Low-Frequency Repetitive Transcranial Magnetic Stimulation with Sensory Arousal Nursing for Post-Stroke Dysphagia

Post-stroke dysphagia can compromise airway protection, nutrition, and functional recovery. This article describes a clinical protocol combining low-frequency repetitive transcranial magnetic stimulation (rTMS) with a structured sensory arousal nursing package for patients with acute ischemic stroke and dysphagia accompanied by feeding-related upper-limb dysfunction. Dysphagia is the primary treatment focus; upper-limb activities address associated limitations in self-feeding. The protocol integrates screening, stimulation safety review, motor-threshold determination, contralesional swallowing-motor targeting, 1 Hz rTMS, sequenced sensory input, feeding-related task practice, and outcome assessment. Representative results come from a single-center, randomized, assessor-blinded study of 160 patients (80 per group) comparing the combined intervention with routine nursing for swallowing rehabilitation over 2 weeks. The between-group difference in Standardized Swallowing Assessment change was -3.9 points (95% confidence interval [CI], -5.8 to -2.0; p < 0.001). The between-group change-score differences were 0.8 levels for the Functional Oral Intake Scale (95% CI, 0.4 to 1.2; p < 0.001) and -0.9 points for the Penetration-Aspiration Scale (95% CI, -1.5 to -0.3; p = 0.004), the latter restricted to participants with paired instrumental assessments (48 versus 46). Aspiration pneumonia occurred in 5/80 versus 11/80 participants (p = 0.118); no serious rTMS-related adverse events were reported. These findings indicate short-term differences in scale scores but do not establish a clinically important benefit in swallowing or a reduced risk of pneumonia. The protocol coordinates established rehabilitation components. Further studies are needed to determine their individual effects and identify patients who may benefit from contralesional inhibition.