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Suh I, You J, Son S, Bae JS, Lim JY. The effect of real versus sham intermittent theta burst transcranial magnetic stimulation combined with conventional treatment on poststroke dysphagia: a randomized controlled trial. Int J Rehabil Res 2024; 47:81-86. [PMID: 38517535 DOI: 10.1097/mrr.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Repetitive transcranial magnetic stimulation to the pharyngeal motor cortex has shown beneficial effects on poststroke dysphagia. Previous studies, however, using intermittent theta burst stimulation (iTBS) for dysphagia have targeted the suprahyoid motor cortex. This study aimed to investigate the effects of iTBS to the pharyngeal motor cortex in patients with poststroke dysphagia, using ultrasound and videofluoroscopic swallowing studies (VFSS). A randomized controlled trial was conducted on patients with dysphagia due to a first-time unilateral stroke. Patients who had signs and symptoms of dysphagia and showed aspiration or penetration on VFSS were included. Twenty-eight patients were randomly assigned to either real or sham iTBS groups, and each patient underwent five sessions of iTBS to the ipsilesional pharyngeal motor cortex. Each iTBS session was followed by conventional dysphagia treatment for 30 min. The hyoid-larynx approximation measured by ultrasound, penetration-aspiration scale (PAS) and functional dysphagia scale (FDS) assessed by VFSS were evaluated before and after completion of iTBS. There were no significant differences between the two groups in terms of demographic and clinical characteristics, including age and type of stroke. The hyoid-larynx approximation ratio increased in the real iTBS group and decreased in the sham iTBS group (median values of pre-post differences were 0.27 vs. -0.01, P < 0.001). The PAS and FDS showed greater improvements in the real iTBS group than in the sham iTBS group (median values of pre-post differences of the PAS were -2.50 vs. 0.00, P = 0.004; median values of pre-post differences of the FDS were -12.50 vs. -2.50, P < 0.001). No adverse effects were reported during or after iTBS sessions. Five-session iTBS to the pharyngeal motor cortex combined with conventional treatment led to a significant improvement in poststroke dysphagia in terms of hyoid-larynx approximation which is related to the suprahyoid muscle. Considering the short duration of one iTBS session, this can be an efficient and effective treatment tool for patients with this condition.
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Affiliation(s)
- InHyuk Suh
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon
| | - JaeIn You
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon
| | - Sangpil Son
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon
| | - Jin Seok Bae
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon
| | - Jong Youb Lim
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon
- Department of Rehabilitation Medicine, Uijeongbu Eulji University Hospital, Eulji University School of Medicine, Uijeongbu, Republic of Korea
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2
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Fang WJ, Zheng F, Zhang LZ, Wang WH, Yu CC, Shao J, Wu YJ. Research progress of clinical intervention and nursing for patients with post-stroke dysphagia. Neurol Sci 2022; 43:5875-5884. [PMID: 35661279 PMCID: PMC9166186 DOI: 10.1007/s10072-022-06191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Post-stroke dysphagia (PSD) is a common and costly complication of stroke and is associated with increased mortality, morbidity, and hospitalization. Although most patients can spontaneously resume swallowing, there are still many patients who do not recover and even die. Despite multiple advances in the acute treatment and secondary prevention of stroke, the effective treatment of PSD remains a neglected area. Studies have shown that repair mechanisms of neurostimulation techniques and increased cortical activity play an important role in the treatment of PSD. In addition, nutritional interventions are also crucial for the treatment of malnutrition in PSD patients. Therefore, this article reviews the effects of the current main clinical treatment methods and nutritional interventions on the treatment and rehabilitation of PSD patients. It also emphasized the necessity of developing an individualized care plan for PSD patients, which is of great significance to promote the clinical treatment, nutritional status, prognosis, and quality of life of PSD patients.
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Affiliation(s)
- Wen-Juan Fang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Fei Zheng
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Lin-Zhi Zhang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Wen-Hui Wang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Cheng-Chen Yu
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Juan Shao
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Yi-Jin Wu
- The Second Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, China.
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Umay E, Eyigor S, Bahat G, Halil M, Giray E, Unsal P, Unlu Z, Tikiz C, Vural M, Cincin AT, Bengisu S, Gurcay E, Keseroglu K, Aydeniz B, Karaca EC, Karaca B, Yalcin A, Ozsurekci C, Seyidoglu D, Yilmaz O, Alicura S, Tokgoz S, Selcuk B, Sen EI, Karahan AY, Yaliman A, Ozkok S, Ilhan B, Oytun MG, Ozturk ZA, Akin S, Yavuz B, Akaltun MS, Sari A, Inanir M, Bilgilisoy M, Çaliskan Z, Saylam G, Ozer T, Eren Y, Bicakli DH, Keskin D, Ulger Z, Demirhan A, Calik Y, Saka B, Yigman ZA, Ozturk EA. Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H. Ann Geriatr Med Res 2022; 26:94-124. [PMID: 35527033 PMCID: PMC9271401 DOI: 10.4235/agmr.21.0145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/26/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
- Corresponding Author Ebru Umay, MD Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara 06200, Turkey E-mail:
| | - Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Pelin Unsal
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Zeliha Unlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Asli Tufan Cincin
- Department of Internal Medicine, Marmara University, Istanbul, Turkey
| | - Serkan Bengisu
- Department of Speech and Language Therapy, Uskudar University, Istanbul, Turkey
| | - Eda Gurcay
- Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kemal Keseroglu
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Banu Aydeniz
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Celik Karaca
- Ministry of Health Eskisehir Provincial Health Directorate, Eskisehir, Turkey
| | - Burak Karaca
- Ministry of Health Inonu Public Health Center, Eskisehir, Turkey
| | - Ahmet Yalcin
- Division of Geriatrics, Department of Internal Medicine, Ankara University, Ankara, Turkey
| | - Cemile Ozsurekci
- Department of Physical Medicine and Rehabilitation, Trabzon Kanuni Training and Research Hospital, University of Health Sciences Turkey, Trabzon, Turkey
| | | | - Ozlem Yilmaz
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Alicura
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Serhat Tokgoz
- Department of General Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Barin Selcuk
- Department of Physical Medicine, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey
| | - Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Usak University, Usak, Turkey
| | - Ayse Yaliman
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Serdar Ozkok
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Birkan Ilhan
- Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Guner Oytun
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Sibel Akin
- Department Internal Medicine, Erciyes University, Kayseri, Turkey
| | - Betul Yavuz
- Department of Physical Medicine and Rehabilitation, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University, Gaziantep, Turkey
| | - Aylin Sari
- Istanbul Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
| | - Murat Inanir
- Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey
| | - Meral Bilgilisoy
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Zuhal Çaliskan
- Department of Gastroenterology, Umraniye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Guleser Saylam
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Tugce Ozer
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Yasemin Eren
- Department of Neurology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | | | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Kirikkale University, Kirikkale, Turkey
| | - Zekeriya Ulger
- Department of Internal Medicine, Kirikkale University, Kirikkale, Turkey
| | - Aylin Demirhan
- Aylin Demirhan Physical Medicine and Rehabilitation Clinic, Izmir, Turkey
| | - Yalkin Calik
- Department of Physical Medicine and Rehabilitation, Bolu Izzet Baysal Training and Research Hospital, Bolu Turkey
| | - Bulent Saka
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Aykin Yigman
- Department of Physical Medicine and Rehabilitation, Polatli City Hospital, Ministry of Health, Ankara, Turkey
| | - Erhan Arif Ozturk
- Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Metaplasticity in the human swallowing system: clinical implications for dysphagia rehabilitation. Neurol Sci 2021; 43:199-209. [PMID: 34654983 PMCID: PMC8724108 DOI: 10.1007/s10072-021-05654-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Dysphagia is a common and devastating complication following brain damage. Over the last 2 decades, dysphagia treatments have shifted from compensatory to rehabilitative strategies that facilitate neuroplasticity, which is the reorganization of neural networks that is essential for functional recovery. Moreover, there is growing interest in the application of cortical and peripheral neurostimulation to promote such neuroplasticity. Despite some preliminary positive findings, the variability in responsiveness toward these treatments remains substantial. The purpose of this review is to summarize findings on the effects of neurostimulation in promoting neuroplasticity for dysphagia rehabilitation and highlight the need to develop more effective treatment strategies. We then discuss the role of metaplasticity, a homeostatic mechanism of the brain to regulate plasticity changes, in helping to drive neurorehabilitation. Finally, a hypothesis on how metaplasticity could be applied in dysphagia rehabilitation to enhance treatment outcomes is proposed.
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Li P, Xu H, Belkacem AN, Zhang J, Xu R, Guo X, Wang X, Wu D, Tan W, Shin D, Liang J, Chen C. Brain Patterns During Single- and Dual-Task Leg Movements. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The brain is able to engage in dual tasks such as motor imagery (MI) and action observation (AO) or motor execution (ME) with action observation. In this study, we have quantitatively compared event-related desynchronization (ERD) patterns during tasks of pure MI, MI with AO (O-MI), ME, and ME with AO (O-ME) of the leg to investigate the underlying neuronal mechanisms using EEG. Subjects were instructed to imagine or perform rhythmical actions while watching a video of leg movements during O-MI and O-ME tasks; In contrast, subjects imagined and performed the leg movements without observing any video during pure MI and ME tasks. We noticed that the amplitude of ERDs from MI, O-MI, ME and O-ME sequentially increases in central regions of the brain. These quantified ERD patterns in EEG were used to study the differences of brain oscillatory changes among the four tasks. We found that ERDs in motor area were more distinct in O-MI, compared with pure MI. These results suggest that O-MI produced stronger motor activations than MI. Plus, O-ME showed significantly greater activations than ME in the beta band. O-ME has produced stronger neurophysiological effects than MI, and stronger behavioral effects than ME. These empirical results do provide convincing evidence of the dual tasks such combined MI or ME with action observation on brain pattern changes. The video of the goal-directed leg movements is most likely able to improve the ability of performing or imagining movements. O-MI and O-ME may get better and closer therapeutic effects in leg rehabilitation and motor skill training. Furthermore, the extent analysis of ERD may provide the basis for evaluating the ability of O-MI and O-ME in leg rehabilitation and motor skill training.
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Affiliation(s)
- Penghai Li
- School of Electrical and Electronic Engineering, Tianjin University of Technology, Tianjin, 300384, China
| | - Han Xu
- School of Electrical and Electronic Engineering, Tianjin University of Technology, Tianjin, 300384, China
| | - Abdelkader Nasreddine Belkacem
- Department of Computer and Network Engineering, College of Information Technology, United Arab Emirates University, Al Ain, 15551, United Arab Emirates
| | - Jianfeng Zhang
- School of Electrical and Electronic Engineering, Tianjin University of Technology, Tianjin, 300384, China
| | - Rui Xu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Xinpu Guo
- School of Computer Science, Tianjin University of Technology, Tianjin, 300384, China
| | - Xiaotian Wang
- School of Artificial Intelligence, Xidian University, Xian, 710071, China
| | - Dongyue Wu
- School of Electrical and Electronic Engineering, Tianjin University of Technology, Tianjin, 300384, China
| | - Wenjun Tan
- School of Computer Science and Engineering, Northeastern University, Shenyang 110189, China
| | - Duk Shin
- Department of Electronics and Mechatronics, Tokyo Polytechnic University, 243-0297, Japan
| | - Jun Liang
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Chao Chen
- School of Electrical and Electronic Engineering, Tianjin University of Technology, Tianjin, 300384, China
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6
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Jones CA, Colletti CM, Ding MC. Post-stroke Dysphagia: Recent Insights and Unanswered Questions. Curr Neurol Neurosci Rep 2020; 20:61. [PMID: 33136216 PMCID: PMC7604228 DOI: 10.1007/s11910-020-01081-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? RECENT FINDINGS There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.
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Affiliation(s)
- Corinne A Jones
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA. .,Speech, Language, & Hearing Sciences; Moody College of Communication, The University of Texas, Austin, TX, USA.
| | - Christina M Colletti
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| | - Ming-Chieh Ding
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
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7
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Huang Y, Chen JC, Tsai CH, Lu MK. Convergent Associative Motor Cortical Plasticity Induced by Conditional Somatosensory and Motor Reaction Afferents. Front Hum Neurosci 2020; 14:576171. [PMID: 33192405 PMCID: PMC7609873 DOI: 10.3389/fnhum.2020.576171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: Associative motor cortical plasticity can be non-invasively induced by paired median nerve electric stimulation and transcranial magnetic stimulation (TMS) of the primary motor cortex (M1). This study investigates whether a simultaneous motor reaction of the other hand advances the associative plasticity in M1. Methods: Twenty-four right-handed subjects received conventional paired associative stimulation (PAS) and PAS with simultaneous motor reaction (PASmr) with at least a 1-week interval. The PASmr protocol additionally included left abductor pollicis brevis muscle movement responding to a digital sound. The motor reaction time was individually measured. The M1 excitability was examined by the motor evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) before and after the PAS protocols. Results: The conventional PAS protocol significantly facilitated MEP and suppressed SICI. A negative correlation between the reaction time and the MEP change, and a positive correlation between the reaction time and the ICF change were found in the PASmr protocol. By subgrouping analysis, we further found significant facilitation of MEP and a reduction of ICF in the subjects with fast reaction times but not in those with slow reaction times. Conclusion: Synchronized motor reaction ipsilateral to the stimulated M1 induces associative M1 motor plasticity through the spike-timing dependent principle. MEP and ICF change could represent this kind of plasticity. The current findings provide a novel insight into designing rehabilitation programs concerning motor function.
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Affiliation(s)
- Yi Huang
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Jui-Cheng Chen
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Kuei Lu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan.,Ph.D. Program for Translational Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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8
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Li WQ, Lin T, Li X, Jing YH, Wu C, Li MN, Ding Q, Lan Y, Xu GQ. TMS brain mapping of the pharyngeal cortical representation in healthy subjects. Brain Stimul 2020; 13:891-899. [PMID: 32289722 DOI: 10.1016/j.brs.2020.02.031] [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: 10/12/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Brain mapping is fundamental to understanding brain organization and function. However, a major drawback to the traditional Brodmann parcellation technique is the reliance on the use of postmortem specimens. It has therefore historically been difficult to make any comparison regarding functional data from different regions or hemispheres within the same individual. Moreover, this method has been significant limited by subjective boundaries and classification criteria and therefore suffer from reproducibility issues. The development of transcranial magnetic stimulation (TMS) offers an alternative approach to brain mapping, specifically the motor cortical regions by eliciting quantifiable functional reactions. OBJECTIVE To precisely describe the motor cortical topographic representation of pharyngeal constrictor musculature using TMS and to further map the brain for use as a tool to study brain plasticity. METHODS 51 healthy subjects (20 male/31 female, 19-26 years old) were tested using single-pulse TMS combined with intraluminal catheter-guided high-resolution manometry and a standardized grid cap. We investigated various parameters of the motor-evoked potential (MEP) that include the motor map area, amplitude, latency, center of gravity (CoG) and asymmetry index. RESULTS Cortically evoked response latencies were similar for the left and right hemispheres at 6.79 ± 0.22 and 7.24 ± 0.27 ms, respectively. The average scalp positions (relative to the vertex) of the pharyngeal motor cortical representation were 10.40 ± 0.19 (SE) cm medio-lateral and 3.20 ± 0.20 (SE) cm antero-posterior in the left hemisphere and 9.65 ± 0.24 (SE) cm medio-lateral and 3.18 ± 0.23 (SE) cm antero-posterior in the right hemisphere. The mean motor map area of the pharynx in the left and right hemispheres were 9.22 ± 0.85(SE) cm2and 10.12 ± 1.24(SE) cm2, respectively. The amplitudes of the MEPs were 35.94 ± 1.81(SE)uV in the left hemisphere and 34.49 ± 1.95(SE)uV in the right hemisphere. By comparison, subtle but consistent differences in the degree of the bilateral hemispheric representation were also apparent both between and within individuals. CONCLUSION The swallowing musculature has a bilateral motor cortical representation across individuals, but is largely asymmetric within single subjects. These results suggest that TMS mapping using a guided intra-pharyngeal EMG catheter combined with a standardized gridded cap might be a useful tool to localize brain function/dysfunction by linking brain activation to the corresponding physical reaction.
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Affiliation(s)
- Wan-Qi Li
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Xue Li
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Ying-Hua Jing
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Meng-Ni Li
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Qian Ding
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Guang-Qing Xu
- Department of Rehabilitation Medicine, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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9
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Raginis-Zborowska A, Cheng I, Pendleton N, Payton A, Ollier W, Michou E, Hamdy S. Genetic influences on the variability of response to repetitive transcranial magnetic stimulation in human pharyngeal motor cortex. Neurogastroenterol Motil 2019; 31:e13612. [PMID: 31033149 DOI: 10.1111/nmo.13612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent studies have reported substantial variability in response to repetitive transcranial magnetic stimulation (rTMS). We hypothesized that an individual's genetic predisposition may contribute to such variability in the pharyngeal motor cortex. This study aimed to investigate the response to 1 and 5 Hz rTMS paradigms on pharyngeal motor cortex in healthy participants and its relationship with genetic predisposition. METHODS Forty-one healthy participants (25.4 ± 4.6 years old) received either or both 1 Hz (n = 39) and 5 Hz rTMS (n = 40) over pharyngeal motor cortex. Pharyngeal and thenar motor-evoked potentials were recorded at baseline and for 1 hour post-rTMS. The participants were then classified according to their response. The associations between rTMS response and gender, time of day of the stimulation, and eight prespecified single nucleotide polymorphisms (SNPs) were analyzed. KEY RESULTS There was no direction-specific response to either paradigm (1 Hz: F[3.69, 129.21] = 0.78, P = 0.56; 5 Hz: F[4.08, 146.85] = 1.38, P = 0.25). Only 13% of participants showed the expected bidirectional response (inhibition for 1 Hz and excitation for 5 Hz). Significant associations were found between response and COMT (1 Hz: P = 0.03) and DRD2 (1 Hz: P = 0.02; 5 Hz: P = 0.04) polymorphisms. Carriers of minor allele G from SNP rs6269 (COMT) were more likely to show inhibitory or excitatory outcomes after 1 Hz rTMS. By contrast, carriers of minor allele A from SNP rs1800497 (DRD2) were more likely to show no response to 1 Hz rTMS and inhibition after 5 Hz rTMS. CONCLUSIONS & INFERENCES Two SNPs from COMT and DRD2 genes may partially explain the response variability to rTMS in the pharyngeal motor system. Further research should focus on stratified approaches for neurostimulatory dysphagia treatment using rTMS.
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Affiliation(s)
- Alicja Raginis-Zborowska
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Antony Payton
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester, UK
| | - William Ollier
- School of Health Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Emilia Michou
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK.,Department of Speech and Language Therapy, Western Greece University of Applied Sciences, Patras, Greece
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
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Lee KM, Joo MC, Yu YM, Kim MS. Mylohyoid motor evoked potentials can effectively predict persistent dysphagia 3 months poststroke. Neurogastroenterol Motil 2018. [PMID: 29532576 DOI: 10.1111/nmo.13323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the association between mylohyoid motor-evoked potentials (MH-MEP) and swallowing function and determine the value of MH-MEP for predicting aspiration 3 months poststroke. METHODS Subacute patients within a month of their first stroke were enrolled up for 2 consecutive years. Videofluoroscopic swallowing studies (VFSS) were performed twice. Patients were evaluated during VFSS using the penetration aspiration scale (PAS) and videofluoroscopic dysphagia scale (VDS). MH-MEP was recorded in the mylohyoid muscles. The active electrode was positioned submentally, 2 cm lateral to midline. Magnetic stimulation was performed on the contralateral motor cortex, 2-4 cm anterior and 4-6 cm lateral to the cranial vertex. The resting motor threshold (rMT), latency, and amplitude stimulation at 120% (amp120) and 150% (amp150) of the rMT were assessed. The ratio of each parameter was also estimated. The relationship between MH-MEP and VFSS findings was analyzed. KEY RESULTS Sixty-eight patients completed the study. On VFSS at 3 months poststroke, 24 (35.3%) patients showed aspiration. The rMT, rMT ratio, amp120 and amp120 ratio were significantly correlated with the PAS and VDS (P < .05). The rMT ratio (OR = 1.208, P = .001) and amp120 ratio (OR = 0.821, P = .002) were independent predictors of aspiration at 3 months. The optimal cut-off value of the rMT ratio was 126.1 (AUC = 0.94, sensitivity = 0.92, specificity = 0.89); that of the amp120 ratio was 66.5 (AUC = 0.89, sensitivity = 0.88, specificity = 0.86). CONCLUSIONS AND INFERENCES MH-MEP was well-correlated with dysphagia severity assessed by VFSS. The rMT ratio and amplitude ratio of MH-MEP can effectively predict persistent dysphagia 3 months poststroke.
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Affiliation(s)
- K M Lee
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - M C Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Y M Yu
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - M-S Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
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11
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Tarri M, Brihmat N, Gasq D, Lepage B, Loubinoux I, De Boissezon X, Marque P, Castel-Lacanal E. Five-day course of paired associative stimulation fails to improve motor function in stroke patients. Ann Phys Rehabil Med 2018; 61:78-84. [DOI: 10.1016/j.rehab.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
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12
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Carrión S, Costa A, Ortega O, Verin E, Clavé P, Laviano A. Complications of Oropharyngeal Dysphagia: Malnutrition and Aspiration Pneumonia. Dysphagia 2018. [DOI: 10.1007/174_2017_168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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13
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Direct and Indirect Therapy: Neurostimulation for the Treatment of Dysphagia After Stroke. Dysphagia 2018. [DOI: 10.1007/174_2017_147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Lin WS, Chou CL, Chang MH, Chung YM, Lin FG, Tsai PY. Vagus nerve magnetic modulation facilitates dysphagia recovery in patients with stroke involving the brainstem - A proof of concept study. Brain Stimul 2017; 11:264-270. [PMID: 29162502 DOI: 10.1016/j.brs.2017.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND & AIMS Stroke involving the brainstem (SBS) causes severe oropharyngeal dysphagia (OD). Research on the therapeutic efficacy of vagus nerve modulation (VNM) by using repetitive transcranial magnetic stimulation (rTMS) in SBS patients with OD has been limited thus far. We aimed to assess the effect of VNM by using rTMS in improving swallowing function after SBS. METHOD We conducted a sham-controlled, double-blinded, parallel pilot study in 28 SBS patients with OD randomly allocated to a real rTMS group (n = 13; TMSreal) or a sham group (n = 15; TMSsham). For VNM, 5-Hz rTMS was applied to the left mastoid in 10 sessions. We evaluated all patients for swallowing function before and after rTMS conditioning, assessed on the 8-point Penetration-Aspiration Scale (PAS) through videofluoroscopy and the Australian Therapy Outcome Measures-Swallowing scale (AusTOMs). We measured the amplitude and latency of cricopharyngeal motor evoked potentials (CP-MEPs) as the neurophysiological parameters. RESULTS TMSreal exhibited significant improvement in all swallowing outcomes-neurophysiological, radiological, and functional-compared with TMSsham: We noted higher CP-MEP amplitude (p = 0.004), shorter CP-MEP latency (p = 0.004), a lower PAS score (p = 0.001), and a higher AusTOMs score (p < 0.001) following rTMS in TMSreal. Moreover, the neurophysiological improvements were significantly correlated with the functional outcomes (p < 0.05). CONCLUSIONS Our results encourage the application of VNM by using rTMS for improving swallowing function after SBS. The immediate therapeutic effects suggest that this novel intervention can be an effective complementary therapy to traditional oropharyngeal rehabilitation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02893033.
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Affiliation(s)
- Wang-Sheng Lin
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Miao-Hsiang Chang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Mei Chung
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Gong Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
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15
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Application of noninvasive brain stimulation for post-stroke dysphagia rehabilitation. Kaohsiung J Med Sci 2017; 33:55-61. [DOI: 10.1016/j.kjms.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/20/2016] [Accepted: 11/09/2016] [Indexed: 11/15/2022] Open
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16
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Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016. [PMID: 27785002 DOI: 10.2147/cia.s107750.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura Wj Baijens
- Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King's College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11:1403-1428. [PMID: 27785002 PMCID: PMC5063605 DOI: 10.2147/cia.s107750] [Citation(s) in RCA: 383] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura WJ Baijens
- Department of Otorhinolaryngology – Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King’s College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Cabib C, Ortega O, Kumru H, Palomeras E, Vilardell N, Alvarez-Berdugo D, Muriana D, Rofes L, Terré R, Mearin F, Clavé P. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function. Ann N Y Acad Sci 2016; 1380:121-138. [DOI: 10.1111/nyas.13135] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/11/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher Cabib
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Hatice Kumru
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
| | - Ernest Palomeras
- Neurology Department, Hospital de Mataró; Universitat Autònoma de Barcelona; Mataró Spain
| | - Natalia Vilardell
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
| | - Daniel Alvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Desirée Muriana
- Neurology Department, Hospital de Mataró; Universitat Autònoma de Barcelona; Mataró Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Rosa Terré
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
| | - Fermín Mearin
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
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19
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Calabrò RS, Nibali VC, Naro A, Floridia D, Pizzimenti M, Salmeri L, Salviera C, Bramanti P. Is non-invasive neuromuscular electrical stimulation effective in severe chronic neurogenic dysphagia? Reporton a post-traumatic brain injury patient. NeuroRehabilitation 2016; 38:53-7. [DOI: 10.3233/nre-151295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Antonino Naro
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina, Messina, Italy
| | | | | | - Lucia Salmeri
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina, Messina, Italy
| | - Carlo Salviera
- Department of Otorinolaringoiatry, University of Messina, Messina, Italy
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20
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Castel-Lacanal E. Sites of electrical stimulation used in neurology. Ann Phys Rehabil Med 2015; 58:201-207. [PMID: 26183200 DOI: 10.1016/j.rehab.2015.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
Rehabilitation aims to decrease neurological impairments, in guiding plasticity. Electrical stimulation has been used for many years in rehabilitation treatment of neurological disabilities as a tool for neuromodulation inducing plasticity, although the mechanisms of its action are not well known. The applications vary, encompassing therapeutic and rehabilitative aims. The type and site of stimulation vary depending on the objectives. Some techniques are widely used in clinical practice; others are still in the research stage. They may be invasive, epidural or in direct contact with neurons; they may be noninvasive, applied transcutaneously or indirectly by current vectors. The indications vary: mobility, functionality, pain as well as pharyngeal, respiratory, and perineal function. This paper aims to summarize current data on electrical neuromodulation techniques used in neurorehabilitation, their effects and their mechanisms of action.
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Affiliation(s)
- E Castel-Lacanal
- Inserm U 825, CHU Purpan, Pavillon Baudot, place du Dr-Baylac, 31024 Toulouse cedex 3, France; Service de Médecine Physique et Réadaptation, CHU Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
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Michou E, Williams S, Vidyasagar R, Downey D, Mistry S, Edden RAE, Hamdy S. fMRI and MRS measures of neuroplasticity in the pharyngeal motor cortex. Neuroimage 2015; 117:1-10. [PMID: 25976926 DOI: 10.1016/j.neuroimage.2015.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Paired associative stimulation (PAS), is a novel non-invasive technique where two neural substrates are employed in a temporally coordinated manner in order to modulate cortico-motor excitability within the motor cortex (M1). In swallowing, combined pharyngeal electrical and transcranial-magnetic-stimulation induced beneficial neurophysiological and behavioural effects in healthy subjects and dysphagic stroke patients. Here, we aimed to investigate the whole-brain changes in neural activation during swallowing using functional magnetic resonance imaging (fMRI) following PAS application and in parallel assess associated GABA changes with magnetic resonance spectroscopy (MRS). METHODS Healthy adults (n=11, 38±9years old) were randomised to receive real and sham PAS to the 'stronger' motor cortex pharyngeal representation, on 2 separate visits. Following PAS, event-related fMRI was performed to assess changes in brain activation in response to water and saliva swallowing and during rest. Data were analysed (SPM8) at P<.001. MRS data were acquired using MEGA-PRESS before and after the fMRI acquisitions on both visits and GABA concentrations were measured (AMARES, jMRUI). RESULTS Following real PAS, BOLD signal changes (group analyses) increased at the site of stimulation during water and saliva swallowing, compared to sham PAS. It is also evident that PAS induced significant increases in BOLD signal to contralateral (to stimulation) hemispheric areas that are of importance to the swallowing neural network. Following real PAS, GABA:creatine ratio showed a trend to increase contralateral to PAS. CONCLUSION Targeted PAS applied to the human pharyngeal motor cortex induces local and remote changes in both primary and non-primary areas for water and saliva tasks. There is a possibility that changes of the inhibitory neurotransmitter, GABA, may play a role in the changes in BOLD signal. These findings provide evidence for the mechanisms underlying the beneficial effects of PAS on the brain swallowing network.
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Affiliation(s)
- Emilia Michou
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital (part of the Manchester Academic Health Sciences Centre (MAHSC)), Eccles Old Road, Salford M6 8HD, UK.
| | - Steve Williams
- Centre for Imaging Science, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, M13 9PT, UK
| | - Rishma Vidyasagar
- Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Melbourne, Victoria, Australia; Department of Anatomy and Neuroscience, Melbourne University, Melbourne, Victoria, Australia
| | - Darragh Downey
- Neuroscience and Psychiatry Unit, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, M13 9PT, UK
| | - Satish Mistry
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital (part of the Manchester Academic Health Sciences Centre (MAHSC)), Eccles Old Road, Salford M6 8HD, UK
| | - Richard A E Edden
- FM Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital (part of the Manchester Academic Health Sciences Centre (MAHSC)), Eccles Old Road, Salford M6 8HD, UK
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Doeltgen SH, Bradnam LV, Young JA, Fong E. Transcranial non-invasive brain stimulation in swallowing rehabilitation following stroke — A review of the literature. Physiol Behav 2015; 143:1-9. [DOI: 10.1016/j.physbeh.2015.02.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 02/11/2015] [Accepted: 02/16/2015] [Indexed: 01/20/2023]
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23
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Macrae PR, Jones RD, Huckabee ML. The effect of swallowing treatments on corticobulbar excitability: a review of transcranial magnetic stimulation induced motor evoked potentials. J Neurosci Methods 2014; 233:89-98. [PMID: 24932964 DOI: 10.1016/j.jneumeth.2014.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 06/07/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
Transcranial magnetic stimulation (TMS) has been used extensively as a method of investigating the corticomotor physiology of many motor tasks, including healthy and disordered swallowing. Changes in excitability of cortical projections to various swallowing muscles have been documented in response to treatments with TMS induced motor evoked potentials (MEPs). These studies have provided valuable insight into CNS response to swallowing impairment, and more importantly, the adaptations associated with functional recovery. However, unique obstacles are presented when investigating corticobulbar neurophysiology associated with the complex task of swallowing. Stringent methodological control and supplementary outcome measures are required to ensure robust and clinically applicable findings. This article offers a tutorial for the researcher who may be considering the use of TMS for investigating changes in cortical excitability associated with various swallowing paradigms. Included is a review of the mechanisms of TMS and what can be measured with this technique, a summary of existing research using MEPs to investigate swallowing, a review of methodological factors that may influence outcomes, and proposed directions for new areas of research.
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Affiliation(s)
- Phoebe R Macrae
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
| | - Richard D Jones
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand; Department of Medicine, University of Otago, Private Bag 4710, Christchurch, New Zealand; Department of Medical Physics and Bioengineering, Canterbury District Health Board, Private Bag 4710, Christchurch, New Zealand.
| | - Maggie-Lee Huckabee
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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Sowman PF, Dueholm SS, Rasmussen JH, Mrachacz-Kersting N. Induction of plasticity in the human motor cortex by pairing an auditory stimulus with TMS. Front Hum Neurosci 2014; 8:398. [PMID: 24917810 PMCID: PMC4042887 DOI: 10.3389/fnhum.2014.00398] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/18/2014] [Indexed: 11/13/2022] Open
Abstract
Acoustic stimuli can cause a transient increase in the excitability of the motor cortex. The current study leverages this phenomenon to develop a method for testing the integrity of auditorimotor integration and the capacity for auditorimotor plasticity. We demonstrate that appropriately timed transcranial magnetic stimulation (TMS) of the hand area, paired with auditorily mediated excitation of the motor cortex, induces an enhancement of motor cortex excitability that lasts beyond the time of stimulation. This result demonstrates for the first time that paired associative stimulation (PAS)-induced plasticity within the motor cortex is applicable with auditory stimuli. We propose that the method developed here might provide a useful tool for future studies that measure auditory-motor connectivity in communication disorders.
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Affiliation(s)
- Paul F Sowman
- Department of Cognitive Science, Macquarie University Sydney, NSW, Australia ; Perception and Action Research Centre (PARC), Faculty of Human Sciences, Macquarie University Sydney, NSW, Australia ; Australian Research Council Centre of Excellence in Cognition and its Disorders (CCD), Macquarie University Sydney, NSW, Australia
| | - Søren S Dueholm
- Department of Cognitive Science, Macquarie University Sydney, NSW, Australia ; Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Aalborg University Aalborg, Denmark
| | - Jesper H Rasmussen
- Department of Cognitive Science, Macquarie University Sydney, NSW, Australia ; Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Aalborg University Aalborg, Denmark
| | - Natalie Mrachacz-Kersting
- Department of Health Science and Technology, Center for Sensory-Motor Interaction (SMI), Aalborg University Aalborg, Denmark
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Abstract
SummaryDysphagia represents a salient concern in many conditions prevalent in older people. There are direct implications for morbidity and mortality. The importance of recognizing and managing dysphagia in hospital and the community also extends to psychosocial impact and quality of life, as well as health, economic and ethical-legal issues. This review outlines reasons for the importance of recognizing and treating dysphagia. It then proceeds to look at recent developments in our understanding of the nature, assessment and management of dysphagia in older people. Whilst there are well-established practices in assessment and management, ongoing work continues to challenge the validity and reliability of many methods. These concerns are covered and directions for future developments highlighted.
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Neurostimulation as an Approach to Dysphagia Rehabilitation: Current Evidence. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0034-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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