| Objective: To observe the therapeutic effect of different frequency repetitive transcranial magnetic stimulation (rTMS) combined with articulation training on dysarthria in patients with Parkinson’s disease (PD). Method: A total of 64 patients with PD articulation disorders were randomly divided into a control group, a high-frequency group, a low-frequency group, and a sham stimulation group, with 16 cases in each group. The control group received 40 min of articulation training. The high-frequency group was treated with 5Hz rTMS stimulation of the both of primary sensory motor area (OF-SM1) on both sides of the mouth and face for 20 min combined with articulation training for 40 min on the basis of the conventional group. The low-frequency group received 1Hz rTMS stimulation of the OF-SM1 area on both sides for 20 min combined with articulation training for 40 min on the basis of the conventional group. The sham stimulation group received rTMS stimulation of the OF-SM1 area on both sides (without magnetic field output) for 20 min combined with articulation training for 40 min on the basis of the conventional group, once a day, for a total of 30 days of treatment. Before treatment, immediately after treatment (30 days after treatment), and during follow-up (30 days after treatment), the frenchay dysarthria rating scale, hoarseness rat-ing scale (GRBAS), The voice handicap index (VHI), The communication effectiveness index (CETI) scale, amplitude standard deviation, continuous speech ability speech rate, speech fundamental frequency standard deviation (F0SD), maximum phonation time (MPT), maximum counting ability (cMCA), contact quotient perturbation (CQP), normalized noise energy (NNE), second formant (F2/i/) and average intensity assessment were used to compare the therapeutic differences in articulatory organ motor function, voice hoarseness degree and self-subjective perception, verbal communication ability, speech rhythm, speech speed, intonation, respiratory support, respiration and vocal coordination, glottic closure regularity, breath sound, oral resonance, and volume among 4 groups. Results: Compared to those before treatment, frenchay scores, amplitude standard deviation, mean intensity, F0SD, MPT, cMCA, mean intensity, F2/i/ and CETI scores in the 4 groups were significantly increased after treatment (P<0.05), while CQP, NNE, CQP, GRBAS scores and VHI scores were significantly decreased (P<0.05). After treatment, the speech rate of continuous speech ability in high frequency group and low frequency group was significantly increased (P<0.05). Compared with those before treatment, amplitude standard deviation, mean intensity, F2/i/ and CETI scores in the 4 groups were significantly increased during follow-up (P<0.05), while NNE, GRBAS and VHI scores were significantly decreased during follow-up (P<0.05). CQP in high frequency group was significantly decreased during follow-up (P<0.05). The frenchay scores, F0SD, the speech rate of continuous speech ability, MPT and cMCA in high frequency group and low frequency group were significantly increased during follow-up (P<0.05). The frenchay scores, amplitude standard deviation, F0SD, the speech rate of continuous speech ability, MPT, cMCA, mean intensity, F2/i/and CETI scores in high frequency group were significantly higher than those in other groups after treatment and at follow-up (P<0.05). CQP, NNE, GRBAS and VHI scores were significantly lower than those of other groups after treatment and at follow-up (P<0.05). Conclusion: High frequency rTMS combined conventional articulation training can improve the articulation movement, respiratory support ability, the coordination ability of breathing and vocalization, the regularity of glottis closure, volume, oral resonance and language communication ability in PD patients, reduce breathing sound, hoarseness and self-subjective feelings of voice disorder, and improve monotonous intonation, mono-loudness, pronunciation delay and pause. Its efficacy is superior to conventional articulation training and low frequency rTMS, and has a certain long-term effect, which is worthy of clinical promotion. |
