Effect of Closed-Loop Neuromodulation Combined with Direct Feeding Training on Swallowing Function in Post-Stroke Dysphagia

<bold>Objective</bold>To observe the effect of "closed-loop" neuromodulation combined with direct feeding training on swallowing function in patients with dysphagia after stroke.<bold>Methods</bold>A total of 100 patients with post-stroke dysphagia who met the inclusion criteria and were treated at the Department of Rehabilitation, Brain Hospital Affiliated to Nanjing Medical University from March 2023 to March 2024 were selected. They were divided into four groups using random number table method: the control group, the feeding group, the "closed-loop" neuromodulation (CLN) group, and the combination group, with 25 cases in each group. During the study, 9 cases were lost to follow-up, including 1 from the control group, 2 from the feeding group, 4 from the CLN group, and 2 from the combination group. All four groups received conventional swallowing training. Additionally, the feeding group received direct feeding training, the CLN group received central + peripheral repetitive transcranial magnetic stimulation (rTMS), and the combination group received both direct feeding training and central + peripheral rTMS. Conventional swallowing training and CLN were conducted once daily, 5 days per week, for 2 consecutive weeks. Relevant data were collected from the four groups before treatment and after 2 weeks of treatment. The Videofluoroscopic Grade of Dysphagia (VGF) was used to assess the severity of dysphagia. The Functional Oral Intake Scale (FOIS) was used to assess oral feeding ability. The Penetration-Aspiration Scale (PAS) was used to assess airway penetration and aspiration. Digital videofluoroscopic swallowing examination was performed using DSA equipment to assess the hyoid bone vertical displacement distance (HV) and hyoid bone anterior displacement distance (HA).<bold>Results</bold>Compared with those before treatment, the VGF scores of all four groups increased after treatment (<italic>P</italic>&lt;0.05); compared with the control group, the VGF scores of the feeding group, CLN group, and combination group all increased after treatment (<italic>P</italic>&lt;0.05); compared with the feeding group, the VGF scores of the combination group increased (<italic>P</italic>&lt;0.05); compared with the CLN group, the VGF score of the combination group increased (<italic>P</italic>&lt;0.05). Compared with those before treatment, the FOIS scores of all four groups increased after treatment (<italic>P</italic>&lt;0.05); compared with the control group, the FOIS scores of the feeding group, CLN group, and combination group all increased after treatment (<italic>P</italic>&lt;0.05); compared with the feeding group, the FOIS scores of the combination group increased (<italic>P</italic>&lt;0.05); compared with the CLN group, the FOIS score of the combination group increased (<italic>P</italic>&lt;0.05). Compared with those before treatment, the PAS scores of all four groups decreased after treatment (<italic>P</italic>&lt;0.05); compared with the control group, the PAS scores of the feeding group, CLN group, and combination group all decreased after treatment (<italic>P</italic>&lt;0.05); compared with the feeding group, the PAS scores of the combination group decreased (<italic>P</italic>&lt;0.05); compared with the CLN group, the PAS score of the combination group decreased (<italic>P</italic>&lt;0.05). Compared with those before treatment, the moving distances of HA and HV in all four groups increased after treatment (<italic>P</italic>&lt;0.05); compared with the control group, the moving distances of HA and HV in the feeding group, CLN group, and combination group all increased after treatment (<italic>P</italic>&lt;0.05); compared with the feeding group, the moving distances of HA and HV in the combination group increased (<italic>P</italic>&lt;0.05); compared with the CLN group, the moving distances of HA and HV in the combination group both increased (<italic>P</italic>&lt;0.05).<bold>Conclusion</bold>The intervention method of "closed-loop" neuromodulation combined with direct feeding training can significantly improve the swallowing function of patients with post-stroke dysphagia, reduce aspiration, and increase oral feeding ability.