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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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Hamzic S, Braun T, Butz M, Khilan H, Weber S, Yeniguen M, Gerriets T, Schramm P, Juenemann M. Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS): a prospective, blind, randomized and controlled clinical trial. Eur J Neurol 2020; 28:172-181. [PMID: 32897605 DOI: 10.1111/ene.14516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/30/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Dysphagia is common in acute stroke and leads to worse overall outcome. Transesophageal echocardiography (TEE) is used in the diagnostic evaluation of stroke with regard to its etiology and is a known cause of postoperative dysphagia in cardiac surgery. The prevalence of dysphagia in acute stroke patients undergoing TEE remains unknown. The aim of the Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS) study was to assess the influence of TEE on swallowing among patients who have experienced acute stroke. METHODS The TEDRAS study was a prospective, blind, randomized, controlled trial that included two groups of patients with acute stroke. Simple unrestricted randomization was performed, and examiners were blinded to each other's results. Swallowing was tested using flexible endoscopic evaluation of swallowing (FEES) at three different time points in the intervention group (24 h before, immediately after and 24 h after TEE) and in the control group (FEES on three consecutive days and TEE earliest after the third FEES). Validated scales were used to assess dysphagia severity for all time points as primary outcome measures. RESULTS A total of 34 patients were randomized: 19 to the intervention group and 15 to the control group. The key findings of the repeated-measures between-group comparisons were significant increases in the intervention group for the following dysphagia measures: (1) secretion severity score (immediately after TEE: P < 0.001; 24 h after TEE: P < 0.001) and (2) Penetration-Aspiration Scale score for saliva (immediately after TEE: P < 0.001; 24 h after TEE: P = 0.007), for small (immediately after TEE: P = 0.009) and large liquid boli (immediately after TEE: P = 0.009; 24 h after TEE: P = 0.025). CONCLUSION The results indicate a negative influence of TEE on swallowing in acute stroke patients for at least 24 hours.
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Affiliation(s)
- S Hamzic
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - T Braun
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - M Butz
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - H Khilan
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Department of Neurology/Stroke Unit, Gesundheitszentrum Wetterau, Friedberg, Hesse, Germany
| | - S Weber
- Department of Neurology/Stroke Unit, Gesundheitszentrum Wetterau, Friedberg, Hesse, Germany
| | - M Yeniguen
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - T Gerriets
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany.,Department of Neurology/Stroke Unit, Gesundheitszentrum Wetterau, Friedberg, Hesse, Germany
| | - P Schramm
- Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany.,Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M Juenemann
- Department of Neurology, University Hospital Giessen and Marburg GmbH, Justus-Liebig-University, Giessen, Germany.,Heart and Brain Research Group, Heart-, Lung-, Vascular- and Rheumatic Centre Bad Nauheim, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
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Validation of the German Version of Functional Oral Intake Scale (FOIS-G) for Flexible Endoscopic Evaluation of Swallowing (FEES). Dysphagia 2020; 36:130-139. [PMID: 32342178 PMCID: PMC7803872 DOI: 10.1007/s00455-020-10114-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
The Functional Oral Intake Scale (FOIS) is the most frequently used scale for the evaluation of functional oral intake by dysphagia patients. FOIS was validated using data from Videofluoroscopic Swallowing Study (VFSS). Until now, a validated German version of FOIS for Flexible Endoscopic Evaluation of Swallowing (FEES) is lacking. The aim of this study was a cross-cultural validation of the German version of FOIS (FOIS-G) for FEES. The translation of the original FOIS was carried out according to the Translation, Review, Adjudication, Pretesting, Documentation (TRAPD) translation methodology. For the validation process, six experienced language therapists (SLT) retrospectively analyzed charts of 93 stroke patients. Inclusion criteria were comprised of stroke, clinical examination by an SLT within 24 h of admission, and FEES within 72 h of admission. The validity was calculated by comparison with Modified Rankin Scale (MRS), Barthel Index (BI), the Penetration-Aspiration-Scale (PAS), and a water swallow test. Spearman rank correlation of all paired raters ranged from rs = 0.96 to rs = 0.99, and percentage agreement ranged from 81 to 94%. The overall agreement between all raters was calculated by Fleiss kappa (0.83) (s.e. 0.02). There is a significant correlation between the BI and the MRS with the FOIS-G (rs = 0.301, p = 0.003 for BI; rs = – 0.366, p < 0.001 for MRS), between the PAS and the FOIS-G (rs = − 0.758, p < 0.001), as well as between the 70 ml-water-test and the FOIS-G (rs = 0.470, p < 0.001). FOIS-G is a valid instrument for the evaluation of the functional oral intake of food and liquids in dysphagia patients.
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Abstract
Dysphagia is common sequela of brain injury with as many as 50% of patients suffering from dysphagia following stroke. Currently, the majority of guidelines for clinical practice in the management of dysphagia focus on the prevention of complications while any natural recovery takes place. Recently, however, non-invasive brain stimulation (NIBS) techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have started to attract attention and are applied to investigate both the physiology of swallowing and influences on dysphagia. TMS allows for painless stimulation of the brain through an intact skull—an effect which would normally be impossible with electrical currents due to the high resistance of the skull. By comparison, tDCS involves passing a small electric current (usually under 2 mA) produced by a current generator over the scalp and cranium external to the brain. Initial studies used these techniques to better understand the physiological mechanisms of swallowing in healthy subjects. More recently, a number of studies have investigated the efficacy of these techniques in the management of neurogenic dysphagia with mixed results. Controversy still exists as to which site, strength and duration of stimulation yields the greatest improvement in dysphagia. And while multiple studies have suggested promising effects of NIBS, more randomised control trials with larger sample sizes are needed to investigate the short- and long-term effects of NIBS in neurogenic dysphagia.
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Otal B, Dutta A, Foerster Á, Ripolles O, Kuceyeski A, Miranda PC, Edwards DJ, Ilić TV, Nitsche MA, Ruffini G. Opportunities for Guided Multichannel Non-invasive Transcranial Current Stimulation in Poststroke Rehabilitation. Front Neurol 2016; 7:21. [PMID: 26941708 PMCID: PMC4764713 DOI: 10.3389/fneur.2016.00021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/09/2016] [Indexed: 12/21/2022] Open
Abstract
Stroke is a leading cause of serious long-term disability worldwide. Functional outcome depends on stroke location, severity, and early intervention. Conventional rehabilitation strategies have limited effectiveness, and new treatments still fail to keep pace, in part due to a lack of understanding of the different stages in brain recovery and the vast heterogeneity in the poststroke population. Innovative methodologies for restorative neurorehabilitation are required to reduce long-term disability and socioeconomic burden. Neuroplasticity is involved in poststroke functional disturbances and also during rehabilitation. Tackling poststroke neuroplasticity by non-invasive brain stimulation is regarded as promising, but efficacy might be limited because of rather uniform application across patients despite individual heterogeneity of lesions, symptoms, and other factors. Transcranial direct current stimulation (tDCS) induces and modulates neuroplasticity, and has been shown to be able to improve motor and cognitive functions. tDCS is suited to improve poststroke rehabilitation outcomes, but effect sizes are often moderate and suffer from variability. Indeed, the location, extent, and pattern of functional network connectivity disruption should be considered when determining the optimal location sites for tDCS therapies. Here, we present potential opportunities for neuroimaging-guided tDCS-based rehabilitation strategies after stroke that could be personalized. We introduce innovative multimodal intervention protocols based on multichannel tDCS montages, neuroimaging methods, and real-time closed-loop systems to guide therapy. This might help to overcome current treatment limitations in poststroke rehabilitation and increase our general understanding of adaptive neuroplasticity leading to neural reorganization after stroke.
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Affiliation(s)
| | - Anirban Dutta
- INRIA (Sophia Antipolis), Université Montpellier, Montpellier, France
| | | | | | - Amy Kuceyeski
- Department of Radiology, Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
| | - Pedro C. Miranda
- Institute of Biophysics and Biomedical Engineering (IBEB), Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Dylan J. Edwards
- Non-Invasive Brain Stimulation and Human Motor Control Laboratory, Burke-Cornell Medical Research Institute, White Plains, NY, USA
| | - Tihomir V. Ilić
- Department of Clinical Neurophysiology, Medical Faculty of Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Michael A. Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Technical University of Dortmund, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Giulio Ruffini
- Neuroelectrics Barcelona, Barcelona, Spain
- Starlab Barcelona, Barcelona, Spain
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Terré R, Mearin F. A randomized controlled study of neuromuscular electrical stimulation in oropharyngeal dysphagia secondary to acquired brain injury. Eur J Neurol 2015; 22:687-e44. [DOI: 10.1111/ene.12631] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/27/2014] [Indexed: 01/25/2023]
Affiliation(s)
- R. Terré
- Functional Digestion Rehabilitation Unit; Institut Guttmann; Neurorehabilitation Hospital; Barcelona Spain
- Institut Guttmann; Institut Universitari de Neurorehabilitació; Bellaterra (Cerdanyola del Vallès) Spain
- Universitat Autònoma de Barcelona; Bellaterra (Cerdanyola del Vallès) Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol; Badalona Barcelona Spain
| | - F. Mearin
- Functional Digestion Rehabilitation Unit; Institut Guttmann; Neurorehabilitation Hospital; Barcelona Spain
- Institut Guttmann; Institut Universitari de Neurorehabilitació; Bellaterra (Cerdanyola del Vallès) Spain
- Universitat Autònoma de Barcelona; Bellaterra (Cerdanyola del Vallès) Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol; Badalona Barcelona Spain
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