS)in different parts on dysphagia and the electrical activity of the cerebral cortex in patients with acute ischemic stroke.To investigate the stimulation site for the best effect of tDCS in treating patients with dysphagia after acute ischemic stroke.To provide the basis for tDCS technology in the rehabilitation of swallowing function after acute ischemic stroke.Methods:Taking patients with dysphagia after acute ischemic stroke as the research object,from February 2021 to August 2021,60 patients who met the inclusion and exclusion criteria were selected from the Department of Neurology of a tertiary grade A general hospital in Nanchong City.Using a factorial design method,60 patients were randomly assigned to the unaffected side stimulation group,the affected side stimulation group,the bilateral stimulation group(affected side stimulation+unaffected side stimulation),and the control group.Control group:received routine swallowing rehabilitation nursing.tDCS intervention group(affected side stimulation group,unaffected side stimulation group,bilateral stimulation group):tDCS treatment was given basedon swallowing rehabilitation nursing.Four groups of patients filled out the general information questionnaire before the intervention.The water swallow test,dysphagia outcome and severity scale(DOSS),standard swallowing function assessment scale(SSA)and quantitative electroencephalograph(qEEG)were collected at TO(1 day before intervention)and T1(end of intervention).Adverse events that occurred during the intervention in tDCS patients were recorded.Result:1 Baseline dataThe general data questionnaire,water swallow test,DOSS,SSA,and left and right cerebral hemisphere relative α,δ/α power values of the four groups of patients were compared,and the difference was not statistically significant(P>0.05).Baseline data Consistently comparable.2 Evaluation of clinical efficacy of swallowing function rehabilitation after intervention(Using the water-drinking experiment in Kubota as a judging tool)The effective rate of swallowing function rehabilitation after intervention:the control group was 40%,the unaffected side stimulation group was 86.7%,80%in both the affected side stimulation group and the bilateral stimulation group.There was a significant difference in the clinical efficacy of swallowing function rehabilitation between the four groups after treatment(P<0.05).Comparison between groups:The recovery rate of swallowing function in the affected side stimulation group,unaffected stimulation group and bilateral stimulation group was higher than that in the control group(P<0.05).There was no significant difference in the effective rate of swallowing function rehabilitation between the healthy side stimulation group and the affected side stimulation group and the bilateral stimulation group(P>0.05).3 Changes of affected side stimulation and unaffected side stimulation on DOSS scoresAfter the intervention,the DOSS scores of the four groups were higher than those before the intervention.The DOSS scores of the affected side stimulation group,the unaffected side stimulation group and the bilateral stimulation group were significantly improved after intervention(P<0.05).There was no significant increase in the DOSS score in the control group after intervention(P>0.05).Two-Factorial design ANOVA of the difference in DOSS scores before and after the intervention showed that:there was an interaction effect between affected and unaffected stimulation on the improvement of DOSS scores(P<0.05);both affected and unaffected stimulation had a statistically significant effect on the improvement of DOSS scores(P<0.05).The separate effect of the difference in DOSS scores before and after the intervention showed that when the affected side stimulation was fixed at no stimulation given,the DOSS scores improved in the unaffected side stimulation group were on average 1.6(P<0.05)higher than in the control group;when the affected side stimulation was fixed at stimulation given,the DOSS scores improved in the affected side stimulation group were on average 0.467(P>0.05)higher than in the bilateral stimulation group.When the unaffected side stimulation was fixed at not giving the stimulation,the improved DOSS score in the affected side stimulation group was 1.533(P<0.05)higher than that in the control group on average;when the unaffected side stimulation was fixed at giving the stimulation,the improved DOSS score in the unaffected side stimulation group was 0.533(P>0.05)higher than that in the bilateral stimulation group on average.One-way ANOVA:There was no difference in the improvement of DOSS score between the affected side stimulation group and the unaffected side stimulation group after intervention(P>0.05).4 Changes of affected side stimulation and unaffected side stimulation on SSA scoresAfter the intervention,the SSA scores of the control group,the affected side stimulation group,the unaffected side stimulation group,and the bilateral stimulation group were all lower than those before the intervention(P<0.05).Two-Factorial design ANOVA of the difference in SSA scores before and after the intervention showed that:the reduction in SSA scores by the affected side stimulation and the unaffected side stimulation did not show a significant interaction effect(P>0.05);the reduction in SSA scores by the affected side stimulation was not statistically significant(P>0.05);the reduction in SSA scores by the unaffected side stimulation was statistically significant(P<0.05).One-way ANOVA:The reduction of SSA score in the stimulation group on the unaffected side after the intervention was higher than that in the stimulation group on the affected side(P<0.05).5 Changes in quantitative EEG relative band power values by stimulation on the affected side versus the unaffected sideAfter the intervention,the relative a power values of the left and right cerebral hemispheres were higher,and the relative δ/α power values were lower in all four groups than before the intervention.In the control group,there was no statistically significant change in the relative a and δ/α power values of the left and right hemispheres after the intervention compared with those before the intervention(P>0.05);there was a statistically significant change in the relative a and δ/α power values of the left hemisphere after the intervention in the affected stimulation group(P<0.05),and no statistically significant change in the relative a and δ/α power values of the right hemisphere(P>0.05);the left and right hemispheres after the intervention in the unaffected stimulation group The changes in the relative a and δ/α power values in the left and right hemispheres after the intervention in the unaffected side stimulation group were statistically significant(P<0.05);the changes in the relative δ/α power values in the left and right hemispheres and the relative a power values in the left hemisphere after the intervention in the bilateral stimulation group were statistically significant(P<0.05),and the changes in the relative α power values in the right hemisphere were not statistically significant(P>0.05).Two-Factorial design ANOVA of the left and right cerebral hemisphere relative α,δ/α power values before and after the intervention showed that:there was a cross-effect between the affected and unaffectedstimuli in increasing the relative alpha power values of the left hemisphere(P<0.05);the affected stimuli had no statistically significant effect on increasing the relative alpha power values of the left and right hemispheres and decreasing the relative δ/alpha power values of the left and right hemispheres(P>0.05);the unaffected stimuli had no statistically significant effect on increasing the relative alpha power values of the left and right hemisphere relative a power values and decreased left,and right hemisphere relative δ/α power values were statistically significant(P<0.05).The separate effect of the difference in left hemisphere EEG relative αpower values before and after the intervention showed that when the stimulation on the affected side was fixed without stimulation,the relative alpha power value of the stimulation group on the unaffected side was 0.135(P<0.05)higher than that in the control group on average;when the stimulation on the affected side was fixed to the given stimulus,the relative alpha power value of the bilateral stimulation group was on average 0.032(P<0.05)higher than that of the affected side stimulation group;when the stimulus on the unaffected side was fixed at no stimulation,the relative alpha power value of the stimulated group on the affected side was 0.017(P>0.05)higher than that in the control group on average;when the stimulus was fixed on the unaffected side with stimulation,the relative alpha power value improved in the unaffected side stimulation group was 0.086(P<0.05)higher than that in the bilateral stimulation group on average.One-way ANOVA:After the intervention in the unaffected side stimulation group,the increase of the left hemisphere relative a power value was higher than that of the affected side stimulation group,and the decrease of the left and right hemisphere relative δ/α power values was higher than that of the affected side stimulation group(P<0.05),there was no significant difference between the two groups in the change of the relative a power value in the right hemisphere after intervention(P>0.05).6 SecurityNo noticeable adverse reactions were found during the intervention.Conclusion:1 Combined with swallowing rehabilitation nursing,tDCS can promote the recovery of swallowing function in patients with dysphagia after stroke,and is better than swallowing rehabilitation alone.2 Both stimulation on the affected side and stimulation on the unaffected side are effective in improving the swallowing function of patients with dysphagia after stroke.However,stimulation of the affected side+stimulation of the unaffected side was not superior to the stimulation of the affected side or the unaffected side alone in improving dysphagia in post-stroke patients.Stimulation of the unaffected side may be the stimulation site for the best results.3 There is a correlation between the relative α,δ/α power values in quantitative EEG and patients with dysphagia after stroke.The increase of the relative a power value and the decrease of the relative δ/α power value indicated that the swallowing function recovered well in the patients with dysphagia after stroke.4 tDCS is safe in the rehabilitation of swallowing function in patients with dysphagia after stroke. |
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