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


CONCLUSIONS
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.
Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea.
Kil-Byung
KB
Lim
Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea.
Hong-Jae
HJ
Lee
Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea.
Jeehyun
J
Yoo
Department of Physical Medicine and Rehabilitation, Inje University Ilsan Paik Hospital, Goyang, Korea.
Yong-Geol
YG
Kwon
Dysphagia; Electrical stimulation; Rehabilitation; Repetitive transcranial magnetic stimulation; Stroke