重复经颅磁刺激联合言语听觉反馈认知训练对缺血性脑卒中后吞咽障碍合并构音障碍患者的影响OA

Objective To evaluate the effects of repetitive transcranial magnetic stimulation(rTMS)combined with speech-auditory feedback cognitive training on cognitive function,memory function,speech function,swallowing function,and quality of life in patients with ischemic stroke complicated by dysphagia and dysarthria.Methods A total of 80 patients with ischemic stroke-induced dysphagia and dysarthria admitted to the Second Hospital of Zhangjiakou City from January 2024 to January 2025 were ran-domly assigned into control group and experimental group using a random number table,with 40 cases in each group.During the treatment,two cases in the experimental group withdrew due to personal reasons and one case was lost to follow-up;one case in the control group withdrew due to hospitalization for non-study-related gastrointestinal disease,and two cases were lost to follow-up.Ul-timately,a total of 37 cases in each group were included.The control group received routine stroke rehabilitation training,dysphagia rehabilitation training,and dysarthria rehabilitation training,once daily,five days per week for eight weeks.The experimental group received rTMS therapy combined with speech-auditory feedback cognitive training in addition to the interventions of the control group.A magnetic stimulator was used for rTMS treatment.When dysphagia was the primary manifestation,the"low-frequency sup-pression of the contralateral hemisphere"mode was applied,with the stimulation target located in the swallowing motor cortex of the contralateral hemisphere,using a stimulation frequency of 1 Hz.When dysarthria was the primary manifestation,the"hemispheric high-frequency stimulation"mode was applied,with the stimulation target located in the Broca's area of the affected side,using a stimulation frequency of 10 Hz.The total number of pulses per session was 2 000,once a day,five days per week for eight weeks.Speech-auditory feedback cognitive training,once a day,30 minutes a time,five days per week for eight weeks.Before and after treatment,the Montreal Cognitive Assessment(MoCA)was used to assess cognitive function;the Rivermead Behavioural Memory Test-Ⅱ(RBMT-Ⅱ)was used to assess memory function;Frenchay Dysarthria Assessment Scale was used to assess the severity of articulatory organ dysfunction;Standardized Swallowing Assessment(SSA),Modified Mann Assessment of Swallowing Ability(MMASA),Videofluoroscopic Swallowing Study(VFSS),and Functional Oral Intake Scale(FOIS)were used to assess swallowing function;Generic Quality of Life Inventory-74(GQOLI-74)was used to assess the quality of life.The incidence of adverse reac-tions,such as headache,dizziness,and nausea was compared between the two groups.Results(1)MoCA and RBMT-Ⅱ scores:compared with those before treatment,the MoCA and RBMT-Ⅱ scores of both groups increased significantly after treatment(P＜0.05).Compared with the control group,MoCA and RBMT-Ⅱ scores in the experimental group were significantly higher after treatment(P＜0.05).(2)Frenchay score:compared with those before treatment,Frenchay scores in both groups decreased significantly after treatment(P＜0.05).Compared with the control group,Frenchay score in the experimental group was significantly lower after treatment(P＜0.05).(3)SSA,MMASA,VFSS,and FOIS scores:compared with those before treatment,SSA scores in both groups decreased significantly after treatment(P＜0.05),and VFSS,MMASA,and FOIS scores increased significantly after treatment(P＜0.05).Compared with the control group,SSA score in the experimental group was significantly lower after treatment(P＜0.05),and VFSS,MMASA,and FOIS scores were significantly higher after treatment(P＜0.05).(4)GQOLI-74 score:compared with those before treatment,GQOLI-74 scores in both groups increased significantly after treatment(P＜0.05).Compared with the control group,GQOLI-74 score in the experimental group was significantly higher after treatment(P＜0.05).(5)Adverse reactions:there was no significant difference in the incidence of adverse reactions between the two groups(P=0.238).Conclusion rTMS com-bined with speech-auditory feedback cognitive training can effectively improve cognitive function,memory function,speech func-tion,swallowing function,and quality of life in patients with ischemic stroke complicated by dysphagia and dysarthria.