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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.
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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.
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75 participants in 2 patient groups, including a placebo group
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Moshera H. Darwish, PhD; Engy BadrEldin S Moustafa, PhD
Data sourced from clinicaltrials.gov
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