Prevalence of Pneumonia After Adding Repetitive Transcranial Magnetic Stimulation in Poststroke Dysphagia

Cairo University (CU)

Status: Enrolling

Conditions: Dysphagia; Stroke, Acute; Pneumonia

Treatments: Device: Sham transcranial magnetic stimulation; Device: Repetitve transcranial magnetic stimulation

Study type: Interventional

Funder types: Other

Identifiers

NCT06123650

P.T.REC/012/004748

Details and patient eligibility

About

BACKGROUND: Dysphagia is one of the most life-threatening stroke complications. Dysphagic stroke patients are at increased risk of aspiration pneumonia. Pneumonia accounts for at least 10% of post stroke deaths within 30 days of hospitalization after stroke. rTMS is effective in improving post-stroke dysphagia and swallowing coordination after stimulation of the unaffected hemisphere, however it's efficacy on the prevalence of pneumonia has not yet been examined.

Purpose of the study: To determine the effect of adding low frequency repetitive transcranial magnetic stimulation to conventional oropharyngeal physical therapy program on the prevalence of aspiration pneumonia in in patients with post stroke dysphagia.

Full description

Seventy Five acute ischemic stroke patients with oropharyngeal dysphagia from both sexes represented the sample of this study. They were diagnosed by a neurologist and stroke diagnosis was confirmed by brain MRI and/or CT. They were selected from the stroke unit El Kasr El Ainy hospital, Cairo university.

Patients will be randomly assigned into two equal groups, the control group (A) and the study group (B). Control group (GA) will be treated using a designed physical therapy intervention for oropharyngeal dysphagia consists of a selected physical therapy rehabilitation program for oropharyngeal muscles in addition to sham repetitive transcranial magnetic stimulation. Study group (GB) will receive low frequency (1 Hz) rTMS to the contra-lesional cerebral hemisphere in addition to the same Oropharyngeal physical therapy program for dysphagia as in group A.

Stroke dysphagia will be diagnosed by a neurologist. Modified Mann Assessment of Swallowing Ability (MASA) will be also used, it is a screening tool for identifying eating and swallowing disorders in acute stroke, used to quantify aspiration risk via bedside test. The Gugging swallowing screen (GUSS) bedside screening test will be used to detect dysphagia and aspiration risk. A2DS2 scale will be used to detect stroke associated pneumonia (SAP). Stroke associated pneumonia (SAP) will be diagnosed according to the criteria of the modified Center for Disease Control and Prevention (CDC), it will be conducted via assessing 4 main measures (body temperature (BT), Total Leukocyte count (TLC), Arterial blood gases (ABG), and Respiratory Rate (RR) . All variables will be assessed at the baseline and immediately after the completion of the treatment protocol.

Enrollment: 75 estimated patients

Sex: All

Ages: 49 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. All the patients were diagnosed of stroke oropharyngeal dysphagia by a neurologist. Sever to moderate dysphagia (GUSS 0-14).
2. Severity of stroke ranged from mild to moderate according to NIHSS score (NIHSS less than or equal 16).
3. Patients' age ranged from 49 to 65 years old.
4. Patients had the ability to understand and follow instructions.
5. Patients were able to sit in upright position.

Exclusion criteria

1. History of previous stroke.
2. History of any swallowing problem.
3. History of any head and neck surgery or tumor that causes swallowing dysfunction.
4. Any lung disease or pneumonia on admission.
5. Patients with cognitive deficits or disturbed conscious level.
6. Patients on mechanical ventilator.
7. Patients with sensory or global aphasia.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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75 participants in 2 patient groups, including a placebo group

Control group (GA)

Placebo Comparator group

Description:

Group (A) will receive conventional Oropharyngeal physical therapy program for dysphagia including; Exercise therapy for the oropharyngeal and tongue muscles , neuromuscular electrical stimulation in addition to sham transcranial magnetic stimulation on the contralesional cerebral hemisphere.

Treatment:

Device: Sham transcranial magnetic stimulation

Study group (GB)

Active Comparator group

Description:

Group (B) will received low frequency (1 Hz) repetitive transcranial magnetic stimulation to the contralesional cerebral hemisphere in addition to the same Oropharyngeal physical therapy program for dysphagia as in group A.

Treatment:

Device: Repetitve transcranial magnetic stimulation