{"title":"Effects of four non-invasive stimulations on swallowing function and quality of life of stroke patients-a network meta-analysis.","authors":"Xinyu Lin, Haojie Li, Xie Wu, Rui Huang","doi":"10.3389/fnhum.2025.1519660","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Stroke is a sudden neurological disorder that causes severe neurological damage mainly due to lack of oxygen to brain cells as a result of interruption of blood flow to the brain. Dysphagia is a common problem in stroke patients, interfering with diet and nutrition and possibly leading to complications. About 50-80% of stroke patients experience dysphagia in the acute phase, which may lead to serious consequences such as aspiration and pneumonia. Therefore, improving swallowing function is essential to enhance patients' quality of life (QoL). Traditional rehab methods are limited, but non-invasive stimulation is safer and improves swallowing function through various mechanisms: pharyngeal electrical stimulation (PES) boosts cortical excitability and plasticity by stimulating pharyngeal nerves; neuro-muscular electrical stimulation (NmeS) enhances infrahyoid muscle strength and mobility with low-frequency pulses; repetitive transcranial magnetic stimulation (rTMS) promotes motor cortex remodeling; transcranial direct current stimulation (tDCS) increases neural activity in swallowing-related regions. These techniques are safe, easy to use, and show great potential for clinical application, needing further study.</p><p><strong>Methods: </strong>Six databases were systematically searched, and 17 randomized controlled trials with 788 stroke patients were finally included. The outcome indicators were swallowing function and QoL related indicators. Net meta-analysis was performed using Stata 17.0 to assess the relative effectiveness of each combined intervention and to test the consistency of direct and indirect evidence.</p><p><strong>Results: </strong>For swallowing function, rTMS [SMD = 5.10, 95% CI (3.20, 7.01), <i>p</i> < 0.0001, SUCRA = 87.3] showed the best results. For QoL, NmeS [SMD = 3.51, 95% CI (0.54, 6.47), <i>p</i> < 0.0001, SUCRA = 79.3] shows all its unique advantages.</p><p><strong>Conclusion: </strong>rTMS can effectively improve the swallowing function of stroke patients, while NmeS has the best effect in improving the QoL.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42024603146.</p>","PeriodicalId":12536,"journal":{"name":"Frontiers in Human Neuroscience","volume":"19 ","pages":"1519660"},"PeriodicalIF":2.4000,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966035/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Human Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fnhum.2025.1519660","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Stroke is a sudden neurological disorder that causes severe neurological damage mainly due to lack of oxygen to brain cells as a result of interruption of blood flow to the brain. Dysphagia is a common problem in stroke patients, interfering with diet and nutrition and possibly leading to complications. About 50-80% of stroke patients experience dysphagia in the acute phase, which may lead to serious consequences such as aspiration and pneumonia. Therefore, improving swallowing function is essential to enhance patients' quality of life (QoL). Traditional rehab methods are limited, but non-invasive stimulation is safer and improves swallowing function through various mechanisms: pharyngeal electrical stimulation (PES) boosts cortical excitability and plasticity by stimulating pharyngeal nerves; neuro-muscular electrical stimulation (NmeS) enhances infrahyoid muscle strength and mobility with low-frequency pulses; repetitive transcranial magnetic stimulation (rTMS) promotes motor cortex remodeling; transcranial direct current stimulation (tDCS) increases neural activity in swallowing-related regions. These techniques are safe, easy to use, and show great potential for clinical application, needing further study.
Methods: Six databases were systematically searched, and 17 randomized controlled trials with 788 stroke patients were finally included. The outcome indicators were swallowing function and QoL related indicators. Net meta-analysis was performed using Stata 17.0 to assess the relative effectiveness of each combined intervention and to test the consistency of direct and indirect evidence.
Results: For swallowing function, rTMS [SMD = 5.10, 95% CI (3.20, 7.01), p < 0.0001, SUCRA = 87.3] showed the best results. For QoL, NmeS [SMD = 3.51, 95% CI (0.54, 6.47), p < 0.0001, SUCRA = 79.3] shows all its unique advantages.
Conclusion: rTMS can effectively improve the swallowing function of stroke patients, while NmeS has the best effect in improving the QoL.
期刊介绍：
Frontiers in Human Neuroscience is a first-tier electronic journal devoted to understanding the brain mechanisms supporting cognitive and social behavior in humans, and how these mechanisms might be altered in disease states. The last 25 years have seen an explosive growth in both the methods and the theoretical constructs available to study the human brain. Advances in electrophysiological, neuroimaging, neuropsychological, psychophysical, neuropharmacological and computational approaches have provided key insights into the mechanisms of a broad range of human behaviors in both health and disease. Work in human neuroscience ranges from the cognitive domain, including areas such as memory, attention, language and perception to the social domain, with this last subject addressing topics, such as interpersonal interactions, social discourse and emotional regulation. How these processes unfold during development, mature in adulthood and often decline in aging, and how they are altered in a host of developmental, neurological and psychiatric disorders, has become increasingly amenable to human neuroscience research approaches. Work in human neuroscience has influenced many areas of inquiry ranging from social and cognitive psychology to economics, law and public policy. Accordingly, our journal will provide a forum for human research spanning all areas of human cognitive, social, developmental and translational neuroscience using any research approach.
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