Ann Rehabil Med.  2014 Oct;38(5):592-602. 10.5535/arm.2014.38.5.592.

Effect of Low-Frequency rTMS and NMES on Subacute Unilateral Hemispheric Stroke With Dysphagia

• Lim KB
• Lee HJ
• Yoo J
• Kwon YG

• KMID: 2266493
• DOI: http://doi.org/10.5535/arm.2014.38.5.592

Abstract

OBJECTIVE
To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on post-stroke dysphagia.
METHODS
Subacute (<3 months), unilateral hemispheric stroke patients with dysphagia were randomly assigned to the conventional dysphagia therapy (CDT), rTMS, or NMES groups. In rTMS group, rTMS was performed at 100% resting motor threshold with 1 Hz frequency for 20 minutes per session (5 days per week for 2 weeks). In NMES group, electrical stimulation was applied to the anterior neck for 30 minutes per session (5 days per week for 2 weeks). All three groups were given conventional dysphagia therapy for 4 weeks. We evaluated the functional dysphagia scale (FDS), pharyngeal transit time (PTT), the penetration-aspiration scale (PAS), and the American Speech-Language Hearing Association National Outcomes Measurement System (ASHA NOMS) swallowing scale at baseline, after 2 weeks, and after 4 weeks.
RESULTS
Forty-seven patients completed the study; 15 in the CDT group, 14 in the rTMS group, and 18 in the NMES group. Mean changes in FDS and PAS for liquid during first 2 weeks in the rTMS and NMES groups were significantly higher than those in the CDT group, but no significant differences were found between the rTMS and NMES group. No significant difference in mean changes of FDS and PAS for semi-solid, PTT, and ASHA NOMS was observed among the three groups.
CONCLUSION
These results indicated that both low-frequency rTMS and NMES could induce early recovery from dysphagia; therefore, they both could be useful therapeutic options for dysphagic stroke patients.

Keyword

Stroke; Dysphagia; Repetitive transcranial magnetic stimulation; Electrical stimulation; Rehabilitation

MeSH Terms

Deglutition
Deglutition Disorders*
Electric Stimulation
Hearing
Humans
Neck
Rehabilitation
Stroke*
Transcranial Magnetic Stimulation

Figure

• 

  Fig. 1 Intervention design. In rTMS group, rTMS is performed for 20 minutes per session, 5 days per week during the first 2 weeks. In NMES group, electrical stimulation is applied for 30 minutes per session, 5 days per week during the first 2 weeks. All three groups are given CDT for 4 weeks. CDT, conventional dysphagia therapy; rTMS, repetitive transcranial magnetic stimulation; NMES, neuromuscular electrical stimulation.

• 

  Fig. 2 Mean changes in functional dysphagia scale (FDS) scores by both per-protocol analysis (A) and intention-to-treat analysis (B). CDT, conventional dysphagia therapy; rTMS, repetitive transcranial magnetic stimulation; NMES, neuromuscular electrical stimulation. *p<0.017 by the Mann-Whitney U test (vs. CDT group).

• 

  Fig. 3 Mean changes in penetration-aspiration scale (PAS) scores by both per-protocol analysis (A) and intention-to-treat analysis (B). CDT, conventional dysphagia therapy; rTMS, repetitive transcranial magnetic stimulation; NMES, neuromuscular electrical stimulation. *p<0.017 by the Mann-Whitney U test (vs. CDT group).

• 

  Fig. 4 Mean changes in American Speech-Language Hearing Association National Outcomes Measurement System (ASHA NOMS) swallowing scale by both per-protocol analysis (A) and intention-to-treat analysis (B). CDT, conventional dysphagia therapy; rTMS, repetitive transcranial magnetic stimulation; NMES, neuromuscular electrical stimulation.

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