“Opening The Orifices And Alleviating Throat Obstruction” Four-step Acupuncture Method Combined with Motor Imagery Therapy for Post-Stroke Dysphagia

Summary

This study evaluates a four-step acupuncture method combined with motor imagery for post-stroke dysphagia. Results demonstrate significant improvements in swallowing safety and oral intake. The protocol provides a standardized, multi-target intervention for clinical rehabilitation.

Abstract

Stroke is a disease with one of the highest disability rates, frequently associated with multiple functional impairments. Among these, dysphagia is a relatively common complication, with an incidence rate exceeding 30%. PSD not only causes malnutrition, dehydration, and aspiration pneumonia but also prolongs hospital stays and severely compromises patients' quality of life. Both the "Opening the Orifices and Alleviating Throat Obstruction" four-step acupuncture technique (a TCM therapy) and motor imagery (MI) therapy are effective for PSD. However, the efficacy of combining this specific acupuncture technique with MI remains unclear. This study aims to investigate the safety and effectiveness of integrating the "Opening the Orifices and Alleviating Throat Obstruction" four-step acupuncture technique with MI therapy for PSD rehabilitation. Patients were randomized into two groups: the control group received standard rehabilitation, while the treatment group received the combined acupuncture and MI therapy in addition to standard care. Outcomes were assessed using the Water Swallowing Test (WST), Functional Oral Intake Scale (FOIS), and Penetration-Aspiration Scale (PAS). The results demonstrated that after 28 days of treatment, the WST and PAS scores decreased in both groups relative to pre-treatment levels, while the FOIS scores increased. Furthermore, the WST and PAS scores in the treatment group were lower than those in the control group, and the FOIS score was higher, with statistically significant differences (P < 0.05). The treatment group scored higher than the control group in three dimensions of the Nurse-Patient Satisfaction Nursing Scale (NPSNS): medical professional level, clinical treatment effect, and overall satisfaction. These differences were statistically significant (P < 0.05). However, no statistically significant differences were observed in the scores for the two dimensions of hardware environment configuration and medical service experience between the two groups (P > 0.05). These results highlight the efficacy of the combined treatment approach in enhancing swallowing function and minimizing leakage and aspiration.

Introduction

Stroke is a leading cause of long-term disability, frequently manifesting as post-stroke dysphagia (PSD), which affects over 30% of survivor¹. Dysphagia not only leads to serious consequences such as malnutrition, dehydration, and aspiration pneumonia for patients, but also significantly prolongs hospital stays, increases the healthcare burden, and severely compromises patients’ quality of life and psychological well-being². Currently, the treatment methods for dysphagia after stroke mainly include neuromuscular electrical stimulation (NMES), swallowing function training, and various compensatory strategies

Protocol

This research protocol was performed in strict accordance with the ethical guidelines approved by the Ethics Committee of Zhejiang Provincial Tongde Hospital (Project Number: 2024-047 (K)). Obtain written informed consent from all patients or their legal representatives prior to participation, ensuring permission for the use and publication of anonymized data. Refer to the Table of Materials for detailed specifications of the materials and instruments used.

1. Study design

1. Randomization: Generate a random allocation sequence using a computer-based random number generator. Seal assignments in seq....

Results

A total of 60 patients were recruited for this study and randomly divided into two groups, with 30 patients in each group (Figure 1). The control group received conventional rehabilitation treatment and consisted of 20 males and 10 females, with a mean age of 52.69 ± 10.34 years and a disease duration of 3.52 ± 0.63 months. The treatment group underwent a combined therapy of the "Opening the Orifices and Alleviating Throat Obstruction" four-step acupuncture method and MI training, comprising.......

Discussion

Post-stroke dysphagia (PSD) involves damage to both central and peripheral neural pathways²⁴. Lesions in the cortical swallowing center and descending tracts cause motor incoordination of pharyngeal muscles, leading to delayed swallowing initiation and aspiration risks²⁵. Clinically, this manifests as food retention in the throat, an increased risk of choking, and a higher likelihood of aspiration³. Anatomical studies further reveal that restricted t.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Acupuncture Needles	HUATUO	0.35 × 50 mm	Used for posterior pharyngeal wall pricking and sublingual bloodletting +1
Acupuncture Needles	HUATUO	0.30 × 40 mm	Used for horizontal needling of vertex/temporal regions
Acupuncture Needles (Long)	HUATUO	0.30 × 75 mm	Used for deep needling at "Three Pharyngeal Points"
Computer	H3C	H3C X5-020s	Used for playing standardized eating demonstration videos for Motor Imagery
Electric toothbrush	BAIR	CCSY-62	Vibration stimulation (60 Hz) in the oral cavity
IBM SPSS Statistics Software	IBM Corp., USA	Version 26.0	Used for data analysis and statistics
Lemon Glycerin Swabs	General Medical Supplier	10113507084228	pH ≤ 3.5; Used for taste trigger stimulation
Metronome	Metronome	Metronome	Used to coordinate speed (0.5 Hz) during dynamic training
Opaque Envelopes	Deli	DL35612	Used for allocation concealment (Randomization)
Silicone Chew Stick	General Medical Supplier	10196923335746	Hardness 50 Shore A; Used for resistance training
Tongue Depressor	HAYNAUT	150mm*18mm	Used to stabilize tongue during Masako technique
Videofluoroscopy Equipment	longest	LGT-5500	Used for VFSS and PAS score evaluation