[Tongnao Huoluo Liyan acupuncture combined with rehabilitation training for post-stroke dysphagia: a randomized controlled trial]

Abstract

Objective: To observe the efficacy of the Tongnao Huoluo Liyan (unblocking brain, activating collaterals and relaxing throat) acupuncture combined with rehabilitation training for post-stroke dysphagia (PSD).

Methods: A total of 92 PSD patients were randomly assigned to an observation group (46 cases, 1 case was discontinued) and a control group (46 cases, 1 case was discontinued, 1 case dropped out). The patients in the control group received rehabilitation training, including low-frequency neuromuscular electrical stimulation for swallowing, lip and tongue movement training, and oral sensory function training, once daily, five times per week, for four weeks. The patients in the observation group received the Tongnao Huoluo Liyan acupuncture method in addition to the same rehabilitation training. Acupoints included Lianquan (CV23), bilateral Jia Lianquan, Jinjin (EX-HN12), Yuye (EX-HN13), Baihui (GV20), Shuigou (GV26), and bilateral Neiguan (PC6), once daily, five times per week, for four weeks. Before and after treatment, Kubota water stvallowing test grading, standardized swallowing assessment (SSA) scores, Fujishima Ichiro swallowing efficacy scores, and swallowing quality of life questionnaire (SWAL-QOL) scores were assessed in both groups. Surface electromyography (sEMG) was used to evaluate the average amplitude (AEMG) and mean swallowing time of the suprahyoid and infrahyoid muscle groups.

Results: After treatment, the proportion of patients classified as Grade Ⅰ or Ⅱ in the Kubota water stvallowing test was increased in both groups (P<0.05), with better results in the observation group compared to the control group (P<0.05). Compare before treatment, SSA scores were decreased in both groups after treatment (P<0.05), with lower scores in the observation group than in the control group (P<0.05). Compare before treatment, Fujishima Ichiro swallowing efficacy scores and SWAL-QOL scores were improved in both groups after treatment (P<0.05), with significantly higher scores in the observation group than those in the control group (P<0.05). Compare before treatment, AEMG values of the Submental musckes and infrahyoid muscles groups were increased (P<0.05), and mean swallowing time was decreased (P<0.05) in both groups after treatment. The observation group showed greater increases in AEMG values and shorter mean swallowing times compared to the control group (P<0.05). The total effective rate was 97.8% (44/45) in the observation group, higher than 84.1% (37/44) in the control group (P<0.05).

Conclusion: The Tongnao Huoluo Liyan acupuncture combined with rehabilitation training could enhance the contraction function in swallowing-related muscle groups, facilitate hyoid and laryngeal elevation, restore swallowing function, and improve patients' quality of life. This combined treatment approach is superior to rehabilitation training alone.

Keywords: Tongnao Huoluo Liyan acupuncture method; dysphagia; randomized controlled trial (RCT); stroke; surface electromyography (sEMG).