메타분석을 이용한 뇌졸중 연하장애에 적용된 반복적 경두개 자기자극(rTMS), 경두개 직류자극(tDCS)과 신경근전기자극치료(NMES)의 효과

Objective: Randomized controlled trials (RCTs) using neuromuscular electronic stimulation (NMES) and non-invasive brain stimulation (NIBS) were applied for early access to clinicians included in a post-stroke swallowing intervention. A meta-analysis of the research will provide concrete effects and suggestions for improvement. Methods: We searched articles from 2008 to 2019 published in Pubmed, CINAHL (EBSCOhost), Psycinfo, Korean Studies Information Service System (KISS), and the Research Information Sharing Service (RISS). The main key words are “stroke OR CVA OR cerebrocascular accident OR vascular accident” AND “dysphagia OR swallowing disorder OR deglutition disorder” AND “tDCS OR transcranial direct current stimulation OR rTMS OR repetitive transcranial magnetic stimulation OR NMES OR neuromuscular electronic stimulation” AND “RCT OR randomized control trial,” “뇌졸중” AND “연하장애,” AND “경두기 자기자극 OR 경두개 직류자극 OR 신경근전기자극” AND “무작위대 조실험.” The inclusion and exclusion criteria were applied to a total of 11 studies. Results: The electrical stimulation intensity of transcranial direct current stimulation (tDCS) was 1 mA, the electrical stimulation intensity of repetitive transcranial magnetic stimulation (rTMS) was 3-5 Hz, the neuromuscular electrical stimulation (NMES) varied from 8 to 15 mA, tDCS and rTMS showed large effect sizes, and NMES demonstrated a medium effect size. Conclusion: This study confirmed the effects of three treatments through a meta-analysis and confirmed the various results according to the patients' characteristics and mediation direction. However, three treatments are deemed effective for the recovery of swallowing disorder after a stroke in Korea and are considered safe. In addition, it is necessary to study various factors leading to a recovery of a swallowing disorder.