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Salazar CA, Welsh JM, Lench D, Harmsen IE, Jensen JH, Grewal P, Yazdani M, Al Kasab S, Spiotta A, Bonilha L, George MS, Kautz SA, Rowland NC. Concurrent tDCS-fMRI after stroke reveals link between attention network organization and motor improvement. Sci Rep 2024; 14:19334. [PMID: 39164440 PMCID: PMC11336178 DOI: 10.1038/s41598-024-70083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/12/2024] [Indexed: 08/22/2024] Open
Abstract
Restoring motor function after stroke necessitates involvement of numerous cognitive systems. However, the impact of damage to motor and cognitive network organization on recovery is not well understood. To discover correlates of successful recovery, we explored imaging characteristics in chronic stroke subjects by combining noninvasive brain stimulation and fMRI. Twenty stroke survivors (6 months or more after stroke) were randomly assigned to a single session of transcranial direct current stimulation (tDCS) or sham during image acquisition. Twenty healthy subjects were included as controls. tDCS was limited to 10 min at 2 mA to serve as a mode of network modulation rather than therapeutic delivery. Fugl-Meyer Assessments (FMA) revealed significant motor improvement in the chronic stroke group receiving active stimulation (p = 0.0005). Motor changes in this group were correlated in a data-driven fashion with imaging features, including functional connectivity (FC), surface-based morphometry, electric field modeling and network topology, focusing on relevant regions of interest. We observed stimulation-related changes in FC in supplementary motor (p = 0.0029), inferior frontal gyrus (p = 0.0058), and temporo-occipital (p = 0.0095) areas, though these were not directly related to motor improvement. The feature most strongly associated with FMA improvement in the chronic stroke cohort was graph topology of the dorsal attention network (DAN), one of the regions surveyed and one with direct connections to each of the areas with FC changes. Chronic stroke subjects with a greater degree of motor improvement had lower signal transmission cost through the DAN (p = 0.029). While the study was limited by a small stroke cohort with moderate severity and variable lesion location, these results nevertheless suggest a top-down role for higher order areas such as attention in helping to orchestrate the stroke recovery process.
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Affiliation(s)
- Claudia A Salazar
- Department of Neurosurgery, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., CSB301 MSC606, Charleston, SC, 29425, USA
- Department of Neuroscience, College of Graduate Studies, Medical University of South Carolina, Charleston, SC, USA
| | - James M Welsh
- Department of Neurosurgery, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., CSB301 MSC606, Charleston, SC, 29425, USA
- Department of Neuroscience, College of Graduate Studies, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel Lench
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Irene E Harmsen
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Jens H Jensen
- Department of Neuroscience, College of Graduate Studies, Medical University of South Carolina, Charleston, SC, USA
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Parneet Grewal
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Milad Yazdani
- Department of Radiology and Radiological Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sami Al Kasab
- Department of Neurosurgery, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., CSB301 MSC606, Charleston, SC, 29425, USA
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Alex Spiotta
- Department of Neurosurgery, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., CSB301 MSC606, Charleston, SC, 29425, USA
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, University of South Carolina, Columbia, SC, USA
| | - Mark S George
- Department of Neuroscience, College of Graduate Studies, Medical University of South Carolina, Charleston, SC, USA
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Psychiatry, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Steven A Kautz
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- MUSC Institute for Neuroscience Discovery (MIND), Medical University of South Carolina, Charleston, SC, USA
| | - Nathan C Rowland
- Department of Neurosurgery, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., CSB301 MSC606, Charleston, SC, 29425, USA.
- Department of Neuroscience, College of Graduate Studies, Medical University of South Carolina, Charleston, SC, USA.
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
- MUSC Institute for Neuroscience Discovery (MIND), Medical University of South Carolina, Charleston, SC, USA.
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Kang J, Lee H, Yu S, Lee M, Kim HJ, Kwon R, Kim S, Fond G, Boyer L, Rahmati M, Koyanagi A, Smith L, Nehs CJ, Kim MS, Sánchez GFL, Dragioti E, Kim T, Yon DK. Effects and safety of transcranial direct current stimulation on multiple health outcomes: an umbrella review of randomized clinical trials. Mol Psychiatry 2024:10.1038/s41380-024-02624-3. [PMID: 38816583 DOI: 10.1038/s41380-024-02624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
Transcranial direct current stimulation (tDCS), which delivers a direct current to the brain, emerged as a non-invasive potential therapeutic in treating a range of neurological and neuropsychiatric disorders. However, a comprehensive quantitative evidence synthesis on the effects of tDCS on a broad range of mental illnesses is lacking. Here, we systematically assess the certainty of the effects and safety of tDCS on several health outcomes using an umbrella review of randomized controlled trials (RCTs). The methodological quality of each included original meta-analysis was assessed by the A Measurement Tool for Assessing Systematic Reviews 2 (AMSTAR2), and the certainty of the evidence for each effect was evaluated with Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). We followed an a priori protocol (PROSPERO CRD42023458700). We identified 15 meta-analyses of RCTs (AMSTAR 2; high 3, moderate 3, and low 9) that included 282 original articles, covering 22 unique health endpoints across 22 countries and six continents. From meta-analyses of RCTs supported by very low to high certainty of evidence, it was found that tDCS improved symptoms related to post-stroke, including post-stroke depression scale score (equivalent standardized mean difference [eSMD], 1.61 [95% confidence level, 0.72-2.50]; GRADE=moderate), activities of daily living independence (7.04 [3.41-10.67]; GRADE=high), motor recovery of upper and lower extremity (upper extremity: 0.15 [0.06-0.24], GRADE=high; lower extremity: 0.10 [0.03-0.16], GRADE=high), swallowing performance (GRADE=low), and spasticity (GRADE=moderate). In addition, tDCS had treatment effects on symptoms of several neurological and neuropsychiatric disorders, including obsessive-compulsive disorder (0.81 [0.44-1.18]; GRADE=high), pain in fibromyalgia (GRADE=low), disease of consciousness (GRADE=low), insight score (GRADE=moderate) and working memory (0.34 [0.01-0.67]; GRADE=high) in schizophrenia, migraine-related pain (-1.52 [-2.91 to -0.13]; GRADE=high), attention-deficit/hyperactivity disorder (reduction in overall symptom severity: 0.24 [0.04-0.45], GRADE=low; reduction in inattention: 0.56 [0.02-1.11], GRADE=low; reduction in impulsivity: 0.28 [0.04-0.51], GRADE=low), depression (GRADE=low), cerebellar ataxia (GRADE=low), and pain (GRADE=very low). Importantly, tDCS induced an increased number of reported cases of treatment-emergent mania or hypomania (0.88 [0.62-1.13]; GRADE=moderate). We found varied levels of evidence for the effects of tDCS with multiple neurological and neuropsychiatric conditions, from very low to high certainty of evidence. tDCS was effective for people with stroke, obsessive-compulsive disorder, fibromyalgia, disease of consciousness, schizophrenia, migraine, attention-deficit/hyperactivity disorder, depression, cerebellar ataxia, and pain. Therefore, these findings suggest the benefit of tDCS for several neurological and neuropsychiatric disorders; however, further studies are needed to understand the underlying mechanism and optimize its therapeutic potential.
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Affiliation(s)
- Jiseung Kang
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Seungyeong Yu
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Myeongcheol Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Guillaume Fond
- Assistance Publique-Hopitaux de Marseille, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Laurent Boyer
- Assistance Publique-Hopitaux de Marseille, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Masoud Rahmati
- Assistance Publique-Hopitaux de Marseille, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Christa J Nehs
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Min Seo Kim
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Tae Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
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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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Chen L, Liu C, Yuan M, Yin X, Niu S, Tang J, Chen H, Xiong B, Feng X. Interventions for Postextubation Dysphagia in Critically Ill Patients: A Systematic Review and Meta-analysis. Dysphagia 2024:10.1007/s00455-024-10695-1. [PMID: 38558176 DOI: 10.1007/s00455-024-10695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This review evaluates the efficacy and safety of dysphagia interventions for patients with prolonged endotracheal intubation (⩾48 h) in critical care units. DATA SOURCES We systematically searched PubMed, Cochrane Library, Medline, Embase, OVID, CINAHL, Wanfang (China), CNKI (China), and ProQuest Dissertations for studies published up to December 31, 2023. STUDY SELECTION Inclusion criteria encompassed randomized controlled trials (RCTs), quasi-randomized trials, and cohort studies comparing dysphagia rehabilitation - such as swallowing stimulation, swallowing and respiratory muscle exercise, and neuromuscular electrical stimulation - with standard care or no treatment. The primary outcomes assessed were dysphagia severity, time to resume oral intake, and incidence of aspiration and aspiration pneumonia. DATA EXTRACTION Detailed information on study design, setting, participant demographics, interventions, and outcomes was systematically extracted. DATA SYNTHESIS Our analysis included ten studies with a total of 1031 participants. The findings demonstrate a significant reduction in dysphagia severity, time to oral intake and the risk of aspiration pneumonia, and an improvement in quality of life among patients receiving swallowing therapy. However, no substantial difference was found in nutritional status. Limited data availability necessitated a descriptive presentation of outcomes like the risk of aspiration, ICU/hospital stay duration, pharyngeal/oral residue severity, and intervention-related adverse events. CONCLUSION The current evidence for the effectiveness of dysphagia interventions in critically ill patients with prolonged endotracheal intubation is limited. There is a pressing need for future research, particularly high-quality RCTs employing standardized outcome measures, to substantiate these findings.
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Affiliation(s)
- Lan Chen
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310009, China
| | - Chang Liu
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310009, China
| | - Mengmei Yuan
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China
| | - Xiaoxiao Yin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310009, China
| | - Shan Niu
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310009, China
| | - Jiaying Tang
- Emergency ICU, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310009, China
| | - Haotian Chen
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310009, China
| | - Bing Xiong
- Rehabilitation Department, The Second Affiliated Hospital of Zhejiang, University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiuqin Feng
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310009, China.
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Gómez-García N, Álvarez-Barrio L, Leirós-Rodríguez R, Soto-Rodríguez A, Andrade-Gómez E, Hernández-Lucas P. Transcranial direct current stimulation for post-stroke dysphagia: a meta-analysis. J Neuroeng Rehabil 2023; 20:165. [PMID: 38082316 PMCID: PMC10712182 DOI: 10.1186/s12984-023-01290-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Strokes may cause some swallowing difficulty or associated dysphagia in 25-80% of patients. This phenomenon has been linked to increased morbidity and mortality. Therefore, the aim of this study was to evaluate the efficacy of transcranial direct current stimulation in patients with dysphagia in post-stroke patients. METHODS A systematic search in PubMed, Scopus, Web of Science and MEDLINE was conducted. The articles must have to evaluate an intervention that included transcranial direct current stimulation; the sample had to consist exclusively of patients with post-stroke dysphagia; and the experimental design consisted of randomized controlled trial. Difference in mean differences and their 95% confidence interval were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity. RESULTS Of the 9 investigations analyzed, all applied transcranial direct current stimulation in combination with conventional dysphagia therapy to the experimental group. All the studies analyzed identified improvements in swallowing function and meta-analysis confirmed their strong effect on reducing the risk of penetration and aspiration (Hedges's g = 0.55). The results showed that participants who received transcranial direct current stimulation significantly improved swallowing function. CONCLUSIONS Transcranial direct current stimulation has positive effects in the treatment of poststroke dysphagia by improving swallowing function, oral and pharyngeal phase times and the risk of penetration and aspiration. Furthermore, its combination with conventional dysphagia therapy, balloon dilatation with catheter or training of the swallowing muscles ensures improvement of swallowing function. PROSPERO registration ID CRD42022314949.
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Affiliation(s)
- Nerea Gómez-García
- Nursing and Physical Therapy Department, University of Leon, Astorga Ave., 24401, Ponferrada, Spain
| | - Lorena Álvarez-Barrio
- Nursing and Physical Therapy Department, University of Leon, Astorga Ave., 24401, Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Astorga Ave., 24401, Ponferrada, Spain
| | - Anxela Soto-Rodríguez
- Pneumology Service, Ourense Hospital, Galician Health Service, 32005, Ourense, Spain
| | - Elena Andrade-Gómez
- Department of Nursing, University of La Rioja, La Rioja, 26004, Logroño, Spain.
| | - Pablo Hernández-Lucas
- Faculty of Physiotherapy, University of Vigo, Campus A Xunqueira, 36005, Pontevedra, Spain
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He Y, Tan X, Kang H, Wang H, Xie Y, Zheng D, Li C. Research trends and hotspots of post-stroke dysphagia rehabilitation: a bibliometric study and visualization analysis. Front Neurol 2023; 14:1279452. [PMID: 38156085 PMCID: PMC10754621 DOI: 10.3389/fneur.2023.1279452] [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: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023] Open
Abstract
Background Post-stroke dysphagia (PSD) is one of the most prevalent stroke sequelae, affecting stroke patients' prognosis, rehabilitation results, and quality of life while posing a significant cost burden. Although studies have been undertaken to characterize the pathophysiology, epidemiology, and risk factors of post-stroke dysphagia, there is still a paucity of research trends and hotspots on this subject. The purpose of this study was to create a visual knowledge map based on bibliometric analysis that identifies research hotspots and predicts future research trends. Methods We searched the Web of Science Core Collection for material on PSD rehabilitation research from its inception until July 27, 2023. We used CiteSpace, VOSviewer, and Bibliometrix R software packages to evaluate the annual number of publications, nations, institutions, journals, authors, references, and keywords to describe present research hotspots and prospective research orientations. Results This analysis comprised 1,097 articles from 3,706 institutions, 374 journals, and 239 countries or regions. The United States had the most publications (215 articles), and it is the most influential country on the subject. "Dysphagia" was the most published journal (100 articles) and the most referenced journal (4,606 citations). Highly cited references focused on the pathophysiology and neuroplasticity mechanisms of PSD, therapeutic modalities, rehabilitation tactics, and complications prevention. There was a strong correlation between the terms "validity" and "noninvasive," which were the strongest terms in PSD rehabilitation research. The most significant words in PSD rehabilitation research were "validity" and "noninvasive brain stimulation," which are considered two of the most relevant hotspots in the field. Conclusion We reviewed the research in the field of PSD rehabilitation using bibliometrics to identify research hotspots and cutting-edge trends in the field, primarily including the pathogenesis and neurological plasticity mechanisms of PSD, complications, swallowing screening and assessment methods, and swallowing rehabilitation modalities, and this paper can provide in the follow-up research in the field of PSD rehabilitation. The results of this study can provide insightful data for subsequent studies in the field of PSD rehabilitation.
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Affiliation(s)
- Yuanyuan He
- College of Nursing, Jinan University, Guangzhou, China
| | - Xuezeng Tan
- Department of Critical Care Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Huiqi Kang
- College of Nursing, Jinan University, Guangzhou, China
| | - Huan Wang
- College of Nursing, Jinan University, Guangzhou, China
| | - Yuyao Xie
- College of Nursing, Jinan University, Guangzhou, China
| | - Dongxiang Zheng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Chen Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Lekoubou A, Nguyen C, Kwon M, Nyalundja AD, Agrawal A. Post-stroke Everything. Curr Neurol Neurosci Rep 2023; 23:785-800. [PMID: 37837566 DOI: 10.1007/s11910-023-01308-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW This review aims at providing updates on selected post-stroke complications. We examined recent advances in diagnosing and treating the following post-stroke complications: cognitive impairment, epilepsy, depression, fatigue, tremors, dysphagia, and pain. RECENT FINDINGS Advances in understanding the mechanisms of post-stroke complications, in general, are needed despite advances made in understanding, treating, and preventing these complications. There are growing progresses in integrating new tools to diagnose post-stroke cognitive impairment. The potential role of acute stroke reperfusion treatment in post-stroke epilepsy and its impact on other stroke complications is getting more transparent. Post-stroke depression remains underestimated and new tools to diagnose depression after stroke are being developed. New promising pharmacological approaches to treating post-stroke pain are emerging. Tremors related to stroke are poorly understood and under-evaluated, while treatment towards post-stroke dysphagia has benefited from new non-pharmacological to pharmacological approaches. CONCLUSIONS An integrative approach to stroke complications and collaborations between providers across specialties are more likely to improve stroke outcomes.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA.
| | - Clever Nguyen
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA
| | - Michelle Kwon
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Center for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of Congo
| | - Ankita Agrawal
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Piveteau E, Di Rienzo F, Bolliet O, Guillot A. Inter-task transfer of force gains is facilitated by motor imagery. Front Neurosci 2023; 17:1228062. [PMID: 37645373 PMCID: PMC10461095 DOI: 10.3389/fnins.2023.1228062] [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: 05/24/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction There is compelling evidence that motor imagery (MI) contributes to improve muscle strength. While strong effects have been observed for finger muscles, only few experiments with moderate benefits were conducted within applied settings targeting large upper or lower limb muscles. The aim of the present study was therefore to extend the investigation of embedded MI practice designed to improve maximal voluntary strength on a multi-joint dynamic exercise involving the lower limbs. Additionally, we tested whether targeting the content of MI on another movement than that physically performed and involving the same body parts might promote inter-task transfer of strength gains. Methods A total of 75 participants were randomly assigned into three groups who underwent a physical training on back squat. During inter-trial recovery periods, a first MI group (n = 25) mentally rehearsed the back squat, while a second MI group (n = 25) performed MI of a different movement involving the lower limbs (deadlift). Participants from the control group (n = 25) completed a neutral cognitive task during equivalent time. Strength and power gains were assessed ecologically using a velocity transducer device at 4 different time periods. Results Data first revealed that participants who engaged in MI of the back squat improved their back squat performance (p < 0.03 and p < 0.01, respectively), more than the control group (p < 0.05), hence supporting the positive effects of MI on strength. Data further supported the inter-task transfer of strength gains when MI targeted a movement that was not physically trained (p = 0.05). Discussion These findings provide experimental support for the use of MI during physical training sessions to improve and transfer force development.
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Affiliation(s)
| | | | | | - Aymeric Guillot
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, Villeurbanne, France
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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 2023:1-18. [PMID: 36966378 DOI: 10.1080/02648725.2023.2184044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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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: 2.0] [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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Cosentino G, Todisco M, Giudice C, Tassorelli C, Alfonsi E. Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease. Curr Opin Neurol 2022; 35:741-752. [PMID: 36226719 DOI: 10.1097/wco.0000000000001117] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Neurogenic dysphagia worsens quality of life and prognosis of patients with different neurological disorders. Management of neurogenic dysphagia can be challenging. This review provides a comprehensive overview of current evidence on screening, diagnosis, and treatment of neurogenic dysphagia in stroke and Parkinson's disease, suggesting clues for clinical practice. RECENT FINDINGS The pros and cons of diagnostic techniques are discussed in the light of updated evidence. Findings from recent meta-analyses of different treatment approaches, including traditional dysphagia therapy, peripheral and central neurostimulation techniques, and treatment with botulinum toxin, are critically discussed, emphasizing inconsistencies and controversial issues. SUMMARY Screening tests and clinical swallow examination should be routinely performed in neurological patients at risk for dysphagia. In patients testing positive for dysphagia, first-line instrumental investigations, represented by fiberoptic endoscopic evaluation of swallowing or videofluoroscopic swallow study, should be performed to confirm the presence of dysphagia, to assess its severity, and to inform the treatment. Second-line and third-line instrumental methods can be used in selected patients to clarify specific pathophysiological aspects of oropharyngeal dysphagia. Treatment strategies should be personalized, and combination of traditional dysphagia therapy with innovative treatment approaches may increase the chance of restoring effective and safe swallowing.
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Affiliation(s)
- Giuseppe Cosentino
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation
- Department of Brain and Behavioral Sciences, University of Pavia
| | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation
- Department of Brain and Behavioral Sciences, University of Pavia
| | - Carla Giudice
- Department of Brain and Behavioral Sciences, University of Pavia
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation
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