单双侧经颅直流电刺激对卒中后吞咽障碍的效果比较

doi:10.3969/j.issn.1006-9771.2025.09.001

Abstract

Abstract:

Objective To investigate the effect of unilateral or bilateral transcranial direct current stimulation (tDCS) on post-stroke dysphagia.

Methods From February, 2023 to March, 2025, 27 stroke patients with dysphagia and nasal feeding in Beijing Bo'ai Hospital were randomly divided into healthy side stimulation group, bilateral stimulation group and sham stimulation group, with nine cases in each group. All the groups received conventional swallowing training and tDCS, while the healthy side stimulation group stimulated on the healthy side of oropharyngeal cortex; and the bilateral stimulation group alternatively stimulated bilateral oropharyngeal cortex, with one hour interval between bilateral stimulation; the sham stimulation group stimulated the healthy side of oropharyngeal cortex for 30 seconds and then stop. The course lasted two weeks. The scores of Standard Swallowing Function Assessment Scale (SSA), Modified Mann Assessment of Swallowing Ability (MMASA) and Rosenbek Penetration-Aspiration Scale (PAS) were compared before and after treatment.

Results The intra-group effect (F= 16.185, P< 0.01) was significant in the scores of SSA, the intra-group effect (F = 28.650, P< 0.01) and interaction effect (F = 3.453, P< 0.01) were significant in the scores of MMASA, and there was no significant difference in the inter-group effect, intra-group effect and interaction effect in the scores of PAS (P> 0.05). Post hoc test showed that there was no significant difference in the scores of SSA, MMASA and PAS among three groups (P> 0.05). There was significant difference in the score difference of MMASA before and after treatment among three groups (F = 4.698, P< 0.05). Post hoc test showed that the score difference of MMAS was more in the healthy side stimulation group than in the bilateral stimulation group and the sham stimulation group (P< 0.05), with no significant difference between the bilateral stimulation group and the sham stimulation group (P> 0.05).

Conclusion tDCS can partly improve post-stroke dysphagia. The healthy side anode stimulation is superior to the alternating bilateral hemisphere anode stimulation.

Key words: post-stroke dysphagia, transcranial direct current stimulation, site

CLC Number:

R743.3

GAO Fei, LIU Lixu, HU Xueyan, WU Xiaoli, YANG Lingyu, YANG Yuqi, YE Changqing, DU Xiaoxia. Effect of unilateral or bilateral transcranial direct current stimulation on post-stroke dysphagia[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 993-999.

Figures/Tables 6

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

References 33

[1]	ARNOLD M, LIESIROVA K, BROEG-MORVAY A, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome[J]. PLoS One, 2016, 11(2): e0148424.
[2]	中国吞咽障碍康复评估与治疗专家共识组. 中国吞咽障碍评估与治疗专家共识(2017年版)第二部分治疗与康复管理篇[J]. 中华物理医学与康复杂志, 2018, 40(1): 1-10.
[3]	张建国, 解虎涛, 杨岸超. 神经调控技术临床应用进展与展望[J]. 中国现代神经疾病杂志, 2025, 25(1): 1-10. doi: 10.3969/j.issn.1672-6731.2025.01.001
	ZHANG J G, XIE H T, YANG A C. Neuromodulation:clinical advances and future perspectives[J]. Chin J Contemp Neurol Neurosurg, 2025, 25(1): 1-10.
[4]	PISEGNA J M, KANEOKA A, PEARSON W G, et al. Effects of noninvasive brain stimulation on post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials[J]. Clin Neurophysiol, 2016, 127(1): 956-968.
[5]	中国经颅直流电刺激脑卒中康复临床应用专家共识组. 经颅直流电刺激技术应用于脑卒中患者康复治疗的专家共识[J]. 中华物理医学与康复杂志, 2021, 43(4): 289-294.
[6]	XIE J, ZHOU C, NGARUWENAYO G, et al. Dosage consideration for transcranial direct current stimulation in post-stroke dysphagia: a systematic review and network meta-analysis[J]. Front Neurol, 2023, 14: 1098831.
[7]	ZHAO N, SUN W, XIAO Z, et al. Effects of transcranial direct current stimulation on poststroke dysphagia: a systematic review and meta-analysis of randomized controlled trials[J]. Arch Phys Med Rehabil, 2022, 103(7): 1436-1447.
[8]	杜锦超, 张承栋, 雷俊芳, 等. 经颅直流电刺激的不同刺激方式对脑卒中后吞咽障碍治疗效果的网状Meta分析[J]. 中国康复医学杂志, 2024, 39(4): 558-564.
[9]	中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic criteria of cerebrovascular diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[10]	HARRISON J E, WEBER S, JAKOB R, et al. ICD-11: an international classification of diseases for the twenty-first century[J]. BMC Med Inform Decis Mak, 2021, 21(Suppl 6): 206.
[11]	中国康复医学会吞咽障碍康复专业委员会. 中国吞咽障碍康复管理指南(2023版)[J]. 中华物理医学与康复杂志, 2023, 45(12): 1057-1072.
[12]	李小霞, 欧阳蕴盈, 余婷, 等. 经颅直流电刺激治疗脑干卒中后吞咽障碍的疗效观察[J]. 中国康复, 2020, 35(12): 625-628.
	LI X X, OUYANG Y Y, YU T, et al. Effectiveness of transcranial direct current stimulation for dysphagia after brainstem stroke[J]. Chin J Rehablil, 2020, 35(12): 625-628
[13]	何欢, 樊红, 王甜甜, 等. 经颅直流电刺激治疗卒中后吞咽障碍的疗效研究[J]. 中国康复, 2018, 33(1): 45-47.
[14]	唐睿, 宋洪文, 孔卓, 等. 经颅直流电刺激治疗常见神经精神疾病的临床应用专家共识[J]. 中华精神科杂志, 2022, 55(5): 327-382.
	TANG R, SONG H W, KONG Z, et al. Chinese experts consensus on clinical application of transcranial direct current stimulation in the treatment of common neurological diseases and mental disorders[J]. Chin J Psychol, 2022, 55(5): 327-382.
[15]	李安, 夏艳秋, 傅建玲, 等. 经颅直流电刺激在卒中后吞咽障碍康复治疗中的应用研究进展[J]. 中国卒中杂志, 2021, 16(8): 855-860.
	LI A, XIA Y Q, FU J L, et al. Progress of transcranial direct current stimulation in rehabilitation of post-stroke dysphagia[J]. Chin J Stroke, 2021, 16(8): 855-860.
[16]	袁英, 汪洁, 黄小波, 等. 吞咽功能的中枢及周围神经调控机制[J]. 中国康复医学杂志, 2018, 33(12): 1479-1482.
[17]	CABIB C, ORTEGA O, KUMRU H, et al. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function[J]. Ann N Y Acad Sci, 2016, 1380(1): 121-138.
[18]	TEISMANN I K, DZIEWAS R, STEINSTRAETER O, et al. Time-dependent hemispheric shift of the cortical control of volitional swallowing[J]. Hum Brain Mapp, 2009, 30(1): 92-100. doi: 10.1002/hbm.20488 pmid: 17979116
[19]	陈柱, 陆瑶, 陈宜懿. 神经调控技术在吞咽障碍康复中的应用进展[J]. 中国康复理论与实践, 2020, 26(11): 1287-1291. doi: 10.3969/j.issn.1006-9771.2020.11.007
	CHEN Z, LU Y, CHEN Y Y. Application of neuromodulation in rehabilitation for dysphagia (review)[J]. Chin J Rehabil Theory Pract, 2020, 26(11): 1287-1291.
[20]	HAMDY S, AZIZ Q, ROTHWELL J C, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex[J]. Gastroenterology, 1998, 115(5): 1104-1112. doi: 10.1016/s0016-5085(98)70081-2 pmid: 9797365
[21]	MICHOU E, MISTRY S, JEFFERSON S, et al. Characterizing the mechanisms of central and peripheral forms of neurostimulation in chronic dysphagic stroke patients[J]. Brain Stimul, 2014, 7(1): 66-73. doi: 10.1016/j.brs.2013.09.005 pmid: 24314909
[22]	KUMAR S, WAGNER C W, FRAYNE C, et al. Noninvasive brain stimulation may improve stroke-related dysphagia: a pilot study[J]. Stroke, 2011, 42(4): 1035-1040. doi: 10.1161/STROKEAHA.110.602128 pmid: 21441148
[23]	SUNTRUP-KRUEGER S, RINGMAIER C, MUHLE P, et al. Randomized trial of transcranial direct current stimulation for poststroke dysphagia[J]. Ann Neurol, 2018, 83(2): 328-340.
[24]	CHENG I, SASEGBON A, HAMDY S. Effects of neurostimulation on poststroke dysphagia: a synthesis of current evidence from randomized controlled trials[J]. Neuromodulation, 2021, 24(8): 1388-1401.
[25]	陈亮, 陈洁, 张茹芳, 等. 经颅直流电刺激治疗卒中后吞咽困难的系统评价[J]. 中国康复理论与实践, 2018, 24(6): 726-733. doi: 10.3969/j.issn.1006-9771.2018.06.019
	CHEN L, CHEN J, ZHANG R F, et al. Effect of transcranial direct current stimulation on post-stroke dysphagia: a systematic review[J]. Chin J Rehabil Theory Pract, 2018, 24(6): 726-733.
[26]	YANG S N, PYUN S B, KIM H J, et al. Effectiveness of noninvasive brain stimulation in dysphagia subsequent to stroke: a systemic review and meta-analysis[J]. Dysphagia, 2015, 30(4): 383-391.
[27]	LIN Q, LIN S F, KE X H, et al. A systematic review and meta-analysis on the effectiveness of transcranial direct current stimulation (tDCS) on swallowing function of post-stroke patients[J]. Am J Phys Med Rehabil, 2022, 101(5): 446-453.
[28]	NITSCHE M A, PAULUS W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation[J]. J Physiol, 2000, 527(Pt 3): 633-639.
[29]	杜宇鹏, 李晓东, 刘文兵, 等. 不同强度的经颅直流电刺激对脑梗死后吞咽障碍患者的疗效比较[J]. 中国康复理论与实践, 2020, 26(5): 583-587. doi: 10.3969/j.issn.1006-9771.2020.05.018
	DU Y P, LI X D, LIU W B, et al. Intensities of transcranial direct current stimulation for dysphagia after cerebral infarction[J]. Chin J Rehabil Theory Pract, 2020, 26(5): 583-587.
[30]	MARCHINA S, PISEGNA J M, MASSARO J M, et al. Transcranial direct current stimulation for post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials[J]. J Neurol, 2021, 268(1): 293-304.
[31]	陈晓荣, 颜流霞, 厚磊, 等. 2015-2019年中国居民脑卒中发病与死亡特征分析[J]. 中国循环杂志, 2024, 39(5): 470-476.
	CHEN X R, YAN L X, HOU L, et al. Trends of stroke incidence and mortality from 2015 to 2019 in China[J]. Chin J Circul, 2024, 39(5): 470-476.
[32]	曹猛, 宋学梅, 梁丽, 等. 急性缺血性脑卒中后吞咽障碍发病率及影响因素分析[J]. 护理学杂志, 2021, 36(2): 24-27.
	CAO M, SONG X M, LIANG L, et al. Prevalence and risk factors of dysphagia among acute ischemic stroke patients[J]. J Nurs Sci, 2021, 36(2): 24-27.
[33]	李玲, 董旭, 吴晔, 等. 脑卒中后咽期吞咽障碍的相关危险因素研究[J]. 中华物理医学与康复杂志, 2023, 45(12): 1088-1093.
	LI L, DONG X, WU Y, et al. The risk factors for pharyngeal dysphagia after a stroke[J]. Chin J Phys Med Rehabil, 2023, 45(12): 1088-1093.

组别	n	性别(男/女)/n	年龄/岁	病灶(半球/脑干小脑)/n	病程/月
健侧刺激组	9	8/1	59.78±10.45	4/5	3.17±1.71
双侧刺激组	9	9/0	53.56±5.79	6/3	3.11±1.76
假刺激组	9	7/2	63.11±9.13	4/5	3.67±1.48
F/t值		2.059	2.809	2.036	0.307
P值		0.751	0.080	0.501	0.739

变量	组别	n	治疗前		治疗后
变量	组别	n	均值	标准差	均值	标准差
SSA	健侧刺激组	9	25.63	5.63	31.88	8.84
	双侧刺激组	9	28.75	6.94	36.88	11.00
	假刺激组	8	25.00	4.63	31.25	8.35
MMASA	健侧刺激组	9	63.38	17.20	76.88	17.97
	双侧刺激组	9	76.13	12.37	79.88	13.60
	假刺激组	8	72.00	18.88	77.75	18.69
PAS	健侧刺激组	9	4.63	2.93	3.88	3.23
	双侧刺激组	9	5.75	2.12	4.38	2.39
	假刺激组	8	4.75	3.37	4.25	2.87

变量		平方和	自由度	均方	F值	P值
SSA	组内	567.188	1	567.188	16.185	0.005
	组间	207.292	2	103.646	1.890	0.188
	组内×组间	9.375	2	4.688	0.127	0.882
MMASA	组内	705.333	1	705.333	28.650	0.001
	组间	503.167	2	251.583	0.558	0.585
	组内×组间	212.167	2	181.872	3.453	0.006
PAS	组内	9.188	1	9.188	4.200	0.080
	组间	5.542	2	2.771	0.161	0.853
	组内×组间	1.625	2	0.813	0.532	0.599

变量	组别	组别	平均值差	P值	95%CI
变量	组别	组别	平均值差	P值	上限	下限
SSA	健侧刺激组	双侧刺激组	-6.111	0.172	-15.07	2.85
	健侧刺激组	假刺激组	0.417	0.926	-8.82	9.66
	双侧刺激组	假刺激组	6.528	0.157	-2.71	15.77
MMASA	健侧刺激组	双侧刺激组	-4.667	0.556	-20.81	11.48
	健侧刺激组	假刺激组	-0.528	0.948	-17.17	16.11
	双侧刺激组	假刺激组	4.139	0.612	-12.50	20.78

变量	组别	n	治疗前后差值	平方和	自由度	均方	F值	P值
SSA	健侧刺激组	9	6.67±5.59	35.150	2	17.575	0.256	0.776
	双侧刺激组	9	8.89±11.40
	假刺激组	8	6.25±6.41
MMASA	健侧刺激组	9	13.56±7.44	474.287	2	237.144	4.698	0.019
	双侧刺激组	9	3.67±3.16
	假刺激组	8	6.13±9.55
PAS	健侧刺激组	9	0.67±1.66	2.483	2	1.241	0.378	0.689
	双侧刺激组	9	1.22±1.79
	假刺激组	8	0.50±2.00

Effect of unilateral or bilateral transcranial direct current stimulation on post-stroke dysphagia

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 33

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LI Hongwei, HUANG Binbin, ZHU Chuanhua, LI Wei. Effect of transcranial direct current stimulation on α-band brain connectivity in disorders of consciousness [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1050-1056.
[2]	NIU Maolin, ZHAO Tan, LIU Xiaoli, GUO Feng. Effect of online and offline high definition transcranial direct current stimulation on finger motor skill learning in healthy adults: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 957-964.
[3]	YANG Bin, LIU Mingyue, GAO Dan, LI Zhe. Application of transcranial direct current stimulation in stroke rehabilitation: a bibliometrics analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(6): 675-685.
[4]	WANG Mingchen, ZHANG Wenyu, ZHANG Xianzuo, ZANG Wanli. Effect of transcranial direct current stimulation on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 183-188.
[5]	GAO Ling, CHU Fengming, JIA Fan, CHEN Jie, ZHANG Ming. Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 202-209.
[6]	XU Fangyuan, HU Peijia, YE Yu, DAI Fan, CHENG Hongliang. Effect of acupuncture and moxibustion on post-stroke dysphagia from 1994 to 2023: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(11): 1299-1310.
[7]	CAI Siyan, FAN Yingjie, TIAN Huifang, XIA Chunya, ZHANG Juan, SU Min. Effect of transcranial direct current stimulation based on music therapy on insomnia: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1193-1202.
[8]	ZHOU Zhining, ZHOU Rong, XIAO Yanwen, WANG Bowen, LÜ Jiaojiao, LIU Yu. Effect of multi-target transcranial direct current stimulation on performance of working memory-postural control dual-task in healthy adults [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 21-28.
[9]	WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.
[10]	LI Fang, HUO Su, DU Jubao, LIU Xiuzhen, LI Xiaoshuang, SONG Weiqun. Effect of transcranial direct current stimulation combined with task-oriented rehabilitation training on forelimb motor dysfunction in rats with spinal cord injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 777-781.
[11]	CAI Qian, XU Liang, YANG Xi, LIU Jin, MA Ming. Effect of anodal or cathodal transcranial direct current stimulation on upper limb function of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 521-526.
[12]	CHEN Tiantian, XU Dongping, SUN Fengbao, LAI Junmei, ZENG Duchun. Effect of transcranial direct current stimulation combined with contralateral control functional electrical stimulation on upper limb function of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 527-532.
[13]	WANG Haibo, TAO Yuanyuan, LI Jing, SUN Jianjun, XIE Tianpei, QIU Hao, FAN Yingjie, LI Jianjun, SU Min. Effect of transcranial direct current stimulation combined with constraint-induced weight training of the affected lower limb on Pusher syndrome after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 269-274.
[14]	PANG Zhengzheng, LÜ Yaxi, GAO Chunhua, YU Liguo, ZHANG Huan. Effect of transcranial direct current stimulation on upper limb motor function of patients with stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 275-279.
[15]	ZENG Yaqin, CHENG Ruidong, ZHANG Li, FANG Shan, DAI Yunlan, LÜ Qian, GONG Xinyi, YE Xiangming. Effect of high-definition transcranial direct current stimulation combined with rehabilitation robot on upper limb and hand function in patients with subacute stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1327-1332.