Observation on the therapeutic efficacy of surface electromyography biofeedback combined with respiratory training in the treatment of post-stroke dysphagia

doi:10.11958/20251362

Abstract

Abstract:

Objective To investigate the efficacy of surface electromyography biofeedback combined with respiratory training on post-stroke dysphagia and its impacts on serum neuron specific enolase (NSE) and insulin-like growth factor 1 (IGF-1) in patients. Methods Totally 120 patients with post-stroke dysphagia in our hospital were stochastically assigned into the control group and the combined group, with 60 patients in each group. Both groups were given conventional treatment first, while the control group received respiratory training treatment. The combined group received surface electromyography biofeedback treatment on the top of the control group. The efficacy, serum NSE, central nervous system specific protein (S100β), IGF-1, functional oral intake scale (FOIS) score, standard swallowing function assessment scale (SSA) score, respiratory function, pharyngeal contraction rate and duration of pharyngeal contraction were compared between the two groups. Results After treatment, the total effective rate was higher in the combined group (χ²=4.876, P<0.05). Compared with before treatment, NSE, S100β, SSA score and pharyngeal contraction rate decreased after treatment in both groups, and those were even lower in the combined group (t=5.193, 9.000, 8.976, 10.614, P<0.05). Compared with before treatment, IGF-1, FOIS score, force vital capacity (FVC), forced expiratory volume in one second (FEV₁), peak expiratory flow rate (PEF) and duration of pharyngeal contraction increased after treatment in both groups, with even higher levels in the combined group (t=4.212, 6.220, 3.765, 6.935, 5.020, 4.249, P<0.05). Conclusion Surface electromyography biofeedback combined with respiratory training can improve neuronal damage in patients with dysphagia, enhance swallowing efficiency, reduce serum NSE, S100β levels and pharyngeal retention time, with significant curative effect.

Key words: stroke, deglutition disorders, neurofeedback, surface electromyography biofeedback, respiratory training

CLC Number:

R743.3

Figures/Tables 6

References 24

[1]	LABEIT B, MICHOU E, HAMDY S, et al. The assessment of dysphagia after stroke:state of the art and future directions[J]. Lancet Neurol, 2023, 22(9):858-870. doi:10.1016/S1474-4422(23)00153-9.
[2]	D'NETTO P, RUMBACH A, DUNN K, et al. Clinical predictors of dysphagia recovery after stroke:a systematic review[J]. Dysphagia, 2023, 38(1):1-22. doi:10.1007/s00455-022-10443-3.
[3]	范秀玉, 毛忠南, 张晓凌, 等. 电针基于不同参数治疗脑卒中后吞咽障碍的研究进展[J]. 中医药信息, 2023, 40(6):76-81.
	FAN X Y, MAO Z N, ZHANG X L, et al. Research progress of electroacupuncture in the treatment of post-stroke dysphagia based on different parameters[J]. Information of Chinese Medicine, 2023, 40(6):76-81. doi:10.19656/j.cnki.1002-2406.20230613.
[4]	景荣华, 周益凡, 孙云丰, 等. 徒手呼吸训练联合电针穴位刺激治疗脑卒中后吞咽障碍的疗效[J]. 世界中西医结合杂志, 2023, 18(4):737-741,746.
	JING R H, ZHOU Y F, SUN Y F, et al. Effect of freehand breathing training combined with electroacupuncture acupoint stimulation on dysphagia after stroke[J]. World Journal of Integrated Traditional Chinese and Western Medicine, 2023, 18(4):737-741,746. doi:10.13935/j.cnki.sjzx.230421.
[5]	宋琦, 李宏玉, 侯鑫磊, 等. 电针颈夹脊穴联合表面肌电生物反馈治疗脑卒中后吞咽障碍的临床观察[J]. 广州中医药大学学报, 2023, 40(3):647-652.
	SONG Q, LI H Y, HOU X L, et al. Clinical observation of electroacupuncture at neck Jiaji combined with surface electromyography biofeedback in the treatment of dysphagia after stroke[J]. Journal of Guangzhou University of Chinese Medicine, 2023, 40(3):647-652. doi:10.13359/j.cnki.gzxbtcm.2023.03.019.
[6]	王高临, 李斌, 韩桂浩, 等. 血清HIF-1α、NSE、Hcy水平与急性缺血性脑卒中介入手术患者神经功能的关系[J]. 中国现代医学杂志, 2025, 35(5):78-83.
	WANG G L, LI B, HAN G H, et al. Relationship between serum levels of HIF-1α,NSE,Hcy and neurological function in patients with acute ischemic stroke undergoing interventional surgery[J]. Chin J Modern Med, 2020, 35(5):78-83. doi:10.3969/j.issn.1005-8982.2025.05.013.
[7]	游蕾蕾, 高理正, 曹晓伟. 脑卒中患者血清Hcy、NSE、S100β、VEGF、Ang-2水平与认知功能的关系研究[J]. 中国医学工程, 2024, 32(4):116-119.
	YOU L L, GAO L Z, CAO X W. The relationship between serum Hcy,NSE,S100β,VEGF,Ang-2 levels and cognitive function in patients with stroke[J]. Chinese Medical Engineering, 2024, 32(4):116-119. doi:10.19338/j.issn.1672-2019.2024.04.027.
[8]	张雯, 金海涛, 王非, 等. 不同频率电针廉泉穴联合吞咽康复训练对脑卒中吞咽障碍患者疗效及血清BDNF、SP水平的影响[J]. 西部中医药, 2023, 36(7):125-129.
	ZHANG W, JIN H T, WANG F, et al. Effect of different frequencies of electroacupuncture at Lianquan point combined with swallowing rehabilitation training on the efficacy and serum BDNF and SP levels in stroke patients with dysphagia[J]. Western Chinese Medicine, 2023, 36(7):125-129. doi:10.12174/j.issn.2096-9600.2023.07.31.
[9]	中国老年医学学会营养与食品安全分会, 中国循证医学中心,《中国循证医学杂志》编辑委员会, 等. 老年吞咽障碍患者家庭营养管理中国专家共识(2018版)[J]. 中国循证医学杂志, 2018, 18(6):547-559.
	Nutrition and Food Safety Branch of Chinese Geriatrics Society,Chinese Evidence-based Medicine Center, Editorial Board of Chinese Journal of Evidence-based Medicine, et al. Chinese expert consensus on home nutrition management of elderly patients with dysphagia(2018 edition)[J]. Chin J Evidence-based Medicine, 2018, 18(6):547-559. doi:10.7507/1672-2531.201805032.
[10]	吕开月, 廖喜琳, 程树锦, 等. 腹针联合经皮穴位电刺激治疗脑卒中后吞咽障碍患者的疗效和安全性[J]. 广西医学, 2023, 45(18):2213-2218.
	LYU K Y, LIAO X L, CHENG S J, et al. Efficacy and safety of abdominal acupuncture combined with transcutaneous electrical acupoint stimulation in the treatment of dysphagia after stroke[J]. Guangxi Med, 2023, 45(18):2213-2218. doi:10.11675/j.issn.0253-4304.2023.18.09.
[11]	包安安, 陈娟, 蔡惠连, 等. 舌针联合会厌通络汤治疗缺血性脑卒中后吞咽障碍疗效观察[J]. 山东中医杂志, 2023, 42(6):608-611,632.
	BAO A A, CHEN J, CAI H L, et al. Effect of tongue acupuncture combined with epiglottic Tongluo decoction on dysphagia after ischemic stroke[J]. Shandong Journal of Traditional Chinese Medicine, 2023, 42(6):608-611,632. doi:10.16295/j.cnki.0257-358x.2023.06.013.
[12]	姚玉婷, 赵鹏, 李燕, 等. 尼麦角林联合低频电刺激治疗对脑卒中后吞咽困难的影响[J]. 中国康复, 2024, 39(4):200-203.
	YAO Y T, ZHAO P, LI Y, et al. Effect of nicergoline combined with low frequency electrical stimulation on dysphagia after stroke[J]. China Rehabilitation, 2024, 39(4):200-203. doi:10.3870/zgkf.2024.04.002.
[13]	潘思京, 郭章宝, 邵卫, 等. SSA量表与GUSS量表在急性脑卒中吞咽障碍评估中的信度和效度对比[J]. 中华物理医学与康复杂志, 2024, 46(1):23-27.
	PAN S J, GUO Z B, SHAO W, et al. Comparison of the reliability and validity of SSA scale and GUSS scale in the assessment of dysphagia in acute stroke[J]. Chin J Physical Med & Rehabilitation, 2024, 46(1):23-27. doi:10.3760/cma.j.issn.0254-1424.2024.01.005.
[14]	宋晓东, 张永卿, 高佳, 等. 双侧高频重复经颅磁刺激联合门德尔松手法对脑卒中后吞咽障碍的影响[J]. 中国康复医学杂志, 2024, 39(7):1004-1008.
	SONG X D, ZHANG Y Q, GAO J, et al. Effect of bilateral high frequency repetitive transcranial magnetic stimulation combined with Mendelssohn manipulation on dysphagia after stroke[J]. Chin J Rehabilitation Med, 2024, 39(7):1004-1008. doi:10.3969/j.issn.1001-1242.2024.07.015.
[15]	周海英, 吴云英, 吴春兰. 电针联合吞咽功能训练治疗脑卒中吞咽功能障碍对患者吞咽功能恢复的影响[J]. 四川中医, 2022, 40(1):198-201.
	ZHOU H Y, WU Y Y, WU C L. Effect of electroacupuncture combined with swallowing function training on the recovery of swallowing function in stroke patients with swallowing dysfunction[J]. Sichuan Traditional Chinese Medicine, 2022, 40(1):198-201.
[16]	LABEIT B, MICHOU E, TRAPL-GRUNDSCHOBER M, et al. Dysphagia after stroke:research advances in treatment interventions[J]. Lancet Neurol, 2024, 23(4):418-428. doi:10.1016/S1474-4422(24)00053-X.
[17]	FARPOUR S, ASADI-SHEKAARI M, BORHANI HAGHIGHI A, et al. Improving swallowing function and ability in post stroke dysphagia:a randomized clinical trial[J]. Dysphagia, 2023, 38(1):330-339. doi:10.1007/s00455-022-10470-0.
[18]	郑继青, 龙耀斌, 徐金. 辣椒素联合重复经颅磁刺激用于脑卒中后吞咽障碍患者的疗效观察[J]. 天津医药, 2024, 52(9):950-953.
	ZHENG J Q, LONG Y B, XU J. Efficacy of capsaicin combined with repetitive transcranial magnetic stimulation in patients with dysphagia after stroke[J]. Tianjin Med J, 2024, 52(9):950-953. doi:10.11958/20231579.
[19]	姚珊, 郭鹏飞, 孙洁, 等. 双侧高频重复经颅磁刺激联合高压氧治疗脑卒中后吞咽障碍的临床研究[J]. 中国医药导报, 2024, 21(11):51-55.
	YAO S, GUO P F, SUN J, et al. Clinical study of bilateral high-frequency repetitive transcranial magnetic stimulation combined with hyperbaric oxygen in the treatment of dysphagia after stroke[J]. China Medical Guide, 2024, 21(11):51-55. doi:10.20047/j.issn.1673-7210.2024.10.12.
[20]	陶林花, 傅晓倩, 陆操, 等. 体外膈肌起搏联合呼吸训练对脑卒中后吞咽障碍患者吞咽和呼吸功能的影响[J]. 浙江医学, 2024, 46(2):191-195.
	TAO L H, FU X Q, LU C, et al. Effects of external diaphragm pacing combined with respiratory training on swallowing and respiratory function in patients with dysphagia after stroke[J]. Zhejiang Medical Journal, 2024, 46(2):191-195. doi:10.12056/j.issn.1006-2785.2024.46.2.2023-1421.
[21]	田智, 武昌, 严静怡. 项丛刺联合表面肌电生物反馈治疗脑卒中后吞咽困难的效果[J]. 中国医药导报, 2023, 20(4):100-103.
	TIAN Z, WU C, YAN J Y. Effect of ngai cluster acupuncture combined with surface electromyographic biofeedback on dysphagia after stroke[J]. China Medical Herald, 2023, 20(4):100-103. doi:10.20047/j.issn.1673-7210.2023.04.22.
[22]	郑红懿, 徐丽, 余茜. 运动观察法对脑卒中后吞咽障碍患者的影响[J]. 实用医院临床杂志, 2023, 20(6):130-133.
	ZHENG H Y, XU L, YU Q. Effect of exercise observation on patients with dysphagia after stroke[J]. Practical Journal of Clinical Medicine, 2023, 20(6):130-133. doi:10.3969/j.issn.1672-6170.2023.06.031.
[23]	陈刘璇子, 廖焦鲁, 王竹行, 等. 脑卒中后吞咽功能障碍经针刺结合电刺激治疗对患者吞咽功能、生命质量-吞咽评分的影响分析[J]. 实用医院临床杂志, 2023, 20(3):51-54.
	CHEN L X Z, LIAO J L, WANG Z X, et al. Effect of acupuncture combined with electrical stimulation on swallowing function and quality of life-swallowing score in patients with dysphagia after stroke[J]. Practical Journal of Clinical Medicine, 2023, 20(3):51-54. doi:10.3969/j.issn.1672-6170.2023.03.015.
[24]	钟利, 陈晓锋, 吴思融, 等. 基于吞咽造影分析评估腹针联合神经肌肉电刺激治疗脑卒中后吞咽障碍疗效的临床研究[J]. 现代生物医学进展, 2024, 24(10):1926-1930.
	ZHONG L, CHEN X F, WU S R, et al. Clinical study on the efficacy of abdominal acupuncture combined with neuromuscular electrical stimulation in the treatment of post-stroke dysphagia based on swallowing contrast analysis[J]. Advances in Modern Biomedicine, 2024, 24(10):1926-1930. doi:10.13241/j.cnki.pmb.2024.10.026.

组别		性别		年龄/岁		体质量指数/（kg/m2）
	男		女
对照组	32（53.3）		28（46.7）	62.83±6.69	23.01±2.42
联合组	34（56.7）		26（43.3）	63.37±6.89	23.49±2.55
χ²或t	0.135			0.430	1.036
组别		病程/d		吸烟史		饮酒史
对照组		13.22±1.56		30（50.0）		35（58.3）
联合组		12.80±2.17		29（48.3）		31（51.7）
χ²或t		1.207		0.033		0.539

组别		性别		年龄/岁		体质量指数/（kg/m2）
	男		女
对照组	32（53.3）		28（46.7）	62.83±6.69	23.01±2.42
联合组	34（56.7）		26（43.3）	63.37±6.89	23.49±2.55
χ²或t	0.135			0.430	1.036
组别		病程/d		吸烟史		饮酒史
对照组		13.22±1.56		30（50.0）		35（58.3）
联合组		12.80±2.17		29（48.3）		31（51.7）
χ²或t		1.207		0.033		0.539

组别	治愈	显效	有效	无效	总有效
对照组	27（45.00）	15（25.00）	6（10.00）	12（20.00）	48（80.00）
联合组	32（53.33）	18（30.00）	7（11.67）	3（5.00）	57（95.00）
χ²					4.876^＊

组别	治愈	显效	有效	无效	总有效
对照组	27（45.00）	15（25.00）	6（10.00）	12（20.00）	48（80.00）
联合组	32（53.33）	18（30.00）	7（11.67）	3（5.00）	57（95.00）
χ²					4.876^＊

组别		NSE/（ng/L）
组别		治疗前			治疗后			t
对照组		80.12±9.17			45.34±5.47			24.259^＊＊
联合组		81.29±9.28			40.21±5.32			33.566^＊＊
t		0.695			5.193^＊＊
组别			S100β/（μg/L）
组别			治疗前	治疗后			t
对照组			4.73±0.61	1.03±0.16			45.446^＊＊
联合组			4.82±0.67	0.81±0.12			45.634^＊＊
t			0.769	9.000^＊＊
组别	IGF-1/（μg/L）
组别	治疗前					治疗后			t
对照组	109.53±13.21					143.90±15.31			13.021^＊＊
联合组	108.89±12.34					156.42±17.21			18.047^＊＊
t	0.274					4.212^＊＊