经颅直流电刺激调节迷走神经兴奋性对脑卒中后吞咽障碍的效果

doi:10.3969/j.issn.1006-9771.2021.09.012

Abstract

Abstract:

Objective To study the effect of transcranial direct current stimulation (tDCS) regulating excitability of the vagus nerve on dysphagia after stroke.Methods From September, 2020 to February, 2021, 28 patients with dysphagia after stroke were randomly divided into control group (n = 14) and tDCS group (n = 14). Both groups accepted swallowing function training, and tDCS group received anodal tDCS over vagus nerve, while the control group received sham tDCS. They were assessed with modified Mann Assessment of Swallowing Ability (MMASA) and Australian Therapy Outcome Measures (AusTOMs)-swallowing scale before and after treatment.Results The scores of MMASA (|t| > 5.593, P < 0.001) and AusTOMs swallowing scale (|Z| > 2.121, P < 0.05) increased in both groups after treatment, and were higher in tDCS group than in the control group (|t| = 2.439, |Z| = 2.079, P < 0.05).Conclusion Anodal tDCS over vagus nerve may further release dysphagia after stroke.

Key words: stroke, dysphagia, transcranial direct current stimulation, vagus nerve

CHEN Jia-jun,WU Deng-chong,SHAO Xiang-zhi,PU Xin-yu,MAO Yan-wu,CHEN Bing. Effects of Transcranial Direct Current Stimulation over Vagus Nerve on Dysphagia after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(9): 1078-1081.

Figures/Tables 3

References 25

[1]	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)[J]. 中华物理医学与康复杂志, 2017, 39(12):881-889.
	Expert Group for Rehabilitation Assessment and Treatment of Dysphagia in China Consensus on Assessment and Treatment of Dysphagia in China (2017)[J]. Chin J Phys Rehabil, 2017, 39(12):881-889.
[2]	YANG S N, PYUN S B, KIM H J, et al. Effectiveness of non-invasive brain stimulation in dysphagia subsequent to stroke: a systemic review and meta-analysis[J]. Dysphagia, 2015, 30(4):383-391. doi: 10.1007/s00455-015-9619-0
[3]	窦祖林. 吞咽障碍评估与治疗[M]. 北京: 人民卫生出版社, 2018.
	DOU Z L. Evaluation and Treatment of Swallowing Disorders [M]. Beijing: People's Health Publishing House, 2018.
[4]	MURRAY J, SCHOLTEN I, DOELTGEN S. Factors contributing to hydration, fluid intake and health status of inpatients with and without dysphagia post stroke[J]. Dysphagia, 2018, 33(5):670-683. doi: 10.1007/s00455-018-9886-7
[5]	朱琪, 杜宇鹏, 徐守宇. 经颅直流电刺激对脑卒中后吞咽障碍恢复的研究进展[J]. 中国康复理论与实践, 2016, 22(1):58-60.
	ZHU Q, DU Y P, XU S Y. Advance of transcranianl direct current stimulation for dysphagia after stroke[J]. Chin J Rehabil Theory Pract, 2016, 22(1):58-60.
[6]	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. doi: 10.1007/s00415-020-10142-9
[7]	段国平, 张旭, 汪洁, 等. 经颅直流电刺激在神经系统疾病康复中的应用现状[J]. 中国康复医学杂志, 2019, 34(9):1106-1111.
	DUAN G P, ZHANG X, WANG J, et al. Application status of transcranial direct current stimulation in rehabilitation of nervous system diseases[J]. Chin J Rehabil Med, 2019, 34(9):1106-1111.
[8]	ANTONIOS N, CARNABY-MANN G, CRARY M, et al. Analysis of a physician tool for evaluating dysphagia on an inpatient stroke unit: the modified Mann Assessment of Swallowing Ability[J]. J Stroke Cerebrovasc Dis, 2010, 19(1):49-57. doi: 10.1016/j.jstrokecerebrovasdis.2009.03.007
[9]	SKEAT J, PERRY A. Outcome measurement in dysphagia: not so hard to swallow[J]. Dysphagia, 2005, 20(2):113-122. doi: 10.1007/s00455-004-0028-z
[10]	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.
	YUAN Y, WANG J, HUANG X B, et al. Central and peripheral nerve regulation mechanism of swallowing function[J]. Chin J Rehabil Med, 2018, 33(12):1479-1482.
[11]	WILMSKOETTER J, DANIELS S K, MILLER A J. Cortical and subcortical control of swallowing: Can we use information from lesion locations to improve diagnosis and treatment for patients with stroke?[J]. Am J Speech Lang Pathol, 2020, 29(2s):1030-1043. doi: 10.1044/2019_AJSLP-19-00068
[12]	KUMAI Y, SAMEJIMA Y, YUMOTO E. Postdeglutitive residue in vagus nerve paralysis and its association with feeding style[J]. Eur Arch Otorhinolaryngol, 2016, 273(12):4369-4375. doi: 10.1007/s00405-016-4182-3
[13]	CAI P Y, BODHIT A, DEREQUITO R, et al. Vagus nerve stimulation in ischemic stroke: old wine in a new bottle[J]. Front Neurol, 2014, 5:107.
[14]	JONES C A, COLLETTI C M, DING M C. Post-stroke dysphagia: recent insights and unanswered questions[J]. Curr Neurol Neurosci Rep, 2020, 20(12):61. doi: 10.1007/s11910-020-01081-z
[15]	PISEGNA J M, KANEOKA A, PEARSON W G, et al. Effects of non-invasive brain stimulation on post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials[J]. Clin Neurophysiol, 2016, 127(1):956-968. doi: 10.1016/j.clinph.2015.04.069
[16]	AHN Y H, SOHN H J, PARK J S, et al. Effect of bihemispheric anodal transcranial direct current stimulation for dysphagia in chronic stroke patients: a randomized clinical trial[J]. J Rehabil Med, 2017, 49(1):30-35. doi: 10.2340/16501977-2170
[17]	LI Y, FENG H, LI J, et al. The effect of transcranial direct current stimulation of pharyngeal motor cortex on swallowing function in patients with chronic dysphagia after stroke: a retrospective cohort study[J]. Medicine (Baltimore), 2020, 99(10):e19121. doi: 10.1097/MD.0000000000019121
[18]	袁英, 汪洁, 吴东宇, 等. 经颅直流电刺激改善卒中后共济失调型吞咽障碍的疗效观察[J]. 中国康复医学杂志, 2015, 30(8):765-770.
	YUAN Y, WANG J, WU D Y, et al. Effects of transcranial direct current stimulation on ataxic dysphagia after stroke[J]. Chin J Rehabil Med, 2015, 30(8):765-770.
[19]	LIN W S, CHOU C L, CHANG M H, et al. Vagus nerve magnetic modulation facilitates dysphagia recovery in patients with stroke involving the brainstem: a proof of concept study[J]. Brain Stimul, 2018, 11(2):264-270. doi: 10.1016/j.brs.2017.10.021
[20]	TREVIZOL A, BARROS M D, LIQUIDATO B, et al. Vagus nerve stimulation in neuropsychiatry: targeting anatomy-based stimulation sites[J]. Epilepsy Behav, 2015, 51:18. doi: 10.1016/j.yebeh.2015.07.009
[21]	DAWSON J, PIERCE D, DIXIT A, et al. Safety, feasibility, and efficacy of vagus nerve stimulation paired with upper-limb rehabilitation after ischemic stroke[J]. Stroke, 2016, 47(1):143-150. doi: 10.1161/STROKEAHA.115.010477
[22]	BRANSCHEIDT M, HOPPE J, FREUNDLIEB N, et al. tDCS over the motor cortex shows differential effects on action and object words in associative word learning in healthy aging[J]. Front Aging Neurosci, 2017, 9:137. doi: 10.3389/fnagi.2017.00137
[23]	ZHAO H, QIAO L, FAN D, et al. Modulation of brain activity with noninvasive transcranial direct current stimulation (tDCS): clinical applications and safety concerns[J]. Front Psychol, 2017, 8:685. doi: 10.3389/fpsyg.2017.00685
[24]	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.
	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.
[25]	GODINHO M M, JUNQUEIRA D R, CASTRO M L, et al. Safety of transcranial direct current stimulation: Evidence based update 2016[J]. Brain Stimul, 2017, 10(5):983-985. doi: 10.1016/j.brs.2017.07.001

组别	n	性别(男/女, n)	年龄(岁)	病程(d)	病变性质(出血/梗死, n)
对照组	14	12/2	63±12.1	98±9.1	2/12
tDCS组	14	13/1	65±9.5	102±15.5	0/14
t值			0.610	0.635
P值		1.000^a	0.553	0.536	0.481^a

组别	n	治疗前	治疗后	t值	P值
对照组	14	65.5±8.8	70.9±7.8	-5.593	< 0.001
tDCS组	14	66.3±6.7	76.8±4.5	-6.623	< 0.001
t值		0.267	2.439
P值		0.792	0.022

组别	n	治疗前	治疗后	Z值	P值
对照组	14	1.64±1.01	2.07±0.83	-2.121	0.034
tDCS组	14	1.79±1.25	3.07±1.21	-3.145	0.002
Z值		-0.048	-2.079
P值		0.962	0.038

Effects of Transcranial Direct Current Stimulation over Vagus Nerve on Dysphagia after Stroke

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 25

Related Articles 15

Metrics

Comments

Recommended 0

[1]	ZHU Lili, ZHAO Jiaxin, CHENG Xue, WANG Huijuan, CHEN Xiaoxia. Experiences and needs of stroke patients during rehabilitation: a qualitative meta-synthesis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 286-293.
[2]	LIU Ping, ZHOU Nan, XUE Xiaojie, SHAO Weibo. Application of rehabilitation therapy techniques for post-stroke dysphagia: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 294-303.
[3]	YANG Ling, WANG Qinglei, WANG Jie, XU Wenjie, WANG Tong, GUO Chuan, QIAN Xue. Activation patterns and mechanism in the prefrontal cortex of post-stroke anxiety patients: a study using functional near-infrared spectroscopy [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 329-336.
[4]	YUE Yuan, ZHANG Tong, LIU Yuanmin, WANG Ya'nan. Effect of lower extremity exoskeleton robots on balance and walking function of patients with post-stroke cerebellar ataxia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 23-29.
[5]	WU Cheng, ZHANG Yunfeng, WANG Weining, YU Kewei, ZHANG Yanzheng, SHEN Jiarong, WU Yi. Effect of elbow-wrist functional orthosis on plantar pressure and balance function in stroke patients with hemiplegia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 30-39.
[6]	ZHANG Junfeng, CHEN Hao, DU Yuzheng, LI Chen, YU Tao, YANG Yuanqing. Non-pharmacological management for post-stroke spasticity from 2004 to 2024: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 45-58.
[7]	GAO Kaixiang, LU Haitao. Research in neurorehabilitation from 2015 to 2024: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 59-68.
[8]	WEI Jingyi, WANG Xiaojing, WANG Ran, WEI Chen, MA Sai, LIU Xihua. Effect of acupuncture synchronized speech training on post-stroke motor aphasia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1000-1008.
[9]	WANG Xiaojing, WEI Jingyi, WEI Chen, WANG Ran, MA Sai, LIU Xihua. Effect of synchronous acupuncture and articulation training on spastic dysarthria after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1009-1016.
[10]	TAN Mingdan, FENG Dingyao, LI Yongxue. Third-party disability in caregivers of head and neck cancer patients with dysphagia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1032-1037.
[11]	ZHOU Xinyue, YE Ruixue, MA Yaqi, XU Ying, CAO Longyao, WANG Yulong. Researches on central post-stroke pain: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1038-1049.
[12]	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.
[13]	GAO Yunhan, HOU Shanshan, WANG Xinyu, ZHU Chongtian. Effect of brain-computer interface on upper limb motor dysfunction in stroke patients based on functional near-infrared spectroscopy [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1066-1073.
[14]	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.
[15]	ZHANG Ziang, CHEN Jing, SHEN Mengru, GENG Zongxiao, HAN Xue, ZHAO Xu, XU Lei. Comparison of effect of different types of exercise on gait and balance for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 896-905.