Post Stroke Dysphagia: Effect of Adding rTMS to Conventional Therapy on the Prevalence of Pneumonia.

NCT ID: NCT06123650

Last Updated: 2025-10-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-03-22

Study Completion Date

2026-01-27

Brief Summary

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BACKGROUND: Dysphagia is one of the most life-threatening stroke complications. Dysphagic stroke patients are at increased risk of aspiration pneumonia. Pneumonia accounts for at least 10% of post stroke deaths within 30 days of hospitalization after stroke. rTMS is effective in improving post-stroke dysphagia and swallowing coordination after stimulation of the unaffected hemisphere, however it's efficacy on the prevalence of pneumonia has not yet been examined.

Purpose of the study: To determine the effect of adding low frequency repetitive transcranial magnetic stimulation to conventional oropharyngeal physical therapy program on the prevalence of aspiration pneumonia in in patients with post stroke dysphagia.

Detailed Description

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Seventy acute ischemic stroke patients with oropharyngeal dysphagia from both sexes will represent the sample of this study. They will be diagnosed by a neurologist and stroke diagnosis was confirmed by brain MRI and/or CT. They will be selected from the stroke unit El Kasr El Ainy hospital, Cairo university.

Patients will be randomly assigned into two equal groups, the control group (A) and the study group (B). Control group (GA) will be treated using a designed physical therapy intervention for oropharyngeal dysphagia consists of a selected physical therapy rehabilitation program for oropharyngeal muscles in addition to sham repetitive transcranial magnetic stimulation. Study group (GB) will receive low frequency (1 Hz) rTMS to the contra-lesional cerebral hemisphere in addition to the same Oropharyngeal physical therapy program for dysphagia as in group A.

Modified Mann Assessment of Swallowing Ability (MASA) will initially used to confirm dysphagia in acute stroke. The Gugging swallowing screening (GUSS) test will be used to detect aspiration risk. A2DS2 scale will be used to detect stroke associated pneumonia (SAP). Criteria of modified Center for Disease Control and Prevention (CDC) will be used to assess SAP via assessing 4 main measures (body temperature (BT), Total Leukocyte count (TLC), Arterial blood gases (ABG), and Respiratory Rate (RR) .

The whole Intervention will consist of 12 sessions, 3 days /week for 4 consecutive weeks , Total duration of the session (TMS + PT session) will be from 40min to 60 min.

Primary \& secondary outcomes will be assessed at the baseline and immediately after the completion of the whole treatment program.

Conditions

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Stroke, Acute Dysphagia Pneumonia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized Controlled Clinical trial, where the recruited patients will be randomly assigned into 2 equal groups ( GA \& GB) using sealed envelopes, control group (GA) and study group (GB). Patients in (GA) will be treated by a designed physiotherapy program consists of: ice massage, oromotor exercises, Masako maneuver, resisted jaw opening exercise, modified chin tuck against resistance, Mandelson maneuver, effortful swallow and chin tuck in addition to sham repetitive transcranial magnetic stimulation. Patients in (GB) will be treated by low frequency (1 Hz) rTMS to the contralesional cerebral hemisphere in addition to the same Oropharyngeal physical therapy program for dysphagia as in group A.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Patients participated will be masked about the type of intervention, where (GA) patients will receive PT program + sham repetitive transcranial magnetic stimulation, while patients in (GB) will receive low frequency (1 Hz) rTMS to the contralesional cerebral hemisphere in addition to the same Oropharyngeal physical therapy program for dysphagia as in group A.

Study Groups

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Control group (GA)

Group (A) will receive conventional oral care and oropharyngeal physical therapy program for dysphagia including; Exercise therapy for the oropharyngeal and tongue muscles , in addition to sham transcranial magnetic stimulation on the contralesional cerebral hemisphere.

Group Type PLACEBO_COMPARATOR

Sham transcranial magnetic stimulation

Intervention Type DEVICE

Repetitive TMS via a sham Magstim coil (identical appearance and noise, but no active stimulation). Identical stimulation schedules as patients in study group.

Study group (GB)

Group (B) will received low frequency (1 Hz) repetitive transcranial magnetic stimulation to the contralesional cerebral hemisphere in addition to the same Oropharyngeal physical therapy program for dysphagia as in group A.

Group Type ACTIVE_COMPARATOR

Repetitve transcranial magnetic stimulation

Intervention Type DEVICE

The Magstim Rapid2 magnetic stimulator system (Model P/N 3576-23-09, Magstim Company, Whitland, UK) was used to deliver rTMS electrical currents via a figure of 8 coil applied to the scalp against the targeted contralesional motor " Hot spot" , at a depth of approximately 1 cm . The inhibitory rTMS will be applied to the intact cerebral hemisphere at 1 Hz with a train of 1200 for 5 consecutive days.

Interventions

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Repetitve transcranial magnetic stimulation

The Magstim Rapid2 magnetic stimulator system (Model P/N 3576-23-09, Magstim Company, Whitland, UK) was used to deliver rTMS electrical currents via a figure of 8 coil applied to the scalp against the targeted contralesional motor " Hot spot" , at a depth of approximately 1 cm . The inhibitory rTMS will be applied to the intact cerebral hemisphere at 1 Hz with a train of 1200 for 5 consecutive days.

Intervention Type DEVICE

Sham transcranial magnetic stimulation

Repetitive TMS via a sham Magstim coil (identical appearance and noise, but no active stimulation). Identical stimulation schedules as patients in study group.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. All the patients were diagnosed of stroke oropharyngeal dysphagia by a neurologist. Sever to moderate dysphagia (GUSS 0-14).
2. Severity of stroke ranged from mild to moderate according to NIHSS score (NIHSS less than or equal 16).
3. Patients' age ranged from 49 to 65 years old.
4. Patients had the ability to understand and follow instructions.
5. Patients were able to sit in upright position.

Exclusion Criteria

1. History of previous stroke.
2. History of any swallowing problem.
3. History of any head and neck surgery or tumor that causes swallowing dysfunction.
4. Any lung disease or pneumonia on admission.
5. Patients with cognitive deficits or disturbed conscious level.
6. Patients on mechanical ventilator.
7. Patients with sensory or global aphasia.
Minimum Eligible Age

49 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cairo University

OTHER

Sponsor Role lead

Responsible Party

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Engy Badreldin Saleh Moustafa, PhD

Lecturer of Physical Therapy for Neurology and Neurosurgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Engy B. Moustafa, PhD

Role: PRINCIPAL_INVESTIGATOR

Faculty of Physical Therapy, Cairo University, Egypt

Locations

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Faculty of Physical Therapy, Cairo University

Giza, Giza Governorate, Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Engy B. Moustafa, PhD

Role: CONTACT

00201099445112

Moshera H. Darwish, PhD

Role: CONTACT

00201015163617

Facility Contacts

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Engy B. Moustafa, PhD

Role: primary

00201099445112

Moshera H. Darwish, PhD

Role: backup

00201015163617

Other Identifiers

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P.T.REC/012/004748

Identifier Type: -

Identifier Source: org_study_id

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