Transcranial direct current stimulation improves the swallowing function in patients with cricopharyngeal muscle dysfunc
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ORIGINAL ARTICLE
Transcranial direct current stimulation improves the swallowing function in patients with cricopharyngeal muscle dysfunction following a brainstem stroke Zhi-Yong Wang 1 & Jian-Min Chen 1 & Zheng-kun Lin 2 & Guo-Xin Ni 1,3 Received: 22 April 2019 / Accepted: 20 October 2019 # Fondazione Società Italiana di Neurologia 2019
Abstract Objective This study investigated the effects of transcranial direct current stimulation (tDCS) combined with conventional swallowing training on the swallowing function in brainstem stroke patients with cricopharyngeal muscle dysfunction (CPD). Methods Twenty-eight brainstem stroke patients with CPD were assigned randomly to an anodal tDCS group or a sham tDCS group. The patients received anodal tDCS or sham tDCS over the bilateral oesophageal cortical area combined with simultaneous catheter balloon dilatation and conventional swallowing therapy for 20 days. Swallowing function was assessed using the functional oral intake scale (FOIS) and the functional dysphagia scale (FDS) and by measuring the pharyngoesophageal Segment Opening (PESO) before and immediately after the intervention. Results Both groups showed a significant improvement in the FDS, FOIS and PESO scores immediately after the intervention (all p < .005). However, compared with the sham stimulation group, the anodal tDCS group showed greater improvements in the FDS, FOIS and PESO scores immediately after the intervention (all p < .005). Conclusion The bihemispheric anodal tDCS combined with simultaneous catheter balloon dilatation and conventional swallowing therapy effectively improves the swallowing function in patients with CPD caused by a brainstem stroke. tDCS may be an effective adjuvant therapy in CPD rehabilitation. Keywords Cricopharyngeal muscle dysfunction . Dysphagia . Brainstem stroke . Transcranial direct current stimulation
Abbreviations tDCS transcranial direct current stimulation CPD cricopharyngeal muscle dysfunction FOIS functional oral intake scale FDS functional dysphagia scale PESO pharyngoesophageal Segment Opening rTMS repetitive transcranial magnetic stimulation VFSS videofluoroscopic swallowing study DOSS Dysphagia Outcome and Severity Scale
* Guo-Xin Ni [email protected] 1
Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005, China
2
Department of Rehabilitation Medicine, The 909th Hospital, 269 Zhanghua Middle Road, Zhangzhou 363000, China
3
School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
Introduction Cricopharyngeal muscle dysfunction (CPD) is characterised by the idiopathic stenosis of the pharyngoesophageal segment and is usually associated with pathological changes of the cricopharyngeal muscle, such as spasticity, impaired coordination and incomplete/abnormal relaxation [1]. This disorder may result from neurogenic diseases, myogenic diseases and local muscle lesions, among which cerebrovascular accident is a leading cause [2]. As a common complica
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