The Effects Of Action Observation Therapy On Patients With Post-stroke Dysphagia Based On SEMG And FNIRS

Objective: In this study,by assessing patients with dysphagia after stroke with Watian swallowing test(WST),the functional oral Intake scale(FOIS),standard swallowing assessment(SSA)and the eating assessment Tool(EAT-10),surface electromyogram(s EMG)and functional near-infrared spectroscopy(f NIRS),we could estimate the clinical efficacy of action observation therapy(AOT),explore possible mechanisms of this therapy,and provide new ideas for the hospital-community-family tertiary rehabilitation path of dysphagia after stroke.Methods: There were 36 patients with dysphagia after stroke selected as research subjects.All of them were divided conventional group(18 cases)and observation group(18 cases)basing on the random number table.What they had in common was: all patients cured in the Sichuan Provincial People’s Hospital Rehabilitation Department from February 2022 to December 2022.Both groups received conventional medical treatment,conventional rehabilitation,and conventional swallowing rehabilitation therapy.According to the specific condition and different dysfunction of each patient,symptomatic treatments such as improving circulation,regulating lipid and stabilizing plaque,stabilizing blood pressure and blood sugar and corresponding functional trainings were given.Conventional swallowing rehabilitation therapy performed once a day,20 minutes each time,five days a week,including swallowing muscle electrical stimulation,oral facial muscle training,breathing training,pharyngeal ice stimulation,Mendelsohn maneuver,feeding training,swallowing position and so on.Basing on the treatments mentioned above,observation group accepted action observation therapy by homemade swallowing video while conventional group watched ordinary landscape video.Two videos both lasted 10 minutes.After watching the video,two groups all received a swallowing movement training for 5 minutes by oral guidance of a therapist.The whole intervention lasted 15 minutes each time,performed before lunch and dinner,five days a week and lasted three weeks.Before and after the intervention,Watian swallowing test(WST),the functional oral Intake scale(FOIS),standard swallowing assessment(SSA)and the eating assessment Tool(EAT-10),surface electromyogram(s EMG)and functional near-infrared spectroscopy(f NIRS)were assessed.Results:1.Swallowing scalesBefore treatment,there were no statistically significant differences between two groups(P > 0.05).After 3-weeks’ treatment,intra-group comparison: WST grades,SSA scores and EAT-10 scores in both groups were lower than those before treatment while FOIS grade was higher,and there were statistical differences(P < 0.05).Comparison between two groups: except for FOIS(P=1.000),the change range of WST,EAT-10 and SSA in observation group was better than it in conventional group with a statistical significance(P<0.01,<0.01,<0.01).2.Surface electromyography(s EMG)There were no statistically significant differences between two groups before treatment.After 3 weeks of training,the amplitude of suprahyoid muscles and subhyoid muscles of both groups were increased than those before treatment while the duration of swallowing muscles decreased,and there were statistical differences(P < 0.01).Comparison between two groups: except for the duration of subhyoid muscles(P > 0.05),the change range of the amplitude of swallowing muscles and the duration of suprahyoid muscles in observation group were better than those in conventional group,with a statistical significance(P < 0.01,< 0.01,< 0.01).3.Functional near-infrared spectroscopy(f NIRS)Global indicators,number of connecting edges,functional connectivity,topographic map did not show significant differences.According to Brodmann area,the regions of interest(ROI)with statistical differences were mainly dorsolateral prefrontal cortex(DLPFC),Broca,pre-motor and supplementary motor cortex(Pre M＿and＿SMC).In the node indicators,Broca＿R region before and after treatment in observation group,Pre M＿and＿SMC-L region before and after treatment in conventional group,and both sides of Pre M＿and＿SMC and DLPFC-R after treatment between two groups were significantly different.Conclusion: 1.From the perspective of swallowing scales,AOT could improve WST,EAT-10,SSA scale scores,and improve swallowing function of patients with stroke dysphagia.2.It could be seen from the s EMG index,which reflected the effector of the swallowing reflex pathway,that action observation therapy could improve strength of the swallowing muscles and shorten swallowing time.3.From the results of f NIRS,which reflected the central of the swallowing reflex pathway,it showed that there were significant differences in some brain regions,mainly involving bilateral PreM＿and＿SMC,DLPFC-R and Broca＿R,although overall brain function connection was not significantly enhanced.4.Combining all results of swallowing scales,s EMG and f NIRS,action observation therapy basing on mirror neuron system,a top-down rehabilitation training,may activate brain areas like PreM＿and＿SMC,DLPFC and Broca,and then enhance swallowing muscles’ strength,shorten swallowing time,improve swallowing process,and promoted recovery of swallowing function eventually.5.AOT based on homemade videos was effective,which was conducive to extension of swallowing therapy after stroke,and provided new ideas for diagnosis and treatment of hospital-community-family tertiary stroke rehabilitation.