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OBJECTIVE@#To compare the effect among ultrasound-guided electroacupuncture (EA) at suprahyoid muscle group, conventional acupuncture and conventional EA at suprahyoid muscle group on pharyngeal dysphagia after stroke, and to explore its biomechanical mechanism.@*METHODS@#A total of 120 patients with pharyngeal dysphagia after stroke were randomly divided into an observation group, a control-1 group and a control-2 group, 40 cases in each group. The patients in the observation group were treated with ultrasound-guided EA at suprahyoid muscle group; the patients in the control-1 group were treated with EA at Lianquan (CV 23), Wangu (GB 12) and Fengchi (GB 20), etc.; the patients in the control-2 group were treated with EA at suprahyoid muscle group according to anatomical location. The EA in the three groups were discontinuous wave, with frequency of 5 Hz and current intensity of 1 mA. The EA was given for 30 minutes, once a day, 6 times were taken as a course of treatment, and 4 courses of treatment were provided. The video floroscopic swallowing study (VFSS) was performed before and after treatment. The Rosenbek penetration-aspiration scale (PAS) score, the forward and upward movement distance of hyoid bone and thyroid cartilage, Ichiro Fujima ingestion-swallowing function score were recorded in the three groups, and the incidences of subcutaneous hematoma were recorded after treatment.@*RESULTS@#Compared before treatment, the PAS scores were reduced and the Ichiro Fujima ingestion-swallowing function scores were increased after treatment in the three groups (P<0.05); the PAS scores in the observation group were lower than those in the control-1 group and the control-2 group, and the Ichiro Fujima ingestion-swallowing function scores in the observation group were higher than those in the control-1 group and the control-2 group (P<0.05). After treatment, the forward and upward movement distance of hyoid bone and thyroid cartilage in the observation group and the control-2 group was increased (P<0.05), and the forward and upward movement distance of hyoid bone was increased in the control-1 group (P<0.05); the forward and upward movement distance of hyoid bone and thyroid cartilage in the observation group was longer than that in the control-1 group and the control-2 group (P<0.05). The incidence of subcutaneous hematoma in the observation group was 0% (0/40), which was lower than 20.0% (8/40) in the control-1 group and 47.5% (19/40) in the control-2 group (P<0.05).@*CONCLUSION@#Ultrasound-guided EA at suprahyoid muscle group could improve the swallowing function in patients with pharyngeal dysphagia after stroke by increasing the motion of hyoid laryngeal complex. Its effect and safety are better than conventional acupuncture and conventional EA at suprahyoid muscle group.
Subject(s)
Humans , Deglutition Disorders/therapy , Electroacupuncture , Muscles , Stroke/diagnostic imaging , Ultrasonography, Interventional/adverse effectsABSTRACT
Objective:To investigate the effect of cricopharyngeal injection of Botulinum toxin under ultrasonic guidance for treatment of dysphagia caused by Wallenberg's syndrome. Methods:A case was reviewed. Results:This patient was diagnosed as cricopharyngeal achalasia after dorsal lateral rostral infarction, and responded poor to routine treatment for swallowing disorders, including balloon dilatation. He accepted cricopharyngeal Botulinum toxin injection under ultrasonic guidance. As evaluated with Toshima Ichiro Ingestion-Swallowing Function Rating Scale, Rosenbek Penetration-Aspiration Scale and videofluoroscopic swallowing study (VFSS), his swallowing improved after treatment, and became normal as follow-up one and three months after treatment. Conclusion:Cricopharyngeal Botulinum toxin injection under ultrasonic guidance is feasible for cricopharyngeal achalasia of Wallenberg's syndrome with immediate and long-term effect.
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OBJECTIVE: To investigate the effect of electrical stimulation with bilateral scalp acupuncture on time parameters in video fluoroscopic swallowing study and cortical excitability in patients with dysphagia after cortical stroke, as well as its possible mechanism of action. METHODS: A total of 84 patients with dysphagia after cortical stroke were randomly divided into control group with 41 patients and observation group with 43 patients. The patients in the control group were given acupuncture based on acupoint selection for pseudobulbar palsy, and in addition to the treatment in the control group, the patients in the observation group were given electrical stimulation of bilateral scalp acupuncture, with acupuncture and pulse acupuncture at the lower 2/5 of the bilateral anterior oblique parietotemporal lines[on the line connecting Qianshencong (EX-HN1) to Xuanli (GB6)] and the lower 2/5 of the bilateral posterior oblique parietotemporal lines [on the line connecting Baihui (GV20)and Qubin (GB7)], with a needle retaining time of 30 minutes, once a day and 6 times a week for 3 weeks. Before treatment and after 3 weeks of treatment, oral delay time (ODT), oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were compared between the two group; the Rosenbek Penetration-Aspiration Scale was used to evaluate penetration-aspiration and appro-ximate entropy (ApEn) of EEG nonlinear index. RESULTS: After treatment, both groups had significant reductions in ODT, OTT, PDT, PTT, and Rosenbek Penetration-Aspiration score and a significant increase in ApEn (P0.05). CONCLUSION: In addition to body acupuncture, electrical stimulation with bilateral scalp acupuncture can improve ODT and OTT in the treatment of patients with dysphagia after cortical stroke, which may be associated with the increased excitability of the swallowing cortex.
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<p><b>OBJECTIVE</b>To assess the effectiveness and safety on post-stroke dysphagia in chronic stage treated with magnetic-ball sticking therapy at the auricular points.</p><p><b>METHODS</b>Ninety cases of post-apoplexy dysphagia in chronic stage were randomized into an auricular points group and an acupuncture group. In the auricular points group, the magnetic-ball sticking therapy was applied to subcortex (pizhixia, AT4), brainstem (naogan, AT(3,4i)), mouth (kou, CO1), cheek (mianjia, LO(5,6i)), tongue (she, LO2) and throat (yanhou, TG3) on one ear each time, and were changed on the other ear once every 3 days. In the acupucnture group, acupuncture was applied to Feng-chi (GB 20), Yifeng (TE 17), Shanglianquan (Extra), Jinjin (EX-HN 12), Yuye (EX-HN 13), Shuigou (GV 26) and Tongli (TH 5), etc. The needles were retained for 30 min in each treatment. The treatment was gi-yen once a day in the two groups and the treatment of 6 days made one session. There was 1 day at an interval among the sessions. Totally, 3 sessions of treatment were required. The video fluoroscopic swallowing study (VFSS) was performed for 4 kinds of food with different properties and shapes in each patient. The main indices were Rosenbek penetration-aspiration score, oral-retaining score and throat-retaining score. The efficacy, and the incidences of aspiration pneumonia and malnutrition were compared between the two groups. The nutrition indices were compared before and after treatment between the two groups, such as the skinfold thickness of triceps brachii muscle, serum albumin and peralbumin.</p><p><b>RESULTS</b>In 21 days of treatment, in the auricular points group, the 1 mL liquid loversol Rosenbek penetration-aspiration score (1.51 +/- 0.69), oral-retaining score (1.17 +/- 0.38) and throat-retaining score (1.30 +/- 0.66) were all lower than those (2.51 +/- 0.67, 1.63 +/- 0.72, 1.67 +/- 0.7) in the acupuncture group separately. The 10 mL liquid loversol Rosenbek penetration-aspiration score (2.27 +/- 0.65), oral-retaining score (1.60 +/- 0.50) and throat-retaining score (1.49 +/- 0.51) were all lower than those (4.19 +/- 0.73, 2.30 +/- 0.51, 2.41 +/- 0.50) in the acupuncture group separately. The 10 mL paste loversol Rosenbek penetration-aspiration score (1.68 +/- 0.81), oral-retaining score (1.11 +/- 0.31) and throat-retaining score (1.10 +/- 0.31) were all lower than those (3.91 +/- 0.68, 1.63 +/- 0.76, 1.60 +/- 0.76) in the acupuncture group separately. The 1/4 cake-form loversol Rosenbek penetration-aspiration score (2.60 +/- 0.65), oral-retaining score (1.40 +/- 0.50) and throat-retaining score (1.74 +/- 0.49) were all lower than those (4.14 +/- 1.10, 2.40 +/- 0.73, 2.30 +/- 0.83) in the acupuncture group separately. The incidence of aspiration pneumonia was 14.9% (7/47) in the auricular points group, which was lower than 55.0% (22/40) in the acupuncture group (P < 0.01). The incidence of malnutrition was 8. 5% (4/47) in the auricular points group, which was lower than 50.0% (20/40) in the acupuncture group (P < 0.01). In 21 days of treatment, the results of the skinfold thickness of triceps brachii muscle and serum albumin in the auricular points group were better than those in the acupuncture group (both P < 0.05).</p><p><b>CONCLUSION</b>The magnetic-ball sticking therapy at auricular points achieves the definite efficacy on post-stoke dysphagia in chronic stage and decreases the incidences of aspiration pneumonia and malnutrition. The efficacy of this therapy is better than acupuncture.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Acupuncture, Ear , Deglutition Disorders , Therapeutics , Magnetics , Stroke , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To assess the clinical efficacy on post-stroke shoulder-hand syndrome (SHS) treated with acupuncture and rehabilitation and the impacts on patients' nailfold microcirculation.</p><p><b>METHODS</b>One hundred and twenty patients were randomized into an acupuncture rehabilitation group and a simple rehabilitation group, 60 cases in each one. In the simple rehabilitation group, OT (comprehensive rehabilitation therapy) training was adopted. In the acupuncture rehabilitation group, on the basis of the treatment as the simple rehabilitation, acu puncture was added at Taiyuan (LU 9), Zusanli (ST 36), Xuanzhong (GB 39), Waiguan (TE 5), Shousanli (LI 10), Quchi (LI 11) and Jianyu (LI 15). Acupuncture was given once a day, 7 days made one session. Totally, 4 sessions of treatment were required. Fugl-Meyer score, upper limb pain score, the score of nerve function defect and the items of nailfold microcirculation of patients were assessed in the the two groups before and after treatment. The efficacy was compared between the two groups.</p><p><b>RESULTS</b>(1) The upper limb pain, the systematic motor function of the upper limbs, the nerve function defect, nailfold microcirculation and clinical symptoms were all improved after treatment in either the acupuncture rehabilitation group or the simple rehabilitation group as compared with those before treatment, indicating the significant difference (P<0. 05, P<0. 01). (2) The im provements in the upper limb pain (0. 90+/-0.71 vs 1. 80+/-0. 66), the systematic motor function of the upper limbs (42. 43 13. 57 vs 29. 98+/-15. 11), the nerve function defect (8. 60+/-11. 61 vs 13. 0+/-1. 74), nailfold microcirculation (total score 3. 18+/-1.32 vs 4.34+/-1.23) and clinical symptoms in the acupuncture rehabilitation group after treatment were different significantly as compared with those in the simple rehabilitation group (PO0. 05,P-O. 01), and the results in the acupuncture rehabilitation group were superior to the simple rehabilitation group. (3) In the acupuncture rehabilitation group, the markedly effective rate was 50. 0% (30/60) and the total effective rate was 93.3% (56/60), which was better than 16.7% (10/60) and 63. 3% (38/60) respectively in the simple rehabilitation group (all P<0. 05).</p><p><b>CONCLUSION</b>Both the combined therapy of acupuncture and rehabilitation and the simple rehabilitation training are effective in the treatment of post-stroke SHS, and promote the status of nailfold microcirculation, the efficacy of the combined therapy is better than that of the latter.</p>