The effect of modified catheter balloon dilatation therapy on corticobulbar excitability in dysphagic brainstem stroke patients / 中华物理医学与康复杂志

ABSTRACT

Objective To explore the effect of the modified balloon dilatation on excitability of the submental swallowing muscle and its relationship with swallowing function of dysphagic patients with brainstem stroke.Methods Thirty unilateral brainstem stroke patients with upper esophageal sphincter (UES) dysfunction were recruited and randomly divided into a dilatation group and a control group,each of 15.The control group was given the routine swallowing therapy twice daily,while the dilatation group was provided one routine swallowing treatment plus a modified balloon dilatation daily.The treatment lasted 3 weeks,30min per day and 5 days per week.Both groups were evaluated using the bilateral submental motor evoked potentials (SMEPs),penetration-aspiration scale (PAS) and functional oral intake scale (FOIS) before and after treatment.Results Repeated analysis of variance showed that there was significant interaction effect of group,time on SMEPs.The MEPs of the affected submental muscle increased significantly in both groups after treatment (P＜0.01),but only the amplitude of SMEP of the affected submental muscles in the dilatation group was higher than that of the control group after treatment (P＜0.05).In the dilatation group,the average FOIS score increased significantly (P＜0.01),while the average PAS score decreased significantly after the treatment (P＜0.05).An increase of amplitude of the affected SMEP was strongly correlated with the improvement in the average PAS score (P＜0.01,r=0.815),but weakly correlated with the average FOIS score (P =0.02,r =0.43).Conclusion The modified balloon dilatation therapy can increase the excitability of the cortical-affected lateral brainstem-swallowing muscle pathway in patients with unilateral brainstem stroke,which might be more correlated with improvement in swallowing safety.