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Yan X, Zhang X, Huang C, Jiang Y, Wan C. Applications of transcranial direct current stimulation over vagus nerve on dysphagia after stroke. J Neurophysiol 2025; 133:464-471. [PMID: 39835801 DOI: 10.1152/jn.00588.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 12/20/2024] [Accepted: 12/21/2024] [Indexed: 01/22/2025] Open
Abstract
Vagus nerve stimulation (VNS) has been commonly employed for the functional rehabilitation of stroke patients. This study aimed to investigate the therapeutic effects of transcranial direct current stimulation on the vagus nerve (TDCSVN) in improving dysphagia in stroke patients. Patients experiencing dysphagia following a stroke were diagnosed with dysphagia by a water swallow test. Swallowing function was evaluated with the standard swallowing scale score and the functional dysphagia scale. Serum levels of interleukin (IL)-1β and IL-8 were measured with enzyme-linked immunosorbent assays. TDCSVN treatment resulted in a significantly greater reduction in both the standard swallowing scale and functional dysphagia scale scores compared to conventional treatment. Furthermore, TDCSVN treatment led to a notable increase in hemoglobin and albumin levels, suggesting a more substantial improvement in dysphagia compared to conventional methods. Additionally, TDCSVN treatment was more effective in decreasing serum levels of IL-1β and IL-8 in dysphagic patients after a stroke. TDCSVN treatment demonstrated a significant inhibitory effect on inflammatory cytokines, resulting in a more pronounced improvement in dysphagia among stroke patients.NEW & NOTEWORTHY The present study demonstrates that transcranial direct current stimulation on the vagus nerve (TDCSVN) treatment shows a significant inhibitory effect on the production of inflammatory factors, resulting in a more pronounced improvement in dysphagia among stroke patients.
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Affiliation(s)
- Xinyue Yan
- Department of Rehabilitation Medicine, Tianjin Medical University General Hospital, Tianjin, China
- Department of Rehabilitation Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Xiwei Zhang
- Department of Rehabilitation Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Chuan Huang
- Department of Rehabilitation Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yujuan Jiang
- Department of Rehabilitation Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Chunxiao Wan
- Department of Rehabilitation Medicine, Tianjin Medical University General Hospital, Tianjin, China
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Zhang B, Wong KP, Guo C, Chen SC, Fu S, Kang R, Xiao Q, Qin J. Effects of Non-Pharmacological Interventions on the Swallowing Function of Patients With Post-Stroke Dysphagia: A Systematic Review and Network Meta-Analysis. J Oral Rehabil 2025; 52:109-120. [PMID: 39532528 DOI: 10.1111/joor.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/02/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Post-stroke dysphagia can lead to serious complications and appropriate rehabilitation can significantly improve swallowing function. However, the best rehabilitation method for post-stroke dysphagia patients is not clear at the present stage, so it is necessary to conduct a comprehensive network meta-analysis and systematic review of different interventions for dysphagia. OBJECTIVE To compare the effectiveness and ranking of different interventions for improving swallowing function, and feeding and daily function in patients with post-stroke dysphagia. METHODS Seven databases were searched from the date of inception to September 1, 2022. Two investigators independently conducted literature searches, selected randomized controlled trials on dysphagia interventions, and assessed study quality. Network meta-analysis was conducted by using Stata software. RESULTS A total of 33 studies involving 1,341 patients were included. According to the ranking probabilities, acupuncture was rated as the most effective of all interventions to enhance patients' swallowing function (surface under cumulative ranking curve values [SUCRCV]: 99.0%, standardized mean difference [SMD]: -2.40, 95% confidence interval [CI]: -3.38 to -1.43), followed by the chin tuck against resistance exercise (CTAR, SUCRA: 89.9%, SMD: -1.83, 95% CI: -2.69 to -0.97). Among all the interventions, acupuncture was the most effective for feeding and daily function (SUCRCV: 88.4%, SMD: -1.62, 95% CI: -2.94 to -0.30). CONCLUSIONS The results showed that acupuncture was the most effective in the rehabilitation of patients with post-stroke dysphagia, followed by CTAR. Considering that CTAR is a low-cost and highly feasible intervention, we suggest that CTAR should be selected as a rehabilitation measure for patients with post-stroke dysphagia to improve their swallowing function.
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Affiliation(s)
- Bohan Zhang
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Ka Po Wong
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Cai Guo
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- School of Computing and Information Engineering, Hanshan Normal University, Chaozhou, Guangdong, China
| | - Shu-Cheng Chen
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Shuojin Fu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ruifu Kang
- School of Nursing, Capital Medical University, Beijing, China
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, China
| | - Jing Qin
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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Wang J, Gao C, Fu C, Li K. Dysphagia in schizophrenia: pathological mechanisms and treatment recommendations. Front Psychiatry 2024; 15:1448623. [PMID: 39359857 PMCID: PMC11445750 DOI: 10.3389/fpsyt.2024.1448623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/27/2024] [Indexed: 10/04/2024] Open
Abstract
Schizophrenia is a chronic, severe, and disabling mental disorder that significantly impacts individuals' lives. Long-term treatment with antipsychotic drugs, coupled with the complications of the disease itself, increases the risk of dysphagia in patients. These disorders further heighten the likelihood of choking and asphyxia death among this population. This project aims to comprehensively review the pathological mechanisms behind dysphagia in schizophrenia, alongside proposing early screening and evaluation methods. It also suggests treatment recommendations to mitigate the risks and complications associated with dysphagia in these patients.
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Affiliation(s)
- Jiahui Wang
- Shandong Daizhuang Hospital, Jining, Shandong, China
| | - Caifeng Gao
- Shandong Daizhuang Hospital, Jining, Shandong, China
| | - Cuiyuan Fu
- Shandong Daizhuang Hospital, Jining, Shandong, China
| | - Kun Li
- Shandong Daizhuang Hospital, Jining, Shandong, China
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Li XY, Hu R, Lou TX, Liu Y, Ding L. Global research trends in transcranial magnetic stimulation for stroke (1994-2023): promising, yet requiring further practice. Front Neurol 2024; 15:1424545. [PMID: 39268062 PMCID: PMC11390666 DOI: 10.3389/fneur.2024.1424545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/09/2024] [Indexed: 09/15/2024] Open
Abstract
Background Scholars have been committed to investigating stroke rehabilitation strategies over many years. Since its invention, transcranial magnetic stimulation (TMS) has been increasingly employed in contemporary stroke rehabilitation research. Evidence has shown the significant potential of TMS in stroke research and treatment. Objective This article reviews the research conducted on the use of TMS in stroke from 1994 to 2023. This study applied bibliometric analysis to delineate the current research landscape and to anticipate future research hotspots. Method The study utilized the Web of Science Core Collection to retrieve and acquire literature data. Various software tools, including VOSviewer (version 1.6.19), CiteSpace (version 6.3.R1), Scimago Graphica (version 1.0.36), and WPS (version 11572), were used for data analysis and visualization. The review included analyses of countries, institutions, authors, journals, articles, and keywords. Results A total of 3,425 articles were collected. The top three countries in terms of publication output were the United States (953 articles), China (546 articles), and Germany (424 articles). The United States also had the highest citation counts (56,764 citations), followed by Germany (35,211 citations) and the United Kingdom (32,383 citations). The top three institutions based on the number of publications were Harvard University with 138 articles, the University of Auckland with 81 articles, and University College London with 80 articles. The most prolific authors were Abo, Masahiro with 54 articles, Fregni, Felipe with 53 articles, and Pascual-Leone, Alvaro with 50 articles. The top three journals in terms of article count were Neurorehabilitation and Neural Repair with 139 articles, Clinical Neurophysiology with 128 articles, and Frontiers in Neurology with 110 articles. The most frequently occurring keywords were stroke (1,275 occurrences), transcranial magnetic stimulation (1,119 occurrences), and rehabilitation (420 occurrences). Conclusion The application of TMS in stroke research is rapidly gaining momentum, with the USA leading in publications. Prominent institutions, such as Harvard University and University College London, show potential for collaborative research. The key areas of focus include post-stroke cognitive impairment, aphasia, and dysphagia, which are expected to remain significant hotspots in future research. Future research should involve large-scale, randomized, and controlled trials in these fields. Additionally, identifying more effective combined therapies with rTMS should be a priority.
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Affiliation(s)
- Xin-Yu Li
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
| | - Rong Hu
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
| | - Tian-Xiao Lou
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
| | - Yang Liu
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
| | - Ling Ding
- Department of Rehabilitation and Traditional Chinese Medicine, Institute of Rehabilitation and Health Care, Hunan College of Traditional Chinese Medicine, Zhu Zhou, China
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Sasegbon A, Cheng I, Labeit B, Lapa S, Rommel N, Hamdy S. New and Evolving Treatments for Neurologic Dysphagia. Drugs 2024; 84:909-932. [PMID: 38954267 DOI: 10.1007/s40265-024-02064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
Despite swallowing being a frequently performed daily function, it is highly complex. For a safe swallow to occur, muscles within the head, neck, and thorax need to contract in a concerted pattern, controlled by several swallowing centers at multiple levels of the central nervous system, including the midbrain, cerebral cortex, and cerebellum in addition to five cranial nerves. Dysphagia, or difficulty swallowing, is caused by a long list of pathologic processes and diseases, which can interfere with various stages along the swallowing sensorimotor pathway. When present, dysphagia leads to increased mortality, morbidity, hospital length of stay, and reduced quality of life. Current dysphagia management approaches, such as altering the texture and consistency of foods and fluids and teaching patients rehabilitative exercises, have been broadly unchanged for many years and, in the case of texture modification, are of uncertain effectiveness. However, evidence is emerging in support of new medication-based and neuromodulatory treatment approaches. Regarding medication-based therapies, most research has focused on capsaicinoids, which studies have shown are able to improve swallowing in patients with post-stroke dysphagia. Separately, albeit convergently, in the field of neuromodulation, there is a growing and positive evidential base behind three non-invasive brain stimulation techniques: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (TDCS), and pharyngeal electrical stimulation (PES). Should some or all of these emerging therapies fulfill their promise, dysphagia-related patient outcomes may be improved. This paper describes the current state of our understanding regarding new medication and neuromodulation-based neurogenic oropharyngeal dysphagia treatments.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignal Analysis, University of Münster, Münster, Germany
- Universitätsklinikum Münster, Münster, Germany
| | - Bendix Labeit
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sriramya Lapa
- Department of Neurology, Goethe University and University Hospital, Frankfurt, Germany
| | - Nathalie Rommel
- Deglutology, Experimental Otorhinolaryngology, Department of Neurosciences, University of Leuven, Leuven, Belgium
- Department of Gastroenterology, Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK.
- Centre for Gastrointestinal Sciences, Salford Royal Foundation Trust, University of Manchester, Clinical Sciences Building, Manchester, Eccles Old Road, Salford, M6 8HD, UK.
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Liu Z, Cheng J, Tan C, Liu H, Han D. Pharyngeal Cavity Electrical Stimulation-Assisted Swallowing for Post-stroke Dysphagia: A Systematic Review and Meta-analysis of Randomized Controlled Studies. Dysphagia 2024; 39:541-551. [PMID: 38117313 DOI: 10.1007/s00455-023-10644-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
Stroke is the leading cause of death and disability among adults. The incidence of stroke per 100, 000 patient-years was 2875. As many as 37% to 78% of patients with acute strokes suffer dysphagia. Dysphagia can easily lead to inhalation pneumonia, dehydration, malnutrition, and other serious complications, affecting the quality of life of stroke patients and increasing their mortality. Effective prevention and treatment of post-stroke dysphagia are of great significance to improving the prognosis and quality of life of patients. Some studies have shown that Pharyngeal cavity electrical stimulation-assisted swallowing (PCES-assisted swallowing) has a positive effect on patients with post-stroke dysphagia. This study will evaluate the effects of PCES-assisted swallowing on post-stroke dysphagia, including swallowing function, withdrawal rate of nasal feeding tubes, duration of hospitalization, and so on. Randomized controlled trials (RCTs) of PCES-assisted swallowing in the treatment of post-stroke dysphagia were searched in eight databases, including Cochrane Library, Embase, PubMed, Web of Science, Chinese Biomedical Literature Database, VIP Information Resource System, CNKI, and Wanfang Medical Science. The retrieval time was from the database establishment to June 2022. Rayyan was used to screen the retrieved literature risk of bias for included studies and was calculated using ROB2.0. The RevMan 5.3 software was used for the meta-analysis with the standard mean difference (SMD) and 95% confidence interval (CI). The model type was a random effect model, The risk ratio (RR) was used as the effect size for the two categorical variables. The swallowing function scores, withdrawal rate of nasal feeding tubes, and Length of stay (LOS) of the intervention and control groups were extracted, and the results of the meta-analysis were presented using a forest plot. Six studies from 2010 to 2018 with a total of 341 people were included in the meta-analysis. All studies reported quantitative outcome measures for the severity of dysphagia, and some reported the withdrawal rate of nasal feeding tubes, LOS, and penetration-aspiration-scale (PAS). The overall swallowing function of the PCES group was better than that of the control group (SMD = - 0.20, 95%CI - 0.38 to - 0.03, P = 0.02). In terms of the severity of dysphagia, there was a statistically significant difference in the Dysphagia Severity Rating scale (DSRS) between the Pharyngeal cavity electrical stimulation (PCES) group and the control group (SMD = - 0.24, 95%CI - 0.48 to 0, P = 0.05). The PCES group nasal feeding withdrawal rate of nasal feeding tubes was higher than the control group (RR = 2.88, 95% CI 1.15 to 7.26, P = 0.02). There was no significant difference in the LOS between the PCES group and the control group (SMD = - 0.19, 95%CI - 0.44 to 0.07, P = 0.15). This systematic review and meta-analysis provide reasonably reliable evidence that PCES-assisted swallowing can improve nasogastric feeding swallowing function and the withdrawal rate of nasal feeding tubes in patients with post-stroke dysphagia. However, the evidence for reducing oral feeding, aspiration, and length of hospitalization stay is lacking, and further studies are needed.
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Affiliation(s)
- Zicai Liu
- Department of Rehabilitation Medicine, Shaoguan First People's Hospital, Shaoguan, 512000, Guangdong, China
| | - Jinling Cheng
- Department of Rehabilitation Medicine, Shaoguan First People's Hospital, Shaoguan, 512000, Guangdong, China
| | - Cheng Tan
- Department of Rehabilitation Medicine, Shaoguan First People's Hospital, Shaoguan, 512000, Guangdong, China.
| | - Huiyu Liu
- Yuebei Second People's Hospital, Shaoguan, 512000, Guangdong, China.
| | - Dongmiao Han
- Department of Rehabilitation Therapy Teaching and Research, Gannan Healthcare Vocational College, Ganzhou, 341000, Jiangxi, China.
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Wang Z, Bai J, Cheng K, Zhang X, Fan Z, Chen Y, Ni J. Effects of different mylohyoid muscle stimulations on swallowing cortex excitability in healthy subjects. Behav Brain Res 2024; 470:115055. [PMID: 38795846 DOI: 10.1016/j.bbr.2024.115055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/11/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Dysphagia has been recognized by the World Health Organization as a medical disability. Improving mylohyoid muscle function plays an important role in pharyngeal dysphagia. The aim of this study was to evaluate the treatment of transcranial magnetic stimulation (TMS), peripheral magnetic stimulation (PMS), and electrical stimulation (ES) for dysphagia. METHODS Forty healthy subjects were randomly divided into four groups: TMS+PMS, TMS, PMS, and ES. TMS stimulated the cortical representative area of the mylohyoid muscle and the PMS was directly stimulating the mylohyoid muscle, both of them at a frequency of 10 Hz for a total of 1,800 pulses. The intensity of ES was based on the subject's tolerance level, usually 2-5 mA. Functional near infrared spectroscopy (fNIRS) and motor evoked potential (MEP) of the mylohyoid muscle were used to evaluate the immediate effects of stimulation on swallowing cortex excitability of healthy subjects before and after intervention. RESULTS The fNIRS results revealed notable activation across multiple channels in the four groups of healthy subjects both pre- and post- the intervention. Among these channels, the activation levels were most pronounced in the TMS+PMS group, followed by the TMS, PMS, and ES groups, respectively. Regarding the MEP results, post-intervention observations indicated a reduction in bilateral latency and an increase in bilateral amplitude in the TMS+PMS group. Additionally, the left amplitude exhibited an increase in the TMS group. CONCLUSIONS In fNIRS, all four stimulation methods significantly activated the swallowing cortex of healthy subjects, and the activation of TMS+PMS was the most obvious, followed by TMS, PMS, and ES.
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Affiliation(s)
- Zhiyong Wang
- Department of Rehabilitation, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Rehabilitation, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Junhui Bai
- Department of Rehabilitation, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Keling Cheng
- Department of Rehabilitation, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Xia Zhang
- Department of Rehabilitation, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Zhenfeng Fan
- Department of Rehabilitation, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Yangjia Chen
- Department of Rehabilitation, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Rehabilitation, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
| | - Jun Ni
- Department of Rehabilitation, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China; Department of Rehabilitation, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
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Braun RG, Arata J, Gonzalez-Fernandez M. Dysphagia and Enteral Feeding After Stroke in the Rehabilitation Setting. Phys Med Rehabil Clin N Am 2024; 35:433-443. [PMID: 38514228 DOI: 10.1016/j.pmr.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Physiatrists play a vital role in post-stroke dysphagia management not only by providing guidance on the risks, benefits, and efficacy of various treatment options but also as advocates for patients' independence and quality of life. While swallow study results are often discussed broadly by acute stroke clinicians as "pass/fail" findings, physiatrists need a more nuanced working knowledge of dysphagia diagnosis and treatment that encompasses swallow pathophysiology, targeted treatment strategies, and prognosis for recovery. To that end, this review summarizes current clinical practice guidelines on dysphagia, nutrition and oral care, risks and benefits of differing enteral access routes, prognostic factors, and approaches to rehabilitation.
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Affiliation(s)
- Robynne G Braun
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland Rehabilitation and Orthopedic Institute, Baltimore, MD, USA; Brain Rehab and Recovery Lab, University of Maryland School of Medicine, Bressler Research Building, Suite 12-019, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Jodi Arata
- Rehabilitation Research Lab, University of Maryland Rehabilitation and Orthopedic Institute, 2200 Kernan Drive, Baltimore, MD 21207, USA
| | - Marlis Gonzalez-Fernandez
- Department of PM&R, Johns Hopkins University School of Medicine, 600 North Wolf Street, Phipps 184, Baltimore, MD 21287, USA; Outpatient PM&R Clinics, Johns Hopkins Hospital, 600 North Wolfe Street Phipps 174, Baltimore, MD 21287, USA
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Zhao F, Chen J, Shan Y, Hong J, Ye Q, Dai Y, Hu J, Zhang J, Li C, Wen H. Comprehensive assessment of HF-rTMS treatment mechanism for post-stroke dysphagia in rats by integration of fecal metabolomics and 16S rRNA sequencing. Front Cell Infect Microbiol 2024; 14:1373737. [PMID: 38686094 PMCID: PMC11057012 DOI: 10.3389/fcimb.2024.1373737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 05/02/2024] Open
Abstract
Background The mechanism by which high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) improves swallowing function by regulating intestinal flora remains unexplored. We aimed to evaluate this using fecal metabolomics and 16S rRNA sequencing. Methods A Post-stroke dysphagia (PSD) rat model was established by middle cerebral artery occlusion. The magnetic stimulation group received HF-rTMS from the 7th day post-operation up to 14th day post-surgery. Swallowing function was assessed using a videofluoroscopic swallowing study (VFSS). Hematoxylin-eosin (H&E) staining was used to assess histopathological changes in the intestinal tissue. Intestinal flora levels were evaluated by sequencing the 16S rRNA V3-V4 region. Metabolite changes within the intestinal flora were evaluated by fecal metabolomics using liquid chromatography-tandem mass spectrometry. Results VFSS showed that the bolus area and pharyngeal bolus speed were significantly decreased in PSD rats, while the bolus area increased and pharyngeal transit time decreased after HF-rTMS administration (p < 0.05). In the PSD groups, H&E staining revealed damaged surface epithelial cells and disrupted cryptal glands, whereas HF-rTMS reinforced the integrity of the intestinal epithelial cells. 16S rRNA sequencing indicated that PSD can disturb the intestinal flora and its associated metabolites, whereas HF-rTMS can significantly regulate the composition of the intestinal microflora. Firmicutes and Lactobacillus abundances were lower in the PSD group than in the baseline group at the phylum and genus levels, respectively; however, both increased after HF-rTMS administration. Levels of ceramides (Cer), free fatty acids (FA), phosphatidylethanolamine (PE), triacylglycerol (TAG), and sulfoquinovosyl diacylglycerol were increased in the PSD group. The Cer, FA, and DG levels decreased after HF-rTMS treatment, whereas the TAG levels increased. Peptococcaceae was negatively correlated with Cer, Streptococcus was negatively correlated with DG, and Acutalibacter was positively correlated with FA and Cer. However, these changes were effectively restored by HF-rTMS, resulting in recovery from dysphagia. Conclusion These findings suggest a synergistic role for the gut microbiota and fecal metabolites in the development of PSD and the therapeutic mechanisms underlying HF-rTMS.
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Affiliation(s)
- Fei Zhao
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Rehabilitation Medicine, Guangzhou, Guangdong, China
| | - Jiemei Chen
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Rehabilitation Medicine, Guangzhou, Guangdong, China
| | - Yilong Shan
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Rehabilitation Medicine, Guangzhou, Guangdong, China
| | - Jiena Hong
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Rehabilitation Medicine, Guangzhou, Guangdong, China
| | - Qiuping Ye
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Rehabilitation Medicine, Guangzhou, Guangdong, China
- Guangzhou University of Chinese Medicine, Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou, Guangdong, China
| | - Yong Dai
- Guangzhou University of Chinese Medicine, Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou, Guangdong, China
| | - Jiahui Hu
- Guangzhou University of Chinese Medicine, Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou, Guangdong, China
| | - Jiantao Zhang
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Rehabilitation Medicine, Guangzhou, Guangdong, China
| | - Chao Li
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Rehabilitation Medicine, Guangzhou, Guangdong, China
| | - Hongmei Wen
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Rehabilitation Medicine, Guangzhou, Guangdong, China
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Labeit B, Michou E, Trapl-Grundschober M, Suntrup-Krueger S, Muhle P, Bath PM, Dziewas R. Dysphagia after stroke: research advances in treatment interventions. Lancet Neurol 2024; 23:418-428. [PMID: 38508837 DOI: 10.1016/s1474-4422(24)00053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024]
Abstract
After a stroke, most patients have dysphagia, which can lead to aspiration pneumonia, malnutrition, and adverse functional outcomes. Protective interventions aimed at reducing these complications remain the cornerstone of treatment. Dietary adjustments and oral hygiene help mitigate the risk of aspiration pneumonia, and nutritional supplementation, including tube feeding, might be needed to prevent malnutrition. Rehabilitative interventions aim to enhance swallowing function, with different behavioural strategies showing promise in small studies. Investigations have explored the use of pharmaceutical agents such as capsaicin and other Transient-Receptor-Potential-Vanilloid-1 (TRPV-1) sensory receptor agonists, which alter sensory perception in the pharynx. Neurostimulation techniques, such as transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and pharyngeal electrical stimulation, might promote neuroplasticity within the sensorimotor swallowing network. Further advancements in the understanding of central and peripheral sensorimotor mechanisms in patients with dysphagia after a stroke, and during their recovery, will contribute to optimising treatment protocols.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, North Rhine-Westphalia, Germany.
| | - Emilia Michou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Achaia, Greece; Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, Greater Manchester, UK
| | - Michaela Trapl-Grundschober
- Karl Landsteiner University of Health Sciences, Krems, Lower Austria, Austria; Division of Neurology, University Hospital Tulln, Tulln, Lower Austria, Austria
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, North Rhine-Westphalia, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, North Rhine-Westphalia, Germany
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic teaching hospital of the University of Muenster, Osnabrueck, Lower Saxony, Germany
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11
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Zhuang Y, Wang X, Yin X, Li X, Liu W. Exploration of treatment methods for patients with post-stroke dysphagia: a network meta-analysis. Biotechnol Genet Eng Rev 2024; 40:436-453. [PMID: 36966378 DOI: 10.1080/02648725.2023.2184044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/15/2023] [Indexed: 03/27/2023]
Abstract
To compare the effects of various therapies in patients with post-stroke dysphagia. DATA SOURCES We searched databases between January 1980 and 2022. STUDY ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) on therapy for dysphagia after stroke. STUDY APPRAISAL AND SYNTHESIS METHODS The outcomes were improvement in dysphagia, case fatality, and chest infection or pneumonia, reported as OR (odd ratio), 95% CrI (confidence interval), and SUCRA (the surface under the cumulative ranking curve analysis) score. Forty-two randomized controlled trials (2,993 patients, seven therapies, and one control) were included. In the improvement of dysphagia analysis, the following therapies were superior to the control: Acupuncture, behavioral interventions, drug therapy, neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES). In the case fatality analysis, OR and 95% CrI indicated none of the therapies were superior to the control. In the chest infection or pneumonia analysis, OR values showed that no therapy was superior to the control. Our Network Meta-analysis suggests that commonly used therapies for dysphagia after stroke have equal efficacies.
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Affiliation(s)
- Yueyang Zhuang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xiaohua Wang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xinbo Yin
- Intensive Care Unit, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Xiaoling Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Weilin Liu
- Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
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El Nahas N, Shokri H, Refaat A, Mousa H, Hamid A, Abdel Monem A, AbuShady E. The effect of transcranial direct current stimulation paired with neuromuscular electrical stimulation on swallowing function in post stroke dysphagia. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2024; 60:21. [DOI: 10.1186/s41983-023-00767-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/25/2023] [Indexed: 01/06/2025] Open
Abstract
Abstract
Background
Transcranial direct current stimulation (tDCS) and neuromuscular electrical stimulation (NMES) are noninvasive neuromodulation techniques that have shown positive effects in a variety of neurological disorders. Most protocols apply one modality at a time. Here we tested the effect of tDCS applied together with NMES on patients with dysphagia after acute stroke. To assess the efficacy of combined tDCS and NMES on improvement of dysphagia after acute stroke, guided by Fiber-optic endoscopic evaluation of swallowing (FEES). This study is a double-blinded randomized case-controlled study conducted in a University hospital. This study enrolled 48 patients diagnosed by FEES and assigned to 3 groups of 16 patients each. The first group received both tDCS and NMES, the second group received NMES only and the third group received sham NMES. Gugging Swallowing Screen (GUSS) test was done before and after intervention.
Results
Significant improvement was seen in all tested materials on GUSS test in tDCS/NMES group. While in the other two groups, there was only improvement for safety of liquid swallowing.
Conclusion
This study shows that the combined application of tDCS and NMES has an advantage in improvement of PSD over active NMES and sham NMES groups in all materials tested by GUSS.
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13
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Bengisu S, Demir N, Krespi Y. Effectiveness of Conventional Dysphagia Therapy (CDT), Neuromuscular Electrical Stimulation (NMES), and Transcranial Direct Current Stimulation (tDCS) in Acute Post-Stroke Dysphagia: A Comparative Evaluation. Dysphagia 2024; 39:77-91. [PMID: 37247074 DOI: 10.1007/s00455-023-10595-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
This study aims to compare the effectiveness of conventional dysphagia therapy (CDT), neuromuscular electrical stimulation (NMES), and transcranial direct current stimulation (tDCS) in the treatment of post-stroke dysphagia. A single-blind randomized controlled trial was conducted with 40 acute stroke patients - 18 females and 22 males with a mean age of 65.8 ± 11.9. The subjects were grouped into 4, with 10 individuals in each. The procedures administered to groups were as follows: the first group, sham tDCS and sham NMES; the second group, tDCS and sham NMES; the third group, NMES and sham tDCS; and the fourth group, all therapy procedures. CDT was applied to all groups either as a standalone procedure or combined with one or two of the instrumental techniques. Gugging Swallowing Screen (GUSS) and Videofluoroscopic Swallowing Study (VFSS) were employed to determine the severity of dysphagia and the effectiveness of treatment modalities. Additionally, the Penetration Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Dysphagia Severity Rating Scale (DSRS) were administered to interpret VFSS data. Pre- and post-treatment comparisons of all groups have revealed a statistically significant difference for all parameters except for the PAS scores at International Dysphagia Diet Standardization Initiative (IDDSI)-Level 4 consistencies. However, the differences between pre- and post-treatment scores of the fourth group across all parameters were significant - GUSS (p = 0.005), FOIS (p = 0.004), DSRS (p = 0.005), PAS IDDSI-4 (p = 0.027), PAS IDDSI-0 (p = 0.004). Inter-group comparisons, on the other hand, pointed out that the difference between pre- and post-treatment GUSS, FOIS, DSRS, and PAS scores at IDDSI Level-0 consistencies was statistically significant for all groups - GUSS (p = 0,009), FOIS (p = 0,004), DSRS (p = 0,002), PAS IDDSI-0 (p = 0,049). Closer examination of treatment groups indicated that the tDCS + CDT group, the NMES + CDT group, and the group that underwent the combination of three modalities made better progress than the one that was treated with only CDT. Though not statistically significant, the NMES + CDT group achieved better improvement than the tDCS + CDT group. This study has yielded that the group in which NMES, tDCS, and CDT were applied in combination has achieved better results than all the other groups. All treatment modalities applied to accelerate the general recovery process in acute stroke patients with dysphagia were found to be effective for the treatment of post-stroke swallowing disorders. The use of instrumental treatments such as NMES and tDCS enhanced the effectiveness of the treatment and provided more significant progress. Furthermore, combining treatment modalities such as NMES and tDCS was more effective when compared to using only conventional therapy. As a result, the most effective treatment outcomes were obtained by the group receiving CDT, NMES, and tDCS in combination. Therefore, the use of combined approaches has been recommended in appropriate patients; yet the provisional results should be tested in randomized trials with more participants.
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Affiliation(s)
- Serkan Bengisu
- Department of Speech and Language Therapy, Faculty of Health Sciences, Fenerbahçe University, Istanbul, Turkey.
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yakup Krespi
- Department of Neurology, Faculty of Medicine, Istinye University, Istanbul, Turkey
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Huang J, Fan Y, Zhao K, Yang C, Zhao Z, Chen Y, Yang J, Wang T, Qu Y. Comparative Efficacy of Neuromodulation Technologies for Overactive Bladder in Adults: A Network Meta-Analysis of Randomized Controlled Trials. Neuromodulation 2023; 26:1535-1548. [PMID: 35989159 DOI: 10.1016/j.neurom.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/09/2022] [Accepted: 06/29/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the comparative efficacy of neuromodulation technologies for overactive bladder (OAB) syndrome in adults. DATA SOURCES A computerized search was conducted of Cochrane Library, EMBASE, MEDLINE (via PubMed), Web of Science, CNKI, Wan Fang Data, and ClinicalTrials.gov up to April 21, 2022. STUDY SELECTION The search selected clinical trials with random allocation to percutaneous tibial nerve stimulation (PTNS), transcutaneous tibial nerve stimulation (TTNS), vaginal electrical stimulation (VES), sacral neuromodulation (SNM), parasacral stimulation (PS), pudendal neuromodulation, or placebo. DATA EXTRACTION The main outcomes were the voiding diary, OAB-related quality of life, and positive response rate. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the risk of bias of each included study, and the Grading of Recommendations Assessment, Development, and Evaluation tool was used to evaluate the overall evidence quality of key outcomes. DATA SYNTHESIS The study included 21 randomized controlled trials involving 1433 participants, and all trials were used for the meta-analysis. In the network meta-analyses, five of six neuromodulation technologies, including PTNS, TTNS, VES, SNM, and PS, were related to higher efficacy than the placebo. Ranking probability showed that SNM was the most efficacious therapy for improving OAB-related quality of life, urinary episodes, and urinary frequency. For urgency incontinence episodes and the number of pads, PTNS and TTNS were the most efficacious modalities, respectively. CONCLUSION Neuromodulation technologies, including PTNS, TTNS, VES, SNM, and PS, may be effective and safe solutions for OAB syndrome in adults. Moreover, SNM is the most efficacious regimen for OAB-related quality of life, urinary episodes, and urinary frequency. PTNS and TTNS are the most efficacious modalities for reducing urgency incontinence episodes and the number of pads, respectively. Future studies should pay more attention to the quality of study design and report, patients who may benefit the most from neuromodulation, and the long-term effect, cost-effectiveness, and satisfaction of neuromodulation.
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Affiliation(s)
- Jiapeng Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ye Fan
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou , Guangdong, China
| | - Kehong Zhao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunlan Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ziqi Zhao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yin Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaen Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Rehabilitation Medicine, Affiliated Foshan Gaoming Hospital of Guangdong Medical University, Foshan, Guangdong, China
| | - Tingting Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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15
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Wang L, Shi A, Xue H, Li Q, Wang J, Yang H, Hong H, Lu Q, Cheng J. Efficacy of Transcranial Direct Current Stimulation Combined with Conventional Swallowing Rehabilitation Training on Post-stroke Dysphagia. Dysphagia 2023; 38:1537-1545. [PMID: 37142734 PMCID: PMC10611834 DOI: 10.1007/s00455-023-10581-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
To observe the clinical effects of transcranial direct current stimulation (tDCS) combined with conventional swallowing rehabilitation training on post-stroke dysphagia and explore its long-term efficacy. A total of 40 patients with dysphagia after the first stroke were randomly divided into a treatment group (n = 20) and a conventional group (n = 20). The treatment group received tDCS combined with conventional swallowing rehabilitation training, while the conventional group only received conventional swallowing rehabilitation training. The Standardized Swallowing Assessment (SSA) Scale and the Penetration-Aspiration Scale (PAS) were used to assess dysphagia before and after treatment, at the end of 10 treatments, and at the 3-month follow-up. The changes in infection indicators [the white blood cell (WBC), C-reactive protein (CRP) and procalcitonin (PCT)], the oxygenation indicator [arterial partial pressure of oxygen (PaO2)] and nutrition-related indicators [hemoglobin (Hb) and serum prealbumin (PAB)] were compared before and after treatment. The SSA and PAS scores were lower in both groups after treatment than before treatment, and the difference was statistically significant (P < 0.01). The SSA and PAS scores of the treatment group were lower than those of the conventional group before and after treatment and during follow-up, and the difference was statistically significant (P < 0.05, P < 0.01). A within-group comparison showed that WBC, CRP and PCT after treatment were lower than those before treatment, and the difference was statistically significant (P < 0.05). The PaO2, Hb and serum PAB were higher after treatment than before treatment, with a statistically significant difference (P < 0.05). The WBC, CRP and PCT of the tDCS group were lower than those of the conventional group, and PaO2, Hb and serum PAB were higher in the treatment group than in the conventional group, with a statistically significant difference (P < 0.01). The tDCS combined with conventional swallowing rehabilitation training can improve dysphagia with a better effect than conventional swallowing rehabilitation training and has a certain long-term efficacy. In addition, tDCS combined with conventional swallowing rehabilitation training can improve nutrition and oxygenation and reduce infection levels.
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Affiliation(s)
- Lingyan Wang
- Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China.
| | - Aiqun Shi
- Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China
| | - Hui Xue
- Electroencephalogram Room, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China
| | - Qiwei Li
- Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China
| | - Jiasheng Wang
- Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China
| | - Heliang Yang
- Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China
| | - Hong Hong
- Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China
| | - Qiaomiao Lu
- Department of Rehabilitation Medicine, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China
| | - Jiaping Cheng
- Electroencephalogram Room, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, 496# Shuangxixi Road, 321017, Jinhua, Zhejiang, China
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16
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Cheng I, Sasegbon A, Hamdy S. Evaluating the Therapeutic Application of Neuromodulation in the Human Swallowing System. Dysphagia 2023; 38:1005-1024. [PMID: 36239821 PMCID: PMC10326109 DOI: 10.1007/s00455-022-10528-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/30/2022] [Indexed: 11/03/2022]
Abstract
In the last two decades, the focus of neurogenic dysphagia management has moved from passive compensatory strategies to evidence-based rehabilitative approaches. Advances in technology have enabled the development of novel treatment approaches such as neuromodulation techniques, which target the promotion of neurological reorganization for functional recovery of swallowing. Given the rapid pace of development in the field, this review aims to summarize the current findings on the effects of neuromodulation techniques on the human swallowing system and evaluate their therapeutic potential for neurogenic dysphagia. Implications for future clinical research and practical considerations for using neuromodulation in clinical practice will also be discussed.
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Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ayodele Sasegbon
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Centre for Gastrointestinal Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Foundation Trust, Eccles Old Road, Salford, M6 8HD, UK.
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Wang Y, Liu W, Chen J, Bai J, Yu H, Ma H, Rao J, Xu G. Comparative efficacy of different noninvasive brain stimulation therapies for recovery of global cognitive function, attention, memory, and executive function after stroke: a network meta-analysis of randomized controlled trials. Ther Adv Chronic Dis 2023; 14:20406223231168754. [PMID: 37332390 PMCID: PMC10272674 DOI: 10.1177/20406223231168754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/23/2023] [Indexed: 06/20/2023] Open
Abstract
Background Which noninvasive brain stimulation (NIBS) treatment - transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) - is more beneficial for stroke patients' cognitive rehabilitation is still up for debate. Objectives Our goal is to provide an overview of the research on the effectiveness and safety of various NIBS protocols. Design Systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs). Methods This NMA compared any active NIBS versus sham stimulation in adult stroke survivors to enhance cognitive function, with a focus on global cognitive function (GCF), attention, memory, and executive function (EF) using the databases MEDLINE, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. The NMA statistical approach was built on a frequency framework. The effect size was estimated by the standardized mean difference (SMD) and a 95% confidence interval (CI). We compiled a relative ranking of the competing interventions based on their surface under the cumulative ranking curve (SUCRA). Results NMA showed that high-frequency repeated TMS (HF-rTMS) improved GCF compared with sham stimulation (SMD = 1.95; 95% CI: 0.47-3.43), while dual-tDCS improved memory performance versus sham stimulation significantly (SMD = 6.38; 95% CI: 3.51-9.25). However, various NIBS stimulation protocols revealed no significant impact on enhancing attention, executive function, or activities of daily living. There was no significant difference between the active stimulation protocols for TMS and tDCS and sham stimulation in terms of safety. Subgroup analysis demonstrated an effect favoring activation site of the left dorsolateral prefrontal cortex (DLPFC) (SUCRA = 89.1) for enhancing GCF and bilateral DLPFC (SUCRA = 99.9) stimulation for enhancing memory performance. Conclusion The HF-rTMS over the left DLPFC appears to be the most promising NIBS therapeutic option for improving global cognitive performance after stroke, according to a comparison of numerous NIBS protocols. Furthermore, for patients with post-stroke memory impairment, dual-tDCS over bilateral DLPFC may be more advantageous than other NIBS protocols. Both tDCS and TMS are reasonably safe. Registration PROSPERO ID: CRD42022304865.
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Affiliation(s)
- Yao Wang
- Department of Rehabilitation Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Wan Liu
- Department of Rehabilitation Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jiu Chen
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
| | - Jianling Bai
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hao Yu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hongxia Ma
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jiang Rao
- Department of Rehabilitation Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, No. 264 Guangzhou Road, Jiangsu Province, Nanjing 210029, China
| | - Guangxu Xu
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Jiangsu Province, Nanjing 210029, China
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18
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Sheng R, Chen C, Chen H, Yu P. Repetitive transcranial magnetic stimulation for stroke rehabilitation: insights into the molecular and cellular mechanisms of neuroinflammation. Front Immunol 2023; 14:1197422. [PMID: 37283739 PMCID: PMC10239808 DOI: 10.3389/fimmu.2023.1197422] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
Stroke is a leading cause of mortality and disability worldwide, with most survivors reporting dysfunctions of motor, sensation, deglutition, cognition, emotion, and speech, etc. Repetitive transcranial magnetic stimulation (rTMS), one of noninvasive brain stimulation (NIBS) techniques, is able to modulate neural excitability of brain regions and has been utilized in neurological and psychiatric diseases. Moreover, a large number of studies have shown that the rTMS presents positive effects on function recovery of stroke patients. In this review, we would like to summarized the clinical benefits of rTMS for stroke rehabilitation, including improvements of motor impairment, dysphagia, depression, cognitive function, and central post-stroke pain. In addition, this review will also discuss the molecular and cellular mechanisms underlying rTMS-mediated stroke rehabilitation, especially immune regulatory mechanisms, such as regulation of immune cells and inflammatory cytokines. Moreover, the neuroimaging technique as an important tool in rTMS-mediated stroke rehabilitation has been discussed, to better understanding the mechanisms underlying the effects of rTMS. Finally, the current challenges and future prospects of rTMS-mediated stroke rehabilitation are also elucidated with the intention to accelerate its widespread clinical application.
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Affiliation(s)
- Rongjun Sheng
- Department of Radiology, The First People’s Hospital of Linping District, Hangzhou, China
| | - Changchun Chen
- Department of Radiology, The People’s Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Guizhou, China
| | - Huan Chen
- Department of Radiology, The People’s Hospital of Longyou, Quzhou, China
| | - Peipei Yu
- Department of Radiology, Sanmen People’s Hospital, Taizhou, China
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Feng HY, Zhang PP, Wang XW. Presbyphagia: Dysphagia in the elderly. World J Clin Cases 2023; 11:2363-2373. [PMID: 37123321 PMCID: PMC10131003 DOI: 10.12998/wjcc.v11.i11.2363] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
Dysphagia has been classified as a “geriatric syndrome” and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide. A characteristic age-related change in swallowing is defined as “presbyphagia.” Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing. However, there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging. Our review provides an overview of presbyphagia, which has been a neglected health problem for a long time. Attention and awareness of dysphagia in the elderly population should be strengthened, and targeted intervention measures should be actively implemented.
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Affiliation(s)
- Hai-Yang Feng
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
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Banda KJ, Wu KC, Jen HJ, Chu H, Pien LC, Chen R, Lee TY, Lin SK, Hung SH, Chou KR. Comparative Effectiveness of Combined and Single Neurostimulation and Traditional Dysphagia Therapies for Post-Stroke Dysphagia: A Network Meta-Analysis. Neurorehabil Neural Repair 2023; 37:194-204. [PMID: 37078600 DOI: 10.1177/15459683231166940] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Comparative therapeutic benefits of combined and single neurostimulation therapies including neuromuscular electrical stimulation (NMES), pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and traditional dysphagia therapy (TDT) remain unknown in post-stroke dysphagia (PSD) rehabilitation. Therefore, we performed the first network meta-analysis (NMA) to determine comparative effectiveness of combined and single neurostimulation and traditional dysphagia therapies for PSD. METHODS A frequentist NMA model was performed with therapy effect sizes presented as standardized mean differences (SMD) and corresponding 95% confidence interval (95% CI) for therapy comparisons while netrank function ranked the therapies in R-Software. Meta-regression models for study characteristics were analyzed using Bayesian NMA Model. RESULTS Overall, 50 randomized controlled studies with 2250 participants were included. NMES + TDT 3.82 (95% CI, 1.62-6.01), tDCS + TDT 3.34 (95% CI, 1.09-5.59), rTMS + TDT 3.32 (95% CI, 1.18-5.47), NMES 2.69 (95% CI, 0.44-4.93), and TDT 2.27 (95% CI, 0.12-4.41) demonstrated very large effect in improving swallowing function. NMES + TDT -0.50 (95% CI, -0.68 to -0.32, rTMS + TDT -0.44 (95% CI, -0.67 to -0.21), TDT -0.28 (95% CI, -0.46 to -0.10), and NMES -0.19 (95% CI, -0.34 to -0.04) demonstrated medium to small effect in reducing pharyngeal transit time (PTT). rTMS -0.51 (95% CI, -0.93 to -0.08) demonstrated medium effect in reducing oral transit time (OTT). No significant therapy comparison differences were found for reducing aspiration/penetration. The highest ranked therapy was NMES + TDT for better swallowing function and reduction of PTT, rTMS for reduction of OTT, and tDCS + TDT for reduction of aspiration/penetration. Therapeutic effects of the therapies were moderated by frequency, sessions, and duration. CONCLUSION Combined therapies including NMES + TDT, tDCS + TDT, and rTMS + TDT demonstrate better therapeutic effect for improved swallowing function and reduction of PTT, OTT, and aspiration/penetration for PSD.
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Affiliation(s)
- Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei
- Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Ko-Chiu Wu
- Department of Interaction Design, National Taipei University of Technology, Taipei
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei
| | - Sheng-Kai Lin
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Shih-Han Hung
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei
- International Master/PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei
- Neuroscience Research Center, Taipei Medical University, Taipei
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21
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Marin S, Ortega O, Serra-Prat M, Valls E, Pérez-Cordón L, Clavé P. Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review. Nutrients 2023; 15:nu15071714. [PMID: 37049553 PMCID: PMC10097035 DOI: 10.3390/nu15071714] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management. Methods: A systematic review was conducted following PRISMA recommendations. Four databases were searched from inception through 30 June 2021. Outcome measures were cost-effectiveness and cost-savings of healthcare interventions. English and Spanish literature were included. Narrative and tables were used to present and synthesise evidence. Quality was evaluated using the CHEERS Statement. Results: A total of 244 studies were identified, and 10 were included. Screening and diagnosis of PS-OD studies found: (1) adjusted reduction in hospitalisation costs when assessed during the first admission day; (2) non-significant reduction in hospitalisation costs with OD management after thrombolysis; and (3) videofluoroscopy as the most cost-effective screening method (compared to bedside evaluation and a combination of both). Two studies showed cost-effective rehabilitation programmes, including OD management. Pelczarska et al. showed an incremental cost–utility ratio of texture-modified diets using a gum-based thickener of 20,977 PLN (4660€) following a dynamic model, and Kotecki et al. commercially prepared thickened fluids that were 44% to 59% less expensive than in situ prepared fluids. Elia et al. showed home enteral nutrition was cost-effective (£12,817/QALY), and Beavan et al. showed higher nutrient intake and low increase in hospitalisation costs using looped-nasogastric tubes (£5.20 for every 1% increase). Heterogeneity between studies precluded a quantitative synthesis. Conclusions: Included studies suggest that healthcare interventions aiming to prevent OD complications are cost-effective. However, studies assessing novel strategies are needed.
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Affiliation(s)
- Sergio Marin
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
- Neurogastroenterology and Motility Research Group, Institut de Recerca Germans Trias I Pujol, 08916 Badalona, Spain
- Correspondence: ; Tel.: +34-93-741-77-00
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Neurogastroenterology and Motility Research Group, Institut de Recerca Germans Trias I Pujol, 08916 Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08340 Mataró, Spain
| | - Mateu Serra-Prat
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08340 Mataró, Spain
- Research Unit, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Ester Valls
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Laia Pérez-Cordón
- Pharmacy Department, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Neurogastroenterology and Motility Research Group, Institut de Recerca Germans Trias I Pujol, 08916 Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08340 Mataró, Spain
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22
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Assoratgoon I, Shiraishi N, Tagaino R, Ogawa T, Sasaki K. Sensory neuromuscular electrical stimulation for dysphagia rehabilitation: A literature review. J Oral Rehabil 2023; 50:157-164. [PMID: 36357332 DOI: 10.1111/joor.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/23/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Dysphagia is a common disorder following a cerebrovascular accident. It can cause detrimental effects on patient's quality of life and nutrition intake, especially in older adults. Neuromuscular electrical stimulation has been one of the management strategies for acceleration of the recovery. This review summarises the current evidence on sensory threshold stimulation of the procedure. METHOD This review compiled data from the Internet database PubMed, Cochrane Library and Scopus using combination of MeSH thesaurus: 'Sensory threshold', 'electrical stimulation', 'neuromuscular stimulation', 'Deglutition', 'Dysphagia'. Eleven studies were intergraded into the review. RESULTS Most of the studies show significant improvement to the outcomes of sensory neuromuscular electrical stimulation treatment. In many cases, the results of the treatment are comparable or superior to motor threshold stimulation and conventional therapy. However, the study design and parameters of the procedure varied greatly without conclusive standardised guidelines. CONCLUSION The sensory neuromuscular electrical stimulation (SNMES) is a viable treatment option for treating oropharyngeal dysphagia. The most suggested application parameters are an intensity at sensory threshold, a frequency of 80 Hz, an impulse time of 700 μs, a combined total duration of 20 h of stimulation in a 2-week period, and placing the electrodes in the submental area of the neck. However, further research is necessary to construct a definitive guideline for clinicians.
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Affiliation(s)
- Itt Assoratgoon
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Chulalongkorn University, Bangkok, Thailand
| | - Naru Shiraishi
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Center for Dysphagia of Tohoku University Hospital, Sendai, Japan
| | - Ryo Tagaino
- Center for Dysphagia of Tohoku University Hospital, Sendai, Japan.,Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Toru Ogawa
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
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23
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Hsiao MY, Choo YJ, Liu IC, Boudier-Revéret M, Chang MC. Effect of Repetitive Transcranial Magnetic Stimulation on Post-stroke Dysphagia: A Meta-analysis of Stimulation Frequency, Stimulation Site, and Timing of Outcome Measurement. Dysphagia 2023; 38:435-445. [PMID: 35763122 DOI: 10.1007/s00455-022-10483-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/10/2022] [Indexed: 01/27/2023]
Abstract
Dysphagia is one of the most frequent sequelae of stroke. It can result in various complications such as malnutrition, dehydration, aspiration pneumonia, and poor rehabilitation outcomes. Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve dysphagia after a stroke; however, effective treatment protocols have not been established yet. We evaluated the effect of the following rTMS parameters on post-stroke dysphagia: stimulation frequency [high frequency (≥ 3 Hz) or low frequency (1 Hz)] and stimulation site (ipsilesional or contralesional mylohyoid cortex). Outcomes were measured immediately, at 3 weeks, and at 4 weeks after the rTMS session. The PubMed, SCOPUS, Embase, and Cochrane Library databases were systematically searched for relevant studies published between January 01, 1980, and December 13, 2021. Randomized controlled trials on the effects of rTMS on post-stroke dysphagia were included. Six studies were finally included in the analysis. The selected studies included 158 patients (rTMS group: 81 patients; sham group: 77 patients). Regarding the effect of high-frequency rTMS on the ipsilesional cortex, the standardized swallowing assessment (SSA) scores showed significant improvement after rTMS sessions immediately and at 4 weeks [immediate: P = 0.02, standard mean difference (SMD) = - 0.61, 95% confidence interval (CI) = - 1.14 to - 0.08; 4 weeks: P = 0.006, SMD = - 0.74, 95% CI = - 1.27 to - 0.21]; however, there was no significant reduction in the Penetration-Aspiration Scale (PAS) scores between the rTMS and sham groups (immediate: P = 0.43, SMD = 0.25, 95% CI = - 0.36, 0.86; 3 weeks: P = 0.39, SMD = 0.37, 95% CI = - 0.47 to 1.22). After low-frequency rTMS on the ipsilesional cortex, a significantly greater improvement in the SSA scores was found in the rTMS group than in the sham group, both immediately and at 4 weeks after rTMS sessions (immediate: P = 0.03, SMD = - 0.59, 95% CI = - 1.12 to - 0.06; 4 weeks: P = 0.001, SMD = - 0.92, 95% CI = - 1.48 to - 0.37). In addition, immediately after the rTMS sessions, the PAS scores were significantly reduced in the rTMS group than in the sham group (P = 0.047, SMD = - 0.60, 95% CI = - 1.19 to - 0.01). However, at 4 weeks after rTMS sessions, there was no significant reduction in the PAS scores in the rTMS group compared to the sham group (P = 0.48, SMD = - 0.19, 95% CI = - 0.71 to 0.33). Both high-frequency rTMS of the ipsilesional cortex and low-frequency rTMS of the contralesional cortex improved some measurements of the swallowing function in stroke patients immediately and at 4 weeks after treatment.
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Affiliation(s)
- Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea
| | - I-Chun Liu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea.
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24
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Xie J, Zhou C, Ngaruwenayo G, Wu M, Jiang X, Li X. Dosage consideration for transcranial direct current stimulation in post-stroke dysphagia: A systematic review and network meta-analysis. Front Neurol 2023; 14:1098831. [PMID: 36761340 PMCID: PMC9902951 DOI: 10.3389/fneur.2023.1098831] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023] Open
Abstract
Objective This systematic review and network meta-analysis sought to determine the efficacy of different intensities of transcranial direct current stimulation (tDCS) in patients with dysphagia after stroke to improve swallowing function. Methods Randomized-controlled trials (RCTs) of tDCS in post-stroke dysphagia were searched from Pubmed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wanfang database, and Chinese Scientific Journals Database (VIP) from databases' inception to June 22, 2022. Article screening, data extraction, and article quality evaluation were completed by 2 independent researchers. Network meta-analysis was performed using Stata. Results A final total of 20 studies involving 838 stroke patients were included. The included control interventions were sham tDCS and conventional therapy (CT). Network meta-analysis showed that 20 min of 1.2, 1.4, 1.5, 1.6, and 2 mA anodal tDCS and 30 min of 2 mA anodal tDCS significantly improved post-stroke dysphagia compared with CT (all P < 0.05). In addition, 20 min of 1, 1.4, 1.6, and 2 mA anodal tDCS also significantly improved post-stroke dysphagia compared with sham tDCS (all P < 0.05). Our results demonstrated that 20 min of stimulation at 1.4 mA was the optimal parameters for anodal tDCS and exhibited superior efficacy to CT [SMD = 1.08, 95% CI (0.46, 1.69)] and sham tDCS [SMD = 1.45, 95% CI (0.54, 2.36)]. Conclusion Different durations and intensities of anodal tDCS are effective in improving post-stroke dysphagia. However, 20 min of tDCS at 1.4 mA may be the optimal regimen. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022342506.
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Affiliation(s)
- Jianwei Xie
- School of Nursing, China Medical University, Shenyang, China
| | - Chiteng Zhou
- School of Nursing, China Medical University, Shenyang, China
| | | | - Minghui Wu
- General Hospital of Pingmei Shenma Group, Pingdingshan, China
| | - Xiaoyu Jiang
- School of Nursing, China Medical University, Shenyang, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, China,*Correspondence: Xiaohan Li ✉
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25
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Lin TY, Shen PC, Lee SA, Yeh SM, Chang KV, Wang TG. Case report: Dysphagia after COVID-19 infection in a stroke patient-Is neurostimulation a potential management? Front Neurol 2023; 14:1126390. [PMID: 36949856 PMCID: PMC10025385 DOI: 10.3389/fneur.2023.1126390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
A 90-year-old man with stroke was weaned from tube feeding 4 months after stroke onset. However, he had a coronavirus disease 2019 (COVID-19) infection after 2 months and suffered from drastically worsened oropharyngeal dysphagia that required a reinsertion of the nasogastric tube. A videofluoroscopic swallowing study revealed poor bolus oral transit, significantly delayed swallowing reflex, reduced pharyngeal movements, and insufficient cough response. Repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation were applied, in addition to conventional swallowing training. The feeding tube was removed after 20 treatment sessions. Clinicians should be aware of the risk of dysphagia after COVID-19 infection in patients with underlying neurological diseases. The management of post-COVID-19 dysphagia has not yet been fully established. Repetitive transcranial electrical stimulation combined with neuromuscular electrical stimulation may be used as an auxiliary intervention in specific cases.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
| | - Peng-Chieh Shen
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
| | - Shao-An Lee
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
| | - Shu-Ming Yeh
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
- *Correspondence: Shu-Ming Yeh
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
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26
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Tan SW, Wu A, Cheng LJ, Wong SH, Lau Y, Lau ST. The Effectiveness of Transcranial Stimulation in Improving Swallowing Outcomes in Adults with Poststroke Dysphagia: A Systematic Review and Meta-analysis. Dysphagia 2022; 37:1796-1813. [PMID: 35430717 DOI: 10.1007/s00455-022-10424-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Transcranial stimulation has been proposed as an alternative rehabilitation therapy for adults with post-stroke dysphagia (PSD). This systematic review sought to determine the effectiveness of transcranial stimulation in patients with post-stroke dysphagia to improve swallowing function. From inception to January 3, 2021, an extensive search was conducted in PubMed, EMBASE, Cochrane, CINAHL, and Scopus, Web of Science. The randomized controlled trials (RCTs) included studies in adults aged 18 years and older who suffered from post-stroke dysphagia. Using Hedges' g as effect size, meta-analyses were conducted using random-effects models. To investigate potential sources of heterogeneity, subgroup analyses, and multivariable meta-regression analyses were conducted. Sixteen RCTs were included in this review, and 13 RCTs were used for meta-analysis. The meta-analysis showed that a large effect size in improving swallowing function after repetitive Transcranial Magnetic Stimulation (g = - 0.86, 95% CI - 1.57, - 0.16) and medium effect size in Transcranial Direct Current Stimulation (g = - 0.61, 95% CI - 1.04, - 0.17) at post-intervention, respectively. Subgroup and meta-regression analysis indicated that stimulation of the esophagus cortical area and middle-aged adults had a greater effect on swallowing function. The overall certainty of evidence assessed using the GRADE approach was low. Despite the positive results, transcranial stimulation requires additional research to reach definitive conclusions about the optimal stimulation protocol and to achieve the greatest benefit. Future trials should be more rigorous and include a larger sample size to demonstrate the efficacy of transcranial stimulation. Transcranial stimulation enables a more efficacious approach to dysphagia mitigation in PSD rehabilitation.
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Affiliation(s)
- Shu Wen Tan
- National Healthcare Group, Department of Nursing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Anping Wu
- National Healthcare Group, Department of Nursing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sai Ho Wong
- Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Clinical Research Centre, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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27
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Evaluation of the Reporting Standard Guidelines of Network Meta-Analyses in Physical Therapy: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10122371. [PMID: 36553895 PMCID: PMC9778181 DOI: 10.3390/healthcare10122371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
The concept of network meta-analyses (NMA) has been introduced to the field of physical therapy. However, the reporting standard guidelines of these studies have not been evaluated. In this systematic review, we included all published NMA physical therapy studies that compared the clinical efficacy of three or more interventions to evaluate whether NMAs in physical therapy exhibit adequate reporting recommendations. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched up to 30 June 2022. Among the 252 identified articles, 19 NMAs including 805 randomized controlled trials were included. We applied both preferred reporting items for systematic reviews and meta-analysis (PRISMA) and PRISMA-NMA checklists, which are 27- and 32-item reporting standard guidelines assessment tools, respectively. Protocol registrations (68.4%), risk of bias across studies (63.2%), additional analysis (57.9%), and funding (31.6%) were problematic items considering the PRISMA guidelines. Four studies reported all five new NMA-reporting items, and 15 (78.9%) did not address items S1-5 from the PRISMA-NMA guidelines. The median score (interquartile range) of the reporting standard guidelines was 27.0 (25.8-28.0). The identified shortcomings of published NMAs should be addressed while training researchers, and they should be encouraged to apply PRISMA-NMA, as a recognized tool for assessing NMA reporting guidelines is required.
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28
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Tomeh A, Yusof Khan AHK, Wan Sulaiman WA. Repetitive transcranial magnetic stimulation of the primary motor cortex in stroke survivors-more than motor rehabilitation: A mini-review. Front Aging Neurosci 2022; 14:897837. [PMID: 36225893 PMCID: PMC9549351 DOI: 10.3389/fnagi.2022.897837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is a leading cause of morbidity and mortality among elderly populations worldwide. During the early phase of stroke, restoring blood circulation is of utmost importance to protect neurons from further injury. Once the initial condition is stabilized, various rehabilitation techniques can be applied to help stroke survivors gradually regain their affected functions. Among these techniques, transcranial magnetic stimulation (TMS) has emerged as a novel method to assess and modulate cortical excitability non-invasively and aid stroke survivors in the rehabilitation process. Different cortical regions have been targeted using TMS based on the underlying pathology and distorted function. Despite the lack of a standard operational procedure, repetitive TMS (rTMS) of the primary motor cortex (M1) is considered a promising intervention for post-stroke motor rehabilitation. However, apart from the motor response, mounting evidence suggests that M1 stimulation can be employed to treat other symptoms such as dysphagia, speech impairments, central post-stroke pain, depression, and cognitive dysfunction. In this mini-review, we summarize the therapeutic uses of rTMS stimulation over M1 in stroke survivors and discuss the potential mechanistic rationale behind it.
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Affiliation(s)
- Abdulhameed Tomeh
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Malaysia
- *Correspondence: Wan Aliaa Wan Sulaiman,
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29
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Tarihci Cakmak E, Sen EI, Doruk C, Sen C, Sezikli S, Yaliman A. The Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Post-stroke Dysphagia: A Randomized Controlled Trial. Dysphagia 2022; 38:874-885. [PMID: 35986170 DOI: 10.1007/s00455-022-10512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
The study aimed to evaluate the effects of traditional dysphagia therapy (TDT) and neuromuscular electrical stimulation (NMES) combined with TDT on functionality of oral intake, dysphagia symptom severity, swallowing- and voice-related quality of life, leakage, penetration-aspiration, and residue levels in patients with post-stroke dysphagia (PSD). Thirty-four patients with PSD were included in our prospective, randomized, controlled, and single-blind study. The patients were divided into two groups: (1) TDT only (control group, n = 17) and (2) TDT with NMES (experimental group, n = 17). TDT was applied to both groups for three consecutive weeks, 5 days a week, 45 min a day. Sensory NMES was applied to the experimental group for 45 min per session. Patients were evaluated by the functional oral intake scale (FOIS), the eating assessment tool (EAT-10), the swallowing quality of life questionnaire (SWAL-QOL), and the voice-related quality of life questionnaire (VRQOL) at baseline, immediately post-intervention, and at the 3rd month post-intervention. Fiberoptic endoscopic evaluation of swallowing (FEES) with liquid and semi-solid food was performed pre- and post-intervention. A significant post-intervention improvement was observed on all scales in both groups, and these improvements were maintained 3 months post-intervention. Leakage and penetration-aspiration levels with semi-solid food declined only in the experimental group. In conclusion, TDT is a non-invasive and inexpensive method that leads to improvement in many swallowing-related features in stroke patients; however, NMES as an adjunct therapy is costly but can provide additional benefits for improving features, such as penetration-aspiration and residue levels.
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Li Y, Chen K, Wang J, Lu H, Li X, Yang L, Zhang W, Ning S, Wang J, Sun Y, Song Y, Zhang M, Hou J, Shi H. Research progress on transcranial magnetic stimulation for post-stroke dysphagia. Front Behav Neurosci 2022; 16:995614. [PMID: 36062260 PMCID: PMC9434690 DOI: 10.3389/fnbeh.2022.995614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Dysphagia is one of the most common manifestations of stroke, which can affect as many as 50–81% of acute stroke patients. Despite the development of diverse treatment approaches, the precise mechanisms underlying therapeutic efficacy remain controversial. Earlier studies have revealed that the onset of dysphagia is associated with neurological damage. Neuroplasticity-based transcranial magnetic stimulation (TMS), a recently introduced technique, is widely used in the treatment of post-stroke dysphagia (PSD) by increasing changes in neurological pathways through synaptogenesis, reorganization, network strengthening, and inhibition. The main objective of this review is to discuss the effectiveness, mechanisms, potential limitations, and prospects of TMS for clinical application in PSD rehabilitation, with a view to provide a reference for future research and clinical practice.
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Affiliation(s)
- Yi Li
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Kerong Chen
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Jiapu Wang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hanmei Lu
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Xiaoyu Li
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Lei Yang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Wenlu Zhang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Shujuan Ning
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Juan Wang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Yi Sun
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Yu Song
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
| | - Mei Zhang
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
- Mei Zhang,
| | - Jianhong Hou
- Department of Orthopedics, Third People’s Hospital of Yunnan Province, Kunming, China
- Jianhong Hou,
| | - Hongling Shi
- Department of Rehabilitation Medicine, Third People’s Hospital of Yunnan Province, Kunming, China
- *Correspondence: Hongling Shi,
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Liu H, Peng Y, Liu Z, Wen X, Li F, Zhong L, Rao J, Li L, Wang M, Wang P. Hemodynamic signal changes and swallowing improvement of repetitive transcranial magnetic stimulation on stroke patients with dysphagia: A randomized controlled study. Front Neurol 2022; 13:918974. [PMID: 36034299 PMCID: PMC9403609 DOI: 10.3389/fneur.2022.918974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Our study aims to measure the cortical correlates of swallowing execution in patients with dysphagia after repetitive transcranial magnetic stimulation (rTMS) therapy using functional near-infrared spectroscopy (fNIRS), and observe the change of pattern of brain activation in stroke patients with dysphagia after rTMS intervention. In addition, we tried to analyze the effect of rTMS on brain activation in dysphagia patients with different lesion sides. This study also concentrated on the effect of stimulating the affected mylohyoid cortical region by 5 Hz rTMS, providing clinical evidence for rTMS therapy of dysphagia in stroke patients. METHODS This study was a sham-controlled, single-blind, randomized controlled study with a blinded observer. A total of 49 patients completed the study, which was randomized to the rTMS group (n = 23) and sham rTMS group (n = 26) by the random number table method. The rTMS group received 5 Hz rTMS stimulation to the affected mylohyoid cortical region of the brain and the sham rTMS group underwent rTMS using the same parameters as the rTMS group, except for the position of the coil. Each patient received 2 weeks of stimulation followed by conventional swallowing therapy. Standardized Swallowing Assessment (SSA), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), Penetration-Aspiration Scale (PAS), and functional oral intake status were assessed at two times: baseline (before treatment) and 2 weeks (after intervention). Meanwhile, we use the fNIRS system to measure the cerebral hemodynamic changes during the experimental procedure. RESULTS The rTMS group exhibited significant improvement in the SSA scale, FEDSS scale, and PAS scale after rTMS therapy (all P < 0.001). The sham rTMS group had the same analysis on the same scales (all P < 0.001). There was no significant difference observed in clinical assessments at 2 weeks after baseline between the rTMS group and sham rTMS group (all P > 0.05). However, there were statistically significant differences between the two groups in the rate of change in the FEDSS score (P = 0.018) and PAS score (P = 0.004), except for the SSA score (P = 0.067). As for the removal rate of the feeding tube, there was no significant difference between the rTMS group and sham rTMS group (P = 0.355), but there was a significant difference compared with the baseline characteristics in both groups (P rTMS < 0.001, P shamrTMS = 0.002). In fNIRS analysis, the block average result showed differences in brain areas RPFC (right prefrontal cortex) and RMC (right motor cortex) significantly between the rTMS group and sham rTMS group after intervention (P channel30 = 0.046, P channel16 = 0.006). In the subgroup analysis, rTMS group was divided into left-rTMS group and right-rTMS group and sham rTMS group was divided into sham left-rTMS group and sham right-rTMS group. The fNIRS results showed no significance in block average and block differential after intervention between the left-rTMS group and sham left-rTMS group, but differences were statistically significant between the right-rTMS group and sham right-rTMS group in block average: channel 30 (T = -2.34, P = 0.028) in LPFC (left prefrontal cortex) and 16 (T = 2.54, P = 0.018) in RMC. After intervention, there was no significance in left-rTMS group compared with baseline, but in right-rTMS group, channel 27 (T = 2.18, P = 0.039) in LPFC and 47 (T = 2.17, P = 0.039) in RPFC had significance in block differential. In the sham rTMS group, neither sham left-rTMS group and sham right-rTMS group had significant differences in block average and block differential in each brain area after intervention (P > 0.05). CONCLUSIONS The present study confirmed that a 5-Hz rTMS is feasible at the affected mylohyoid cortical region in post-stroke patients with dysphagia and rTMS therapy can alter cortical excitability. Based on previous studies, there is a dominant hemisphere in swallowing and the results of our fNIRS analysis seemed to show a better increase in cortical activation on the right side than on the left after rTMS of the affected mylohyoid cortical region. However, there was no difference between the left and right hemispheres in the subgroup analysis. Nevertheless, the present study provides a novel and feasible method of applying fNIRS to assessment in stroke patients with dysphagia.
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Affiliation(s)
- Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Yang Peng
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Zicai Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Xin Wen
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Fang Li
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Lida Zhong
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Jinzhu Rao
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Li Li
- Yue Bei People's Hospital, Shaoguan, China
| | - Minghong Wang
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
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Minelli C, Luvizutto GJ, Cacho RDO, Neves LDO, Magalhães SCSA, Pedatella MTA, de Mendonça LIZ, Ortiz KZ, Lange MC, Ribeiro PW, de Souza LAPS, Milani C, da Cruz DMC, da Costa RDM, Conforto AB, Carvalho FMM, Ciarlini BS, Frota NAF, Almeida KJ, Schochat E, Oliveira TDP, Miranda C, Piemonte MEP, Lopes LCG, Lopes CG, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Castro SS, de Andrade JBC, Silva GS, Pontes-Neto OM, de Carvalho JJF, Martins SCO, Bazan R. Brazilian practice guidelines for stroke rehabilitation: Part II. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:741-758. [PMID: 36254447 PMCID: PMC9685826 DOI: 10.1055/s-0042-1757692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 10/14/2022]
Abstract
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
- Instituto Você sem AVC, Matão SP, Brazil
| | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | | | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Estadual Geral de Goiânia Dr. Alberto Rassi, Goiânia GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia, GO, Brazil
| | - Lucia Iracema Zanotto de Mendonça
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Pontíficia Universidade Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, São Paulo SP, Brazil
| | - Karin Zazo Ortiz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fala, Linguagem e Ciências Auditivas, São Paulo SP, Brazil
| | | | | | | | - Cristiano Milani
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Serviço de Neurologia Vascular e Emergências Neurológicas, Ribeirão Preto SP, Brazil
| | | | | | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
| | | | - Bruna Silva Ciarlini
- Universidade de Fortaleza, Programa de Pos-Graduação em Ciências Médicas, Fortaleza CE, Brazil
| | | | | | - Eliane Schochat
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Tatiana de Paula Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Camila Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Laura Cardia Gomes Lopes
- Universidade Estadual de São Paulo, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, São Paulo SP, Brazil
| | | | | | | | | | | | | | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | - Sheila C. Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
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Tomeh A, Yusof Khan AHK, Inche Mat LN, Basri H, Wan Sulaiman WA. Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence. Brain Sci 2022; 12:brainsci12060761. [PMID: 35741646 PMCID: PMC9221422 DOI: 10.3390/brainsci12060761] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a novel technique to stimulate the human brain through the scalp. Over the years, identifying the optimal brain region and stimulation parameters has been a subject of debate in the literature on therapeutic uses of repetitive TMS (rTMS). Nevertheless, the primary motor cortex (M1) has been a conventional target for rTMS to treat motor symptoms, such as hemiplegia and spasticity, as it controls the voluntary movement of the body. However, with an expanding knowledge base of the M1 cortical and subcortical connections, M1-rTMS has shown a therapeutic efficacy that goes beyond the conventional motor rehabilitation to involve pain, headache, fatigue, dysphagia, speech and voice impairments, sleep disorders, cognitive dysfunction, disorders of consciousness, anxiety, depression, and bladder dysfunction. In this review, we summarize the latest evidence on using M1-rTMS to treat non-motor symptoms of diverse etiologies and discuss the potential mechanistic rationale behind the management of each of these symptoms.
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Affiliation(s)
- Abdulhameed Tomeh
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
- Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Liyana Najwa Inche Mat
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Hamidon Basri
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Wan Aliaa Wan Sulaiman
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
- Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: ; Tel.: +60-3-9769-5560
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Transcranial magnetic stimulation versus transcutaneous neuromuscular electrical stimulation in post stroke dysphagia: A clinical randomized controlled trial. J Stroke Cerebrovasc Dis 2022; 31:106554. [PMID: 35691184 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy of high-frequency repeated transcranial magnetic stimulation (rTMS) applied contralesionally versus transcutaneous neuromuscular electrical stimulation (TNES) in acute post-stroke dysphagic patients. MATERIALS AND METHODS A randomized, parallel, comparative, controlled trial was conducted on patients with acute ischemic stroke who were admitted to our department. Fifteen patients received rTMS, 15 patients received TNES, and 15 patients were recruited as a control group. Between the second and tenth days after a stroke, patients were enrolled. The study and follow-up periods were completed by all patients. RESULTS Among the screened patients, 45 (31.47%) right-handed patients were diagnosed with post-stroke dysphagia with a mean age of 60.53 ± 8.23 years. Immediately after intervention both rTMS and TNES groups significantly improve the swallowing disturbance questionnaire (SDQ) and penetration aspiration scale (PAS), compared to the control (p < 0.001 and p = 0.027), respectively. rTMS was more effective than TNES in reducing SDQ and PAS (p < 0.05). rTMS and TNES improved the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) significantly (p = 0.002); however, their efficacy was comparable (p > 0.05). A significant (p < 0.001) strong negative correlation was observed between the grade of weakness and all scores. CONCLUSION Our findings showed that high-frequency rTMS and TNES effectively improved the clinical condition of acute post-stroke dysphagic patients in terms of swallowing disturbance assessed by SDQ, pharyngeal residue assessed by YPRSRS, and the severity of penetration and aspiration events evaluated by PAS, compared to the controls. The outcomes of high-frequency rTMS were more favorable than those of TNES in terms of SDQ and PAS.
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Marin S, Serra-Prat M, Ortega O, Clavé P. Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review. Syst Rev 2022; 11:92. [PMID: 35568891 PMCID: PMC9107184 DOI: 10.1186/s13643-022-01969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Oropharyngeal dysphagia (OD) affects 40-81% of patients after stroke. A recent systematic review on the costs of OD and its main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could reduce clinical complications and costs. The purpose of this systematic review is to assess the available literature for healthcare interventions that are efficient or cost-effective in the management of OD. METHODS A systematic review on economic evaluations of health care interventions will be performed on post-stroke patients with OD following PRISMA recommendations. Four bibliographic databases will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetised with a narrative method and using tables. Quality evaluation will be done using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. DISCUSSION The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarise the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. TRIAL REGISTRATION PROSPERO CRD42020136245.
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Affiliation(s)
- Sergio Marin
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Catalunya, Spain. .,Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain. .,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Catalunya, Spain.
| | - Mateu Serra-Prat
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Catalunya, Spain.,Research Unit, Consorci Sanitari del Maresme, Mataró, Catalunya, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Catalunya, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Catalunya, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Catalunya, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Catalunya, Spain
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Griffin L, Kamarunas E, Kuo C, O'Donoghue C. Comparing amplitudes of transcranial direct current stimulation (tDCS) to the sensorimotor cortex during swallowing. Exp Brain Res 2022; 240:1811-1822. [PMID: 35551431 DOI: 10.1007/s00221-022-06381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Transcranial direct current stimulation (tDCS) can alter cortical excitability, making it a useful tool for promoting neuroplasticity in dysphagia rehabilitation. Clinical trials show functional improvements in swallowing following anodal tDCS despite varying dosing parameters and outcomes. The aim of the current study was to determine the most effective amplitude criterion (e.g., 0 mA [sham/control], 1 mA, 2 mA) of anodal tDCS for upregulating the swallowing sensorimotor cortex. METHOD As a novel paradigm, tDCS, functional near-infrared spectroscopy (fNIRS), and surface electromyography (sEMG) were simultaneously administered while participants completed a swallowing task. This allowed for measurement of the cortical hemodynamic response and submental muscle contraction before, during, and after tDCS. At the conclusion of the study, participants were asked to rate their level of discomfort associated with tDCS using a visual analog scale. RESULTS There was no significant difference in the hemodynamic response by time or amplitude. However, post-hoc analyses indicated that in the post-stimulation period, changes to the hemodynamic response in the left (stimulated) hemisphere were significantly different for the groups receiving 1 mA and 2 mA of tDCS compared to baseline. Participants receiving 1 mA of tDCS demonstrated reduced hemodynamic response. There was no significant difference in submental muscle contraction during or after tDCS regardless of amplitude. Anodal tDCS was well tolerated in healthy adults with no difference among participant discomfort scores across tDCS amplitude. CONCLUSIONS During a swallowing task, healthy volunteers receiving 1 mA of anodal tDCS demonstrated a suppressed hemodynamic response during and after stimulation whereas those receiving 2 mA of anodal tDCS had an increase in the hemodynamic response. tDCS remains a promising tool in dysphagia rehabilitation, but dosing parameters require further clarification.
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Affiliation(s)
- Lindsay Griffin
- School of Communication, Communication Sciences and Disorders, Emerson College, 120 Boylston St., Boston, MA, 02116, USA. .,College of Health and Behavioral Studies, Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, Harrisonburg, VA, 22807, USA.
| | - Erin Kamarunas
- College of Health and Behavioral Studies, Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, Harrisonburg, VA, 22807, USA
| | - Christina Kuo
- College of Health and Behavioral Studies, Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, Harrisonburg, VA, 22807, USA
| | - Cynthia O'Donoghue
- College of Health and Behavioral Studies, Communication Sciences and Disorders, James Madison University, 235 Martin Luther King Jr. Way, Harrisonburg, VA, 22807, USA
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Lin Q, Lin SF, Ke XH, Jia XF, Huang DB. A Systematic Review and Meta-analysis on the Effectiveness of Transcranial Direct Current Stimulation on Swallowing Function of Poststroke Patients. Am J Phys Med Rehabil 2022; 101:446-453. [PMID: 34261896 PMCID: PMC9005094 DOI: 10.1097/phm.0000000000001845] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the therapeutic effects of transcranial direct current stimulation on swallowing function in poststroke patients. DESIGN We searched for potentially eligible randomized controlled trials from electronic databases, including the PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Chinese Science and Technology Periodical (VIP) databases, from their inception to January 15, 2021. All statistical analyses were performed using RevMan 5.4, and the standardized mean difference with 95% confidence intervals was estimated for the swallowing function outcomes and to understand the mean effect size. RESULTS Ten studies involving 343 participants were included in this meta-analysis. The overall analyses demonstrated a significant effect size for swallowing function. Subgroup analyses suggested that both acute and chronic stroke patients showed significant effects on swallowing function after transcranial direct current stimulation. Furthermore, compared with sham stimulation, transcranial direct current stimulation anodal to the affected, unaffected, and bilateral hemispheres can produce a significant effect size for swallowing function in stroke patients. CONCLUSIONS This meta-analysis showed that transcranial direct current stimulation is likely to be effective for the recovery of dysphagia in poststroke patients, in the acute or chronic phase, and that the effect of anodal transcranial direct current stimulation to unaffected hemispheres is larger.
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Qiao J, Ye QP, Wu ZM, Dai Y, Dou ZL. The Effect and Optimal Parameters of Repetitive Transcranial Magnetic Stimulation on Poststroke Dysphagia: A Meta-Analysis of Randomized Controlled Trials. Front Neurosci 2022; 16:845737. [PMID: 35573312 PMCID: PMC9095943 DOI: 10.3389/fnins.2022.845737] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The objectives of the study were to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) treatment for poststroke dysphagia (PSD) and explore the optimal stimulation parameters. Method The databases of Medline, Embase, Web of Science, and Cochrane Library were searched from the establishment to June 2021. All randomized controlled trials about rTMS treatment for PSD were enrolled. Dysphagia Grade (DG) and Penetration Aspiration Scale (PAS) were applied as the major dysphagia severity rating scales to evaluate the outcomes. Results A total of 12 clinical randomized controlled studies were included in our study. The summary effect size indicated that rTMS had a positive effect on PSD (SMD = −0.67, p < 0.001). The subgroup analysis for treatment duration and different stroke stages showed significant differences (treatment duration >5 days: SMD = −0.80, p < 0.001; subacute phase after stroke: SMD = −0.60, p < 0.001). Furthermore, no significant differences were observed among the other stimulation parameter subgroups (including stimulation frequency, location, and a single stimulation time) (p > 0.05). Conclusion rTMS is beneficial to the recovery of PSD patients, while an intervention of more than 5 days and in the subacute phase after stroke might bring new strategies and rational therapeutics to the treatment of PSD. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022299469.
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Affiliation(s)
- Jia Qiao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiu-ping Ye
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-min Wu
- Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Dai
- Clinical Medical of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zu-lin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zu-lin Dou
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Kesikburun S. Non-invasive brain stimulation in rehabilitation. Turk J Phys Med Rehabil 2022; 68:1-8. [PMID: 35949977 PMCID: PMC9305642 DOI: 10.5606/tftrd.2022.10608] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
Non-invasive brain stimulation (NIBS) has been seen more common in rehabilitation settings. It can be used for the treatment of stroke, spinal cord injury, traumatic brain injury and multiple sclerosis, as well as for some diagnostic neurophysiological measurements. Two major modalities of NIBS are transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). As an add-on therapy to conventional rehabilitative treatments, the main goal of NIBS is to create neuromodulation by inhibiting or activating neural activity in the targeted cortical region. Indications for therapeutic NIBS in neurorehabilitation are motor recovery, aphasia, neglect, dysphagia, cognitive disorders, spasticity, and central pain. The NIBS can be regarded a safe technique with appropriate patient selection and defined treatment parameters. This review provides an overview on NIBS modalities, specifically TMS and tDCS, the working mechanisms, the stimulation techniques, areas of use, neuronavigation systems and safety considerations.
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Affiliation(s)
- Serdar Kesikburun
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane Medical School, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials-Part II: Brain Neurostimulation. J Clin Med 2022; 11:jcm11040993. [PMID: 35207265 PMCID: PMC8878820 DOI: 10.3390/jcm11040993] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Objective. To assess the effects of brain neurostimulation (i.e., repetitive transcranial magnetic stimulation [rTMS] and transcranial direct current stimulation [tDCS]) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed) to retrieve randomised controlled trials (RCTs) only. Using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), the methodological quality of included studies was evaluated, after which meta-analysis was conducted using a random-effects model. Results. In total, 24 studies reporting on brain neurostimulation were included: 11 studies on rTMS, 9 studies on tDCS, and 4 studies on combined neurostimulation interventions. Overall, within-group meta-analysis and between-group analysis for rTMS identified significant large and small effects in favour of stimulation, respectively. For tDCS, overall within-group analysis and between-group analysis identified significant large and moderate effects in favour of stimulation, respectively. Conclusion. Both rTMS and tDCS show promising effects in people with oropharyngeal dysphagia. However, comparisons between studies were challenging due to high heterogeneity in stimulation protocols and experimental parameters, potential moderators, and inconsistent methodological reporting. Generalisations of meta-analyses need to be interpreted with care. Future research should include large RCTs using standard protocols and reporting guidelines as achieved by international consensus.
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Oliveira IDJ, Couto GR, Santos RV, Campolargo AM, Lima C, Ferreira PL. Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022; 39:145-162. [PMID: 39469309 PMCID: PMC11320086 DOI: 10.1159/000520505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/18/2021] [Indexed: 10/30/2024] Open
Abstract
Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts' consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.
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Affiliation(s)
- Isabel de Jesus Oliveira
- Portuguese Red Cross Northern Health School, Oliveira de Azeméis, Portugal
- Centre for Health Studies and Research of the University of Coimbra, Coimbra, Portugal
| | - Germano Rodrigues Couto
- Health School of the University of Fernando Pessoa, Porto, Portugal
- Center for Health Technology and Services Research, Porto, Portugal
| | - Rosa Vilares Santos
- Center for Health Technology and Services Research, Porto, Portugal
- University Hospital Center of São João, Porto, Portugal
| | | | - Cláudia Lima
- Hospital Center Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Lopes Ferreira
- Centre for Health Studies and Research of the University of Coimbra, Coimbra, Portugal
- Faculty of Economics of the University of Coimbra, Coimbra, Portugal
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Gharooni AA, Kwon BK, Fehlings MG, Boerger TF, Rodrigues-Pinto R, Koljonen PA, Kurpad SN, Harrop JS, Aarabi B, Rahimi-Movaghar V, Wilson JR, Davies BM, Kotter MRN, Guest JD. Developing Novel Therapies for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 7]: Opportunities From Restorative Neurobiology. Global Spine J 2022; 12:109S-121S. [PMID: 35174725 PMCID: PMC8859698 DOI: 10.1177/21925682211052920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To provide an overview of contemporary therapies for the James Lind Alliance priority setting partnership for degenerative cervical myelopathy (DCM) question: 'Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?' METHODS A review of the literature was conducted to outline the pathophysiology of DCM and present contemporary therapies that may hold therapeutic value in 3 broad categories of neuroprotection, neuroregeneration, and neuromodulation. RESULTS Chronic spinal cord compression leads to ischaemia, neuroinflammation, demyelination, and neuronal loss. Surgical intervention may halt progression and improve symptoms, though the majority do not make a full recovery leading to lifelong disability. Neuroprotective agents disrupt deleterious secondary injury pathways, and one agent, Riluzole, has undergone Phase-III investigation in DCM. Although it did not show efficacy on the primary outcome modified Japanese Orthopaedic Association scale, it showed promising results in pain reduction. Regenerative approaches are in the early stage, with one agent, Ibudilast, currently in a phase-III investigation. Neuromodulation approaches aim to therapeutically alter the state of spinal cord excitation by electrical stimulation with a variety of approaches. Case studies using electrical neuromuscular and spinal cord stimulation have shown positive therapeutic utility. CONCLUSION There is limited research into interventions in the 3 broad areas of neuroprotection, neuroregeneration, and neuromodulation for DCM. Contemporary and novel therapies for DCM are now a top 10 priority, and whilst research in these areas is limited in DCM, it is hoped that this review will encourage research into this priority.
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Affiliation(s)
- Aref-Ali Gharooni
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Benjamin M. Davies
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - Mark R. N. Kotter
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
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Speyer R, Sutt AL, Bergström L, Hamdy S, Heijnen BJ, Remijn L, Wilkes-Gillan S, Cordier R. Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials-Part I: Pharyngeal and Neuromuscular Electrical Stimulation. J Clin Med 2022; 11:jcm11030776. [PMID: 35160228 PMCID: PMC8836998 DOI: 10.3390/jcm11030776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 12/22/2022] Open
Abstract
Objective. To assess the effects of neurostimulation (i.e., neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES)) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted to retrieve randomised controlled trials in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of included studies was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Results. In total, 42 studies reporting on peripheral neurostimulation were included: 30 studies on NMES, eight studies on PES, and four studies on combined neurostimulation interventions. When conducting meta analyses, significant, large and significant, moderate pre-post treatment effects were found for NMES (11 studies) and PES (five studies), respectively. Between-group analyses showed small effect sizes in favour of NMES, but no significant effects for PES. Conclusions. NMES may have more promising effects compared to PES. However, NMES studies showed high heterogeneity in protocols and experimental variables, the presence of potential moderators, and inconsistent reporting of methodology. Therefore, only conservative generalisations and interpretation of meta-analyses could be made. To facilitate comparisons of studies and determine intervention effects, there is a need for more randomised controlled trials with larger population sizes, and greater standardisation of protocols and guidelines for reporting.
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Affiliation(s)
- Renée Speyer
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 ZA Leiden, The Netherlands;
- Correspondence:
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD 4032, Australia;
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Liza Bergström
- Remeo Stockholm, 128 64 Stockholm, Sweden;
- Speech Therapy Clinic, Danderyd University Hospital, 182 88 Stockholm, Sweden
| | - Shaheen Hamdy
- GI Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Bas Joris Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 ZA Leiden, The Netherlands;
| | - Lianne Remijn
- School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands;
| | - Sarah Wilkes-Gillan
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK;
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Cheng I, Hamdy S. Current perspectives on the benefits, risks, and limitations of noninvasive brain stimulation (NIBS) for post-stroke dysphagia. Expert Rev Neurother 2021; 21:1135-1146. [PMID: 34530656 DOI: 10.1080/14737175.2021.1974841] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies have shown that noninvasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), can promote neuroplasticity, which is considered important for functional recovery of swallowing after stroke. Despite extensive studies on NIBS, there remains a gap between research and clinical practice. AREAS COVERED In this article, we update the current knowledge on the benefits and challenges of rTMS and tDCS for post-stroke dysphagia. We identify some key limitations of these techniques that hinder the translation from clinical trials to routine practice. Finally, we discuss the future of NIBS as a treatment for post-stroke dysphagia in real-world settings. EXPERT OPINION Current evidence suggests that rTMS and tDCS show promise as a treatment for post-stroke dysphagia. However, these techniques are limited by the response variability, uncertainty on the safety in patients with comorbidities and difficulties in clinical study designs. Such limitations call for further work to enhance their utility through individualized approaches. Despite this, the last decade has seen a growing acceptance toward these techniques among clinical personnel. As such, we advocate caution but support optimism that NIBS will gradually be recognized as a mainstream treatment approach for post-stroke dysphagia in the future.
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Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Li C, Qiu C, Shi Y, Yang T, Shao X, Zheng D. Experiences and perceptions of stroke patients living with dysphagia: A qualitative meta-synthesis. J Clin Nurs 2021; 31:820-831. [PMID: 34369025 DOI: 10.1111/jocn.15995] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/22/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
AIMS To systematically review and synthesise the findings of qualitative research exploring experiences of dysphagia from stroke patients' perspectives. BACKGROUND Poststroke patients with dysphagia are suffering from impaired physical functions and heavy psychological burden, and they are living with compromised quality of life. Through synthesising qualitative studies to fully portrait the experiences of poststroke patients living with dysphagia, we can care better for this population. DESIGN A systematic review and synthesis of qualitative studies reported by following ENTREQ. REVIEW METHODS Five electronic databases (CINAHL, Embase, PubMed, Web of Science and Cochrane Library) and three Chinese databases (CNKI, VIP and Wanfang) were searched from inception until January 2021. Qualitative studies were included if they were related to the experiences of poststroke patients with dysphagia. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to appraise study quality. Data were synthesised using the Thomas and Harden method thematic and content analysis. RESULTS Five studies were included in the meta-synthesis. Four analytical themes were identified: life changes after dysphagia, coping with social events, rebuilding a normal life and limited professional services. CONCLUSIONS More attention should be given to psychological health and social interaction in poststroke dysphagia patients. Healthcare professionals, especially nurses, should make joint efforts to provide patients with dysphagia-related knowledge and long-term individualised support. To improve the quality of life of dysphagia patients, further research should implement high-quality interventions based on dysphagia experience and clinical treatment. RELEVANCE TO CLINICAL PRACTICE These findings outline the changes in poststroke patients with dysphagia. Nurses as the first-line force, should deliver comprehensive and individualised intervention for managing physiological and psychosocial symptoms of patients.
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Affiliation(s)
- Chen Li
- Neurology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chunmei Qiu
- Neurology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ying Shi
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Tao Yang
- Neurosurgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xinmei Shao
- Neurology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dongxiang Zheng
- Neurology Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Arreola V, Ortega O, Álvarez-Berdugo D, Rofes L, Tomsen N, Cabib C, Muriana D, Palomera E, Clavé P. Effect of Transcutaneous Electrical Stimulation in Chronic Poststroke Patients with Oropharyngeal Dysphagia: 1-Year Results of a Randomized Controlled Trial. Neurorehabil Neural Repair 2021; 35:778-789. [PMID: 34137329 DOI: 10.1177/15459683211023187] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background. Chronic poststroke oropharyngeal dysphagia (CPSOD) is associated with impaired oropharyngeal sensory/motor function. We aimed to assess effect of sensory (SES) and motor (NMES) transcutaneous electrical stimulation (TES) on safety of swallow and clinical outcomes in patients with CPSOD in a one-year follow-up randomized controlled trial. Methods. Ninety patients (74.1 ± 11.5 y, modified Rankin score 2.6 ± 1.7) with CPSOD and impaired safety of swallow were randomized to (a) compensatory treatment (CT), (b) CT + SES, and (c) CT + NMES. Patients were treated with up to two cycles (6 months apart) of 15 × 1 hour TES sessions over two weeks and followed up with 4-5 clinical and videofluoroscopic assessments during one year. Key results. Baseline penetration-aspiration scale (PAS) was 4.61 ± 1.75, delayed time to laryngeal vestibule closure (LVC) 396.4 ± 108.7 ms, and impaired efficacy signs 94.25%. Swallowing parameters significantly improved between baseline and 1-year follow-up in SES and NMES groups for prevalence of patients with a safe swallow (P < .001), mean PAS (P < .001), time to LVC (P < .01), and need for thickening agents (P < .001). Patients in the CT presented a less intense improvement of signs of impaired safety of swallow without significant changes in time to LVC. No differences between groups were observed for 1-year mortality (6.1%), respiratory infections (9.6%), nutritional and functional status, QoL, and hospital readmission rates (27.6%). No significant adverse events related to TES were observed. Conclusions and inferences. Transcutaneous electrical stimulation is a safe and effective therapy for older patients with CPSOD. After 1-year follow-up, TES greatly improved the safety of swallow and reduced the need for fluid thickening in these patients.
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Affiliation(s)
- Viridiana Arreola
- Gastrointestinal Physiology Laboratory, 16380Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, 16380Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Daniel Álvarez-Berdugo
- Gastrointestinal Physiology Laboratory, 16380Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, 16380Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, 16380Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Christopher Cabib
- Gastrointestinal Physiology Laboratory, 16380Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Desiree Muriana
- Neurology Unit, 16380Hospital de Mataró, Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain
| | - Elisabet Palomera
- Unitat de Suport a La Recerca, Fundació Salut Del Consorci Sanitari Del Maresme, Mataró, Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, 16380Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation. Dysphagia 2021; 36:800-820. [PMID: 33399995 DOI: 10.1007/s00455-020-10218-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).
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Cheng I, Sasegbon A, Hamdy S. Effects of Neurostimulation on Poststroke Dysphagia: A Synthesis of Current Evidence From Randomized Controlled Trials. Neuromodulation 2020; 24:1388-1401. [PMID: 33301231 PMCID: PMC9292042 DOI: 10.1111/ner.13327] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate the effects of neurostimulation, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and pharyngeal electrical stimulation (PES), for poststroke dysphagia based on evidence from randomized controlled trials (RCTs). Materials and Methods Electronic databases were systematically searched between January 1985 and June 2020 and studies were included based on prespecified selection criteria. The quality of studies was evaluated and data were extracted and synthesized by two independent reviewers. The primary outcome measure was change in (any) relevant clinical swallowing‐related characteristic. Subgroup analysis were conducted based on follow‐up period and stimulation parameters. Results Data from 852 stroke patients were collected from 26 RCTs studies. Active neurostimulation treatments demonstrated a significant and moderate effect size compared to control treatment (0.69 [95% CI = 0.50, 0.89]; p < 0.001). The effect size of rTMS was the largest (0.73 [95% CI = 0.49, 0.98]; p < 0.001), followed by PES (0.68 [95% CI = 0.22, 1.14]; p = 0.004) and tDCS (0.65 [95% CI = 0.25, 1.04]; p = 0.001). All treatments showed comparable effect sizes within the first two weeks. Between three weeks and two months, tDCS demonstrated the largest effects (1.02 [95% CI = 0.45, 1.59]; p < 0.001) among the three treatments. No significant treatment effects were reported beyond three months. The combined effect size was large when applied in acute (<14 days) stroke (0.8 [95% CI = 0.34, 1.26]; p < 0.001). For noninvasive brain stimulation (NIBS), bihemispheric stimulation demonstrated the strongest effect size (0.93 [95% CI = 0.53, 1.33]; p < 0.001). In contrast, unilateral rTMS using ipsilesional high‐frequency stimulation had a combined effect size of 0.83 (95% CI = 0.14, 1.52; p = 0.02). For tDCS, a significant effect size was found only with anodal stimulation applied over the contralesional hemisphere (1.04 [95% CI = 0.54, 1.53]; p < 0.001). Conclusions The results show that neurostimulation can benefit patients with poststroke dysphagia. The treatment effects were the strongest in acute stroke patients and within the first two months of application. For NIBS, bihemispheric stimulation appeared to be most effective. The most beneficial hemisphere for unilateral stimulation differed between rTMS and tDCS. These findings provide a platform for future studies and clinical practice.
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Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester Manchester UK
| | - Ayodele Sasegbon
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester Manchester UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester Manchester UK
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The effect of VNS on the rehabilitation of stroke: A meta-analysis of randomized controlled studies. J Clin Neurosci 2020; 81:421-425. [PMID: 33222954 DOI: 10.1016/j.jocn.2020.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The efficacy of vagus nerve stimulation (VNS) for the rehabilitation of stroke remains controversial. We conduct a systematic review and meta-analysis to explore the influence of VNS on the rehabilitation of stroke. METHODS We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through March 2020 for randomized controlled trials (RCTs) assessing the effect of VNS on the rehabilitation of stroke. This meta-analysis is performed using the random-effect model. RESULTS Three RCTs are included in the meta-analysis. Overall, compared with control group in stroke, VNS is associated with significantly improved FMA-UE (SMD = 3.86; 95% CI = 1.19 to 6.52; P = 0.005) and Motor Function Test (SMD = 0.33; 95% CI = 0.04 to 0.62; P = 0.03), but has no obvious impact on Box and Block Test (SMD = -0.31; 95% CI = -3.48 to 2.86; P = 0.85), Nine-Hole Peg Test (SMD = 8.35; 95% CI = -40.59 to 57.28; P = 0.74), atrial fibrillation (RR = 3.46; 95% CI = 0.39 to 30.57; P = 0.26) or adverse events (RR = 0.59; 95% CI = 0.21 to 1.61; P = 0.30). CONCLUSIONS VNS may be beneficial to the rehabilitation of stroke.
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