Abstract
Objective
To observe the effect of acupoint massage plus Vitalstim electrical stimulation on deglutition function and surface electromyography (SEMG) of deglutition muscle groups.
Methods
A total of 60 patients with deglutition disorder after stroke were selected and divided into an electrical stimulation group, a massage group and an integrated group according to the random number table method, with 20 cases in each group. Patients in these three groups were given the same routine rehabilitation training for deglutition. In addition, patients in the electrical stimulation group were given extra Vitalstim electrical stimulation, patients in the massage group were given extra acupoint massage on the head, face and neck, and patients in the integrated group were given extra acupoint massage plus Vitalstim electrical stimulation. Fujishima Ichiro food intake level scale (FILS) was scored before and after treatment. The swallowing duration and maximal amplitude of masseter muscle in SEMG were evaluated before and after treatment.
Results
After treatment, the FILS score and the maximal amplitude of recruitment potential generated by muscular contraction of masseter muscle group in the three groups were higher than those before treatment (all P<0.05), and the swallowing duration of masseter muscle group was shortened compared with that in the same group before treatment (all P<0.05). After treatment, the FILS score in the integrated group was higher than that in the electrical stimulation group and the massage group (both P<0.05). The swallowing duration of masseter muscle group measured by SEMG was lower than that in the electrical stimulation group and the massage group (both P<0.05), while the maximal amplitude was higher than that of the electrical stimulation group and the massage group (P<0.05). After treatment, there were no significant differences in the FILS score, swallowing duration and maximal amplitude of masseter muscle group between the electrical stimulation group and the massage group (all P>0.05).
Conclusion
Both acupoint massage and electrical stimulation can improve the deglutition function in patients with deglutition disorder after stroke, and improve the coordination and flexibility of masseter muscle. The integration of the two is more effective.
摘要
目的: 观察穴位按摩结合Vitalstim电刺激对脑卒中后吞咽障碍患者吞咽功能及吞咽肌群表面肌电图的影 响。方法: 将60例脑卒中后吞咽障碍患者按照随机数字表法分为电刺激组、按摩组和联合组, 每组20例。三组均 采用相同的吞咽常规康复训练, 电刺激组加用Vitalstim电刺激, 按摩组加用头面颈项部穴位按摩, 联合组加用 Vitalstim电刺激和穴位按摩。于治疗前后进行藤岛一郎吞咽困难分级量表(FILS)评分和表面肌电图中咬肌群的吞咽 时程、最大振幅评估。 结果: 治疗后, 3组的FILS评分和咬肌群肌肉大力收缩时产生的募集电位最大振幅均较同组 治疗前提高(均P<0.05), 咬肌群的吞咽时程均较同组治疗前缩短(均P<0.05)。治疗后, 联合组FILS评分高于电刺激 组和按摩组(均P<0.05), 表面肌电图测量的咬肌群的吞咽时程低于电刺激组和按摩组(均P<0.05), 而最大振幅高 于电刺激组和按摩组(均P<0.05)。治疗后, 电刺激组和按摩组FILS评分、咬肌群的吞咽时程和最大振幅差异均无 统计学意义(均P>0.05) 。结论: 穴位按摩及电刺激治疗均可改善脑卒中后吞咽障碍患者的吞咽功能, 提高咬肌群 的协调性和灵活性, 两种方法联合使用疗效更佳。
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References
Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke, 2005, 36(12): 2756–2763.
Roth EJ, Lovell L, Harvey RL, Heinemann AW, Semik P, Diaz S. Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke, 2001, 32(2): 523–529.
Sun WP, Ayiguli AS, Liu R, Sun W, Huang YN. Risk factors of aspiration in acute stroke patients. Zhongguo Kangfu Yixue Zazhi, 2010, 25(2): 131–134.
Dou ZL. Assessment and Treatment of Dysphagia. 2nd Edition. Beijing: People’s Medical Publishing House, 2017.
Ning P, Yang JJ, Sun TY, Guo YF. Analysis of prevalence rate and risk factors for aspiration pneumonia in elderly inpatients. Zhonghua Laonianxue Zazhi, 2017, 36(4): 428–432.
China Expert Consensus Group on Rehabilitation Evaluation and Treatment of Deglutition Disorders. China expert consensus on rehabilitation evaluation and treatment of deglutition disorders (2017). Zhonghua Wuli Yixue Yu Kangfu Zazhi, 2017, 39(12): 881–892.
Chinese Neuroscience Society, Chinese Neurosurgical Society. Key diagnostic points for cerebrovascular diseases. Zhonghua Shenjingke Zazhi, 1996, 29(6): 379–380.
Chinese Expert Group on Deglutition Disorder and Nutrition Management in Stroke Patients. Chinese expert consensus on deglutition and nutrition management of stroke patients (2013 edition). Zhongguo Cuzhong Zazhi, 2013, 8(12): 973–983.
State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 119.
Collaborative Group of Acute Encephalopathy of State Administration of Traditional Chinese Medicine. Standard for diagnosis and therapeutic effect evaluation of stroke (trial). Beijing Zhongyiyao Daxue Xuebao, 1996, 19(1): 55–56.
Rao ML. China Guideline for Cerebrovascular Diseases Prevention and Treatment. Beijing: People’s Medical Publishing House, 2007: 64.
Yoon WL, Khoo JK, Rickard Liow SJ. Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise. Dysphagia, 2014, 29(2): 243–248.
General Administration of Quality Supervision, Inspection and Quarantine of the People’s Republic of China, Standardization Administration of the People’s Republic of China. Nomenclature and Location of Acupuncture Points (GB/T 12346-2006). Beijing: Standards Press of China, 2006.
Chang L, He PL, Zhou ZZ, Li YH. Efficacy observation of dysphagia after acute stroke treated with acupuncture and functional electric stimulation. Zhongguo Zhen Jiu, 2014, 34(8): 737–740.
Qin L, Zhang XP, Yang XC, Cui CH, Shi J, Jia CS. Deep acupuncture of Lianquan (CV 23) and Yifeng (TE 17) in combination with conventional acupuncture of other acupoints is superior to swallowing rehabilitation training in improving poststroke dysphagia in apoplexy patients. Zhen Ci Yan Jiu, 2019, 44(2): 144–147.
Zhang LZ, Xu NG, Li RL, Wang L. Clinical study of electroacupuncture with different frequencies at Lianquan (CV 23) and Fengfu (GV 16) for stroke dysphagia. Zhongguo Zhen Jiu, 2018, 38(2): 115–118.
Yuan Y, Cai XH, Chen F, Chen DX, Gao Y, Liu ZZ, Ling MX, Xu P. Clinical trials of acupuncture treatment of post-stroke dysphagia by deep acupuncture of Tiantu (CV 22) in combination with swallowing rehabilitation training. Zhen Ci Yan Jiu, 2019, 44(1): 47–50.
Zheng H, Feng SM, Zhang JK, Ma BX. A clinical study on cerebral palsy with dysphagia by acupuncture combined with massage treatment. Zhongguo Kangfu Yixue Zazhi, 2014, 29(10): 918–922.
Wang XQ, Bao CL. Clinical observation on acupoint massage combined with swallowing training in the treatment of stroke with dysphagia. Shanghai Zhongyiyao Daxue Xuebao, 2014, 28(5): 46–48.
Li YN, Wang J, Zhou HF, Liu J, Zhang XF. Effects of different depths of acupuncture at Dicang (ST 4) and Jiache (ST 6) on the quality of life and facial nerve function of patients with peripheral facial paralysis. Zhongyi Zazhi, 2019, 60(2): 142–145.
Han Q, Xu MS, Zhang YJ, Xu J, Ge LB. Effect of electroacupuncture at Fengchi (GB 20) on synaptophysin and growth associated protein-43 in rats with ischemia/reperfusion injury. Shanghai Zhenjiu Zazhi, 2019, 38(6): 674–680.
Kushner DS, Peters K, Eroglu ST, Perless-Carroll M, Johnson-Greene D. Neuromuscular electrical stimulation efficacy in acute stroke feeding tube-dependent dysphagia during inpatient rehabilitation. Am J Phys Med Rehabil, 2013, 92(6): 486–495.
Suntrup S, Marian T, Schröder BJ, Suttrup I, Muhle P, Oelenberg S, Hamacher C, Minnerup J, Warnecke T, Dziewas R. Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial. Intensive Care Med, 2015, 41(9): 1629–1637.
Vaiman M, Eviatar E. Surface electromyography as a screening method for evaluation of dysphagia and odynophagia. Head Face Med, 2009, 5: 9.
Li LJ, Li YM, Wu XH, Wang GH, Yi XJ, Zhao YC, Guo MJ, Pan MZ, Tang CL. The value of adding transcutaneous neuromuscular electrical stimulation (Vitalstim) to traditional therapy for post-stroke dysphagia: a randomized controlled trial. Eur J Phys Rehabil Med, 2015, 51(1): 71–78.
Su WH, Yan WJ, Zhong MH, Li YM, Gao CF, Zhu QX. The effect of neuromuscular electrical stimulation on swallowing function after stroke. Zhonghua Wuli Yixue Yu Kangfu Zazhi, 2015, 37(3): 183–186.
Acknowledgments
This work was supported by Project of Hunan Province Administration of Traditional Chinese Medicine (湖南省 中医药管理局课题, No. 2015136).
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Tian, L., Nie, St., Lou, Tx. et al. Clinical observation on acupoint massage plus Vitalstim electrical stimulation for deglutition disorder after stroke. J. Acupunct. Tuina. Sci. 18, 438–444 (2020). https://doi.org/10.1007/s11726-020-1212-x
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DOI: https://doi.org/10.1007/s11726-020-1212-x
Keywords
- Acupoint Pressure Therapy
- Electric Stimulation Therapy
- Electromyography
- Poststroke Syndrome
- Pseudobulbar Palsy
- Deglutition Disorders