Abstract:

Objective To clarity the effects of neuromuscular electrical stimulation (NMES) on swallowing function of post-stroke patients from kinematic research of swallowing by video fluoroscopy swallowing study (VFSS). Methods Patients with dysphagia were recruited and randomly allocated to the study group and the control group. VFSS was performed before treatments. Patients in the study group received real NMES, and patients in the control group received sham NMES. Different interventions were applied for 20 min per time, 5 times per week, for 4 weeks. All the patients received traditional swallowing therapy at the same time. The evaluation was performed by using VFSS before and after treatment. Rosenbek Penetration-Aspiration scale (PAS) of 3 ml liquid barium food, 10 ml liquid barium food, semisolid barium food and solid barium food, pharyngeal transit time (PTT), pharyngeal delayed time (PDT), maximal extent of forward laryngeal movement and upward laryngeal movement, maximal extent of forward hyoid movement and upward hyoid movement

were obtained. The differences between two groups before and after treatment were identified respectively. Results A total of 43 patients were enrolled into study including 23 cases in study group and 20 cases in control group. After treatments, the scores of PAS of swallowing of 4 kinds of food in both groups were significantly reduced, and PDT and PTT were shorter compared with those before treatment (All P <0.05). There were no significant differences between two groups in the scores of PAS, PTT and PDT before and after treatment. Before treatment, there was no significance in difference in forward laryngeal movement, upward laryngeal movement, forward hyoid movement and upward hyoid movement between two groups. After treatment, upward laryngeal movement and upward of hyoid movement of study group were significantly increased compared with those of the control group (All P <0.05), however, there were no significant differences in forward laryngeal movement and forward hyoid movement between two groups. Conclusion NMES and traditional swallowing therapy can improve the swallowing function of stroke patients. The application of NMES could improve the upward movement of hyolaryngeal complex better.

Key words: Stroke; Dysphagia; Neuromuscular electrical stimulation

摘要：

目的 应用视频透视吞咽检查（video fluoroscopy swallowing study，VFSS）方法从吞咽运动学变化方 面研究神经肌肉电刺激（neuromuscular electrical stimulation，NMES）对卒中患者吞咽障碍的治疗作用。 方法 将卒中后吞咽障碍患者随机分为研究组和对照组，研究组给予NMES治疗，对照组给予假 刺激，治疗均为每次20 mi n，5次/周，持续4周。同时所有患者均进行吞咽常规训练。治疗前后均行 VFSS，获取3 ml液态钡食、10 ml液态钡食、半固体钡食及固体钡食4种食团吞咽的Rosenbek渗透-误吸 量表（penetration-aspiration scale，PAS）评分、咽传递时间（pharyngeal transit time，PTT）、咽延迟时间 （pharyngeal delayed time，PDT）、舌骨向前最大幅度、舌骨向上运动最大幅度、喉向前最大幅度及喉向 上运动最大幅度。对比两组治疗前后PAS量表评分及上述吞咽运动学参数的变化。 结果 研究共纳入43例患者，其中研究组23例，对照组20例。治疗后，两组患者4种食团吞咽时PAS评 分均较治疗前下降，PTT、PDT较治疗前缩短（均P＜0.05）。治疗前和治疗后，研究组在各食团吞咽时 PAS评分及PTT、PDT较对照组差异均无显著性。治疗前，两组间舌骨向前、向上运动，喉向前、向上运 动的最大幅度差异均无显著性；治疗后，研究组食团吞咽时舌骨向上运动、喉向上运动的最大幅度 均较对照组显著增大（均P＜0.05），但两组舌骨向前、喉向前运动差异无显著性。 结论 NMES和常规吞咽康复训练均可改善卒中患者的吞咽功能。NMES更能提高喉-舌骨复合体的向 上运动。

were obtained. The differences between two groups before and after treatment were identified respectively. Results A total of 43 patients were enrolled into study including 23 cases in study group and 20 cases in control group. After treatments, the scores of PAS of swallowing of 4 kinds of food in both groups were significantly reduced, and PDT and PTT were shorter compared with those before treatment (All P <0.05). There were no significant differences between two groups in the scores of PAS, PTT and PDT before and after treatment. Before treatment, there was no significance in difference in forward laryngeal movement, upward laryngeal movement, forward hyoid movement and upward hyoid movement between two groups. After treatment, upward laryngeal movement and upward of hyoid movement of study group were significantly increased compared with those of the control group (All P <0.05), however, there were no significant differences in forward laryngeal movement and forward hyoid movement between two groups. Conclusion NMES and traditional swallowing therapy can improve the swallowing function of stroke patients. The application of NMES could improve the upward movement of hyolaryngeal complex better. 【Key Words】 Stroke

关键词: 卒中; 吞咽障碍; 神经肌肉电刺激