Estudios primarios relacionados a este tópico

loading
149 Referencias (148 articles) Revertir Estudificar

Estudio primario

No clasificado

Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia.

Autores Park E , Kim MS , Chang WH , Oh SM , Kim YK , Lee A , Kim YH
Revista Brain stimulation
Año 2017
Enlaces Pubmed DOI
Cargando información sobre las referencias
BACKGROUND: Optimal protocol of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia remains uncertain with regard to its clinical efficacy. OBJECTIVE: The aim of the present study is to investigate the effects of high-frequency rTMS at the bilateral motor cortices over the cortical representation of the mylohyoid muscles in the patients with post-stroke dysphagia. METHODS: This study was a single-blind, randomized controlled study with a blinded observer. Thirty-five stroke patients were randomly divided into three intervention groups: the bilateral stimulation group, the unilateral stimulation group, and the sham stimulation group. For the bilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional and 500 pulses of 10 Hz rTMS over the contralesional motor cortices over the cortical areas that project to the mylohyoid muscles were administered daily for 2 consecutive weeks. For the unilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional motor cortex over the cortical representation of the mylohyoid muscle and the same amount of sham rTMS over the contralesional hemisphere were applied. For the sham stimulation group, sham rTMS was applied at the bilateral motor cortices. Clinical swallowing function and videofluoroscopic swallowing studies were assessed before the intervention (T0), immediately after the intervention (T1) and 3 weeks after the intervention (T2) using Clinical Dysphagia Scale (CDS), Dysphagia Outcome and Severity Scale (DOSS), Penetration Aspiration Scale (PAS), and Videofluoroscopic Dysphagia Scale (VDS). RESULTS: There were significant time and intervention interaction effects in the CDS, DOSS, PAS, and VDS scores (p < 0.05). In the direct comparison of the changes in the swallowing parameters among the three groups, the change in CDS scores at T1 and T2 showed a significantly higher improvement in the bilateral simulation group than in two other groups (p < 0.05). There was a significantly larger change in the DOSS, PAS, and VDS scores at T1 in the bilateral stimulation group than in two other groups (p < 0.05). CONCLUSIONS: The results of the present study provide substantial evidence that 10 Hz rTMS at the bilateral motor cortices over the cortical areas projecting to the mylohyoid muscles is effective as an additional treatment strategy to traditional dysphagia therapies.

Estudio primario

No clasificado

眼针-头针-电针联合西药治疗急性期基底节区脑出血随机平行对照研究

Revista 实用中医内科杂志
Año 2016
Enlaces DOI
Cargando información sobre las referencias
[目的]观察眼针-头针-电针联合西药治疗急性期基底节区脑出血疗效。[方法]使用随机平行对照方法,将40例基底节出血量≤40m L,发病≥2d,血肿稳定住院患者按病志号抽签简单随机分为两组。对照组20例常规西医治疗,单唾液酸四己糖4m L+0.9%氯化钠250m L,1次/d,静点;连续治疗7d为1疗程。治疗组20例眼针(双侧上焦区、中焦区、下焦区、肝区、肾区,华佗牌31号0.5寸不锈钢毫针,横刺,不施手法,留针30min);头针(双侧顶颞前斜线、顶颞后斜线,29号1寸华佗牌针灸针,与头皮呈15°角进针;快速捻转,得气后留针30min);电针(普通针刺,上肢取合谷、内关、手三里、臂臑,下肢取风市、阳陵泉、足三里、丰隆、太冲,华佗牌29号2寸不锈钢毫针,得气后加电针,上肢4穴每3d选1组2穴加电极,下肢5穴每3d选2穴加电极,每3天换1组;捻转得气后连接华佗牌SDZ-Ⅱ型电针仪,疏密波,强度以肌肉抽动为主,留针30min);西药治疗同对照组;连续治疗6d休息1d为1疗程。观测临床症状、神经功能缺损程度评分(GCS)、不良反应。治疗1疗程,判定疗效。[结果]治疗组基本痊愈0例,显效15例,有效4例,无效1例,总有效率95.00%;对照组基本痊愈0例,显效7例,有效11例,无效2例,总有效率90.00%;治疗组疗效优于对照组(P<0.05)。神经功能缺损评分两组均有明显降低(P<0.05),治疗组降低幅度大于对照组(P<0.05)。[结论]眼针-头针-电针联合西药治疗急性期基底节区脑出血,疗效满意,无严重不良反应,值得推广。

Estudio primario

No clasificado

Acupuncture for a first episode of acute ischaemic stroke: an observer-blinded randomised controlled pilot study.

Revista Acupuncture in medicine : journal of the British Medical Acupuncture Society
Año 2016
Enlaces Pubmed DOI
Cargando información sobre las referencias
OBJECTIVE: To determine the required sample size for, and feasibility of, a RCT examining the effectiveness of early acupuncture for acute ischaemic stroke. METHODS: Thirty-eight patients aged 40-85 years with a first episode of acute ischaemic stroke presenting within 72 h of stroke onset were randomly assigned to receive manual acupuncture (MA group; n=20) plus standard care or standard care only (control group, n=18). The acupuncture treatment was provided daily for 2 weeks. The primary outcome was the change in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 4 weeks. Secondary outcomes included changes in the Fugl-Meyer assessment (FMA) and the functional independence measure scores between baseline and 4 weeks, and changes in NIHSS, Barthel Index and modified Rankin Scale scores at 12 weeks. RESULTS: Thirty-one patients completed the study (dropout rate=18%) and adverse effects were minimal. No significant differences were seen between groups in the improvements in NIHSS scores, although there tended to be a greater reduction in NIHSS score after 1 week in the MA group relative to the control group (p=0.066). The post-stroke motor activity at 4 weeks was associated with a significantly increased FMA score in the acupuncture group compared with the control group (p<0.05), but not supported by intergroup analysis. CONCLUSIONS: This pilot study indicates that acupuncture appears to be safe for patients in the acute stage of ischaemic stroke. A subsequent trial with a larger sample size (estimated at n=122) is required to confirm whether early acupuncture intervention contributes to earlier functional improvement and to assess the longer-term clinical efficacy of acupuncture. TRIAL REGISTRATION NUMBER: NCT02210988; Results.

Estudio primario

No clasificado

Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke? a randomized controlled trial.

Autores Xia W , Zheng C , Zhu S , Tang Z
Revista Clinical rehabilitation
Año 2016
Enlaces Pubmed DOI PubMed Central
Cargando información sobre las referencias
OBJECTIVE: To assess the effect of adding acupuncture to standard swallowing training for patients with dysphagia after stroke. DESIGN: Single-blind randomized controlled trial. SETTING: Inpatient and outpatient clinics. Subjects: A total of 124 patients with dysphagia after stroke were randomly divided into two groups: acupuncture and control. INTERVENTIONS: The acupuncture group received standard swallowing training and acupuncture treatment. In comparison, the control group only received standard swallowing training. Participants in both groups received six days of therapy per week for a four-week period. Main measures: The primary outcome measures included the Standardized Swallowing Assessment and the Dysphagia Outcome Severity Scale. The secondary outcome measures included the Modified Barthel Index and Swallowing-Related Quality of Life, which were assessed before and after the four-week therapy period. RESULTS: A total of 120 dysphagic subjects completed the study (60 in acupuncture group and 60 in control group). Significant differences existed in the Standardized Swallowing Assessment, Dysphagia Outcome Severity Scale, Modified Barthel Index, and Swallowing-Related Quality of Life scores of each group after the treatment (P &lt; 0.01). After the four-week treatment, the Standardized Swallowing Assessment (mean difference − 2.9; 95% confidence interval (CI) – 5.0 to − 0.81; P &lt; 0.01), Dysphagia Outcome Severity Scale (mean difference 2.3; 95% CI 0.7 to 1.2; P &lt; 0.01), Modified Barthel Index (mean difference 17.2; 95% CI 2.6 to 9.3; P &lt; 0.05) and Swallowing-Related Quality of Life scores (mean difference 31.4; 95% CI 3.2 to 11.4; P &lt; 0.01) showed more significant improvement in the acupuncture group than the control group. CONCLUSIONS: Acupuncture combined with the standard swallowing training may be beneficial for dysphagic patients after stroke.

Estudio primario

No clasificado

Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial.

Autores Lifang , Chen , Jianqiao , Fang , Ruijie , Ma , Xudong , Gu , Lina , Jianhua
Revista BMC complementary and alternative medicine
Año 2016
Enlaces DOI
Cargando información sobre las referencias

Estudio primario

No clasificado

Pharyngeal Electrical Stimulation in Dysphagia Poststroke: A Prospective, Randomized Single-Blinded Interventional Study.

Revista Neurorehabilitation and neural repair
Año 2016
Enlaces Pubmed DOI
Cargando información sobre las referencias
Background Pharyngeal electrical stimulation (PES) appears to promote cortical plasticity and swallowing recovery poststroke. Objective We aimed to assess clinical effectiveness with longer follow-up. Methods Dysphagic patients (n = 36; median = 71 years; 61% male) recruited from 3 trial centers within 6 weeks of stroke, received active or sham PES in a single-blinded randomized design via an intraluminal pharyngeal catheter (10 minutes, for 3days). The primary outcome measure was the Dysphagia Severity Rating (DSR) scale (<4, no-mild; ≥4, moderate-severe). Secondary outcomes included unsafe swallows on the Penetration-Aspiration Scale (PAS ≥ 3), times to hospital discharge, and nasogastric tube (NGT) removal. Data were analyzed using logistic regression. Odds/hazard ratios (ORs/HRs) >1 for DSR <4, hospital discharge, and NGT removal and OR <1 for PAS ≥3, indicated favorable outcomes for active PES. Results Two weeks post-active PES, 11/18 (61%) had DSR <4: OR (95% CI) = 2.5 (0.52, 14). Effects of active versus sham for secondary outcomes included the following: PAS ≥3 at 2 weeks, OR (95% CI) = 0.61 (0.27, 1.4); times to hospital discharge, 39 days versus 52 days, HR (95% CI) = 1.2 (0.55, 2.5); NGT removal 8 versus 14 days, HR (95% CI) = 2.0 (0.51, 7.9); and DSR <4 at 3 months, OR (95% CI) = 0.97 (0.13, 7.0). PES was well tolerated, without adverse effects or associations with serious complications (chest infections/death). Conclusions Although the direction of observed differences were consistent with PES accelerating swallowing recovery over the first 2 weeks postintervention, suboptimal recruitment prevents definitive conclusions. Our study design experience and outcome data are essential to inform a definitive, multicenter randomized trial.

Estudio primario

No clasificado

Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial.

Autores Chen L , Fang J , Ma R , Gu X , Chen L , Li J , et al.
Revista BMC Complementary and Alternative Medicine
Año 2016
Cargando información sobre las referencias

Estudio primario

No clasificado

Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke: A Randomized Controlled Trial.

Revista Stroke
Año 2016
Enlaces Pubmed DOI PubMed Central
Cargando información sobre las referencias
<b>Background and PURPOSE: </b>Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials.<b>METHODS: </b>We randomly assigned 162 patients with a recent ischemic or hemorrhagic stroke and dysphagia, defined as a penetration aspiration score (PAS) of ≥3 on video fluoroscopy, to PES or sham treatment given on 3 consecutive days. The primary outcome was swallowing safety, assessed using the PAS, at 2 weeks. Secondary outcomes included dysphagia severity, function, quality of life, and serious adverse events at 6 and 12 weeks.<b>RESULTS: </b>In randomized patients, the mean age was 74 years, male 58%, ischemic stroke 89%, and PAS 4.8. The mean treatment current was 14.8 (7.9) mA and duration 9.9 (1.2) minutes per session. On the basis of previous data, 45 patients (58.4%) randomized to PES seemed to receive suboptimal stimulation. The PAS at 2 weeks, adjusted for baseline, did not differ between the randomized groups: PES 3.7 (2.0) versus sham 3.6 (1.9), P=0.60. Similarly, the secondary outcomes did not differ, including clinical swallowing and functional outcome. No serious adverse device-related events occurred.<b>CONCLUSIONS: </b>In patients with subacute stroke and dysphagia, PES was safe but did not improve dysphagia. Undertreatment of patients receiving PES may have contributed to the neutral result.<b>Clinical Trial Registration: </b>URL: http://www.controlled-trials.com. Unique identifier: ISRCTN25681641.

Estudio primario

No clasificado

Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial.

Autores Park JS , Oh DH , Chang MY , Kim KM
Revista Journal of oral rehabilitation
Año 2016
Enlaces Pubmed DOI
Cargando información sobre las referencias
Expiratory muscle strength training ( EMST) involves forcible blowing as a means of generating high expiratory pressure, against adjustable resistance. EMST has recently been introduced as a potential treatment for dysphagia. This study was performed to investigate the effects of EMST on the activity of suprahyoid muscles, aspiration and dietary stages in stroke patients with dysphagia. Twenty-seven stroke patients with dysphagia were randomly divided into two groups. The experimental group performed EMST with a 70% threshold value of maximal expiratory pressure, using an EMST device, 5 days a week for 4 weeks. The placebo group trained with a sham device. The EMST regime involved 5 sets of 5 breaths through the EMST device for a total of 25 breaths per day. Activity in the suprahyoid muscle group was measured using surface electromyography ( sEMG). Further, the penetration-aspiration scale ( PAS) was used to assess the results of the videofluoroscopic swallowing study ( VFSS). In addition, dietary stages were evaluated using the Functional Oral Intake Scale ( FOIS). The experimental group exhibited improved suprahyoid muscle group activity and PAS results, when compared to the placebo group. Following intervention, statistical analysis indicated significant differences in measured suprahyoid muscle activity ( P = 0·01), liquid PAS outcomes ( P = 0·03) and FOIS results ( P = 0·06), but not semisolid type PAS outcomes ( P = 0·32), between the groups. This study confirms EMST as an effective treatment for the development of suprahyoid muscle activity in stroke patients with dysphagia. Additionally, improvements in aspiration and penetration outcomes were observed.

Estudio primario

No clasificado

Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: A randomized, double-blind clinical trial.

Autores Du J , Yang F , Liu L , Hu J , Cai B , Liu W , Xu G , Liu X
Revista Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
Año 2016
Enlaces Pubmed DOI
Cargando información sobre las referencias
OBJECTIVE: This randomized, sham-controlled, double-blind study was conducted to investigate the effects of high-frequency versus low-frequency repetitive transcranial magnetic stimulation (rTMS) on patients with poststroke dysphagia during early rehabilitation. METHODS: Forty patients with poststroke dysphagia were randomized to receive five daily sessions of sham, 3-Hz ipsilesional, or 1-Hz contralesional rTMS. Swallowing function, the severity of stroke and functional disability, and cortical excitability were examined before, immediately after five daily sessions, as well as the first, second, and third month after the last session. RESULTS: At baseline, no significant differences between groups were observed in terms of demographic and clinical rating scales. However, a significantly greater improvement in swallowing function as well as functional disability was observed after real rTMS when compared with sham rTMS, which remained 3 months after the end of the treatment sessions. In addition, 1-Hz rTMS increased cortical excitability of the affected hemisphere and decreased that of the non-affected hemisphere; however, 3-Hz rTMS only increased cortical excitability of the affected hemisphere. CONCLUSION: rTMS (both high and low frequency) improved swallowing recovery in patients with poststroke dysphagia, and the effects lasted for at least 3 months. SIGNIFICANCE: rTMS appears to be a beneficial therapeutic modality for patients with dysphagia during the early phase of stroke.