Ye Changming, WANG Lili, XIA Lijuan, XIANG Xinyu, CHEN Yaru
ObjectiveTo 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 post-stroke dysphagia complicated with dysarthria.MethodsFrom January 2024 to January 2025，80 patients with post-stroke dysphagia complicated with dysarthria treated at Zhangjiakou No. 2 Hospital were randomly divided into the control group and the experimental group using a random number table，with 40 cases in each group. During the treatment period，2 cases in the experimental group withdrew due to personal reasons，1 case was lost to follow-up; 1 case in the control group withdrew due to hospitalization for non-study-related gastrointestinal disease，and 2 cases were lost to follow-up. Finally，37 cases in each group were included in the analysis. The control group received routine stroke rehabilitation training，dysphagia rehabilitation training，and dysarthria rehabilitation training，once daily，5 days per week，for 8 weeks. The experimental group additionally received rTMS therapy combined with speech-auditory feedback cognitive training. rTMS was delivered using a figure-of-eight coil with a MagPro R30 stimulator. For patients with predominant dysphagia，a "low-frequency inhibition of the contralesional hemisphere" protocol was applied at 1 Hz over the swallowing motor cortex of the contralesional hemisphere; for patients with predominant dysarthria，a "high-frequency excitation of the ipsilesional hemisphere" protocol was applied at 10 Hz over Broca's area of the ipsilesional hemisphere. Each session delivered 2，000 pulses，once daily，5 days per week，for 8 weeks. Cognitive function was assessed using the Montreal Cognitive Assessment （MoCA）; memory function was assessed using the Rivermead Behavioural Memory Test-Second Edition （RBMT-II）; speech function was assessed using the Frenchay Dysarthria Assessment Scale; swallowing function was assessed using the Standardized Swallowing Assessment （SSA），Modified Mann Assessment of Swallowing Ability （MMASA），Video Fluoroscopic Swallowing Study （VFSS），and Functional Oral Intake Scale （FOIS）; quality of life was assessed using the Generic Quality of Life Inventory-74 （GQOLI-74）. Adverse reactions （headache，dizziness，nausea，etc. ） were recorded and compared between the two groups.Results①MoCA score and RBMT-II score：Compared with before treatment，the MoCA score and RBMT-II score of both groups significantly increased after treatment （P0. 05）. Compared with the control group，the experimental group showed significantly higher MoCA and RBMT-II scores after treatment （P0. 05）. ②Frenchay scores：Compared with baseline，both groups showed significant decreases in Frenchay scores after treatment （P0. 05）. Compared with the control group，the experimental group showed significantly lower Frenchay scores after treatment （P0. 05）. ③SSA，MMASA，VFSS，and FOIS scores：Compared with baseline，both groups showed significant decreases in SSA scores and significant increases in VFSS，MMASA，and FOIS scores after treatment （P0. 05）. Compared with the control group，the experimental group showed significantly lower SSA scores and significantly higher VFSS，MMASA，and FOIS scores after treatment （P0. 05）. ④GQOLI-74 scores：Compared with baseline，both groups showed significant increases in GQOLI-74 scores after treatment （P0. 05）. Compared with the control group，the experimental group showed significantly higher GQOLI-74 scores after treatment （P0. 05）. ⑤Adverse reactions：No significant difference was observed in the incidence of adverse reactions between the two groups （χ2=1. 390，P=0. 238）.ConclusionThe combination of rTMS and speech-auditory feedback cognitive training can effectively improve cognitive function，memory function，speech function，swallowing function，and quality of life in patients with post-stroke dysphagia complicated with dysarthria.