Brain-Swallowing Network Modulation: Neurorestoration by Bilateral Cerebell ar iTBS and Laryngeal Elevation Training in Post-Stroke Dysphagia

Brain-Swallowing Network Modulation: Neurorestoration by Bilateral Cerebell ar iTBS and Laryngeal Elevation Training in Post-Stroke Dysphagia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Brain-Swallowing Network Modulation: Neurorestoration by Bilateral Cerebell ar iTBS and Laryngeal Elevation Training in Post-Stroke Dysphagia Haiquan Zhang, Jingyun Tan, Di Zhang, Wei Lu, Min Liu, Shanshan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8315560/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Previous studies have shown that pharyngeal elevation training can improve swallowing function in stroke patients, but the central nervous system interventions have limited effects. Intermittent theta burst stimulation (iTBS) applied to bilateral cerebellar hemispheres may enhance cortical excitability. However, the efficacy and underlying mechanisms of combining bilateral cerebellar iTBS with real-time biofeedback-guided pharyngeal elevation training for post-stroke dysphagia remain unclear. Objective This study investigates, for the first time, the combined effect of bilateral cerebellar iTBS and biofeedback-guided pharyngeal elevation training on swallowing function and cortical activity in stroke patients during the recovery phase.Methods:Forty-two stroke patients with dysphagia were enrolled based on hospital electronic screening; 3 dropped out, and 1 ceased due to condition change, another transferred hospitals, and 1 withdrew voluntarily, leaving 42 participants. They were randomly assigned to three groups (n = 14 each): Control (conventional rehabilitation), Sham-iTBS + SET, and Active-iTBS + SET. The latter two groups received additional interventions: Sham or active bilateral cerebellar iTBS combined with swallowing exercises. Swallowing function was assessed using the Standardized Swallowing Assessment (SSA) and Penetration-Aspiration Scale (PAS) before and after 4 weeks of treatment. Functional near-infrared spectroscopy (fNIRS) recorded cortical activation during tasks and resting-state functional connectivity.Results:After 4 weeks, all groups exhibited significant improvements in SSA and PAS scores (P < 0.05). Compared to the control, both Sham-iTBS + SET and Active-iTBS + SET showed superior improvements (P < 0.05), with the Active-iTBS + SET group outperforming the Sham group (P < 0.05). fNIRS revealed that the Active-iTBS + SET group significantly activated the right prefrontal cortex (RPFC) and premotor areas (PM), enhancing interhemispheric and intra-network functional connectivity, including between the PFC and other regions, and between M1 and PM (P < 0.05). Local node connectivity was also increased (P < 0.05). Improvements in SSA scores correlated positively with activation in RPM and RPFC (P < 0.05). Conclusion Bilateral cerebellar iTBS combined with pharyngeal elevation training significantly improves swallowing function in post-stroke dysphagia patients, associated with increased activation of the right prefrontal cortex and premotor areas, and enhanced cortico-cortical connectivity. The RPM region may serve as a potential neural target for cerebellar iTBS in stroke rehabilitation. Health sciences/Neurology Biological sciences/Neuroscience Stroke Cortical function Repetitive transcranial magnetic stimulation Laryngeal ascending reinforcement training Functional near-infrared spectroscopy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Post-stroke dysphagia presents a significant challenge in neurorehabilitation, with epidemiological data indicating a high prevalence of up to 30–67% (Pinho et al., 2024 ). This impairment not only increases the risk of aspiration pneumonia by over threefold (Karisik et al., 2025 ) but also often prevents rapid recovery of swallowing function, leading to secondary complications such as malnutrition and dehydration (Imaz-Higuera et al., 2025 ; Kwakkel et al., 2023 ; Lee et al., 2025 ; Tarvonen-Schroeder & Koivisto, 2023 ), significantly prolonging recovery time and elevating the 30-day readmission rate (Li et al., 2025 ). While conventional rehabilitation methods can offer short-term improvements in swallowing symptoms, they largely fail to restore the neuro-muscular coordination involved in swallowing initiation, execution, and cortical regulation—including laryngeal movement—leading to over 50% of patients experiencing delayed or insufficient laryngeal lift even in later stages of recovery (Ma et al., 2024 ). This underscores the limitations of current interventions in modulating neuroplasticity within the corticobulbar-cerebellar pathways (Mottolese et al., 2013 ). Fundamentally, this bottleneck stems from the difficulty peripheral training faces in reconstructing the dynamic coordination between swallowing initiation, execution, and cortical control (Everaert et al., 2025 ). In recent years, non-invasive brain stimulation techniques have offered new avenues for reorganizing swallowing neural circuits. Numerous studies have confirmed that repetitive transcranial magnetic stimulation (rTMS) can improve swallowing function by modulating cortical excitability (Bath et al., 2018 ; Cheng & Hamdy, 2021 ; Li et al., 2020 ). However, current interventions primarily target the primary motor cortex, with limited research focusing on the cerebellum—a crucial regulator in swallowing (Sasegbon et al., 2021 ; Wang et al., 2023 ). Notably, JAMA studies have shown that the cerebellum, via the dentate nucleus-thalamus-cortex pathway, participates in temporal coordination of motor activities, with its neuroplasticity potentially providing new therapeutic targets for functional recovery (Koch et al., 2019 ). Importantly, intermittent theta burst stimulation (iTBS), a novel rTMS protocol, can induce long-term potentiation-like effects to enhance synaptic plasticity. Related research indicates that bilateral cerebellar iTBS surpasses unilateral stimulation in improving cortical function (Rao et al., 2022 ). Meanwhile, pharyngeal elevation training demonstrates unique peripheral intervention benefits. This training employs resistance swallowing, glottic elevation swallowing, and biofeedback techniques to precisely enhance the timely contraction of the thyrohyoid and mentalist muscles. Its mechanisms have evolved from anatomical studies to functional imaging evidence (Meng et al., 2023 ). Our earlier research validates that pharyngeal elevation training, combined with conventional rehabilitation, effectively improves swallowing function in post-stroke dysphagia patients (Meng et al., 2025 ). However, isolated peripheral training encounters limitations in modulating the corticobulbar-cerebellar pathways (Huckabee et al., 2023 ; Kagaya & Inamoto, 2022 ). Whether a “closed-loop” approach—integrating central nervous system stimulation with peripheral training—can enhance therapeutic efficacy remains unclear. Building on these limitations, our study adopts the “central-peripheral-central” (CPC) regulation theory (Jia, 2022 ). We innovatively establish a combined intervention paradigm targeting bilateral cerebellar iTBS and pharyngeal elevation training, with the addition of functional near-infrared spectroscopy (fNIRS) monitoring of cortical activity during rest and task states. The primary aim is to explore whether synergistic reinforcement through this combined approach can improve swallowing function in stroke patients during recovery, aiming to overcome the limitations of individual treatments. Additionally, we intend to assess cortical functional changes under the combined protocol to provide a theoretical basis for precision rehabilitation of dysphagia. Materials and Methods 2.1 Participants This study is a randomized, single-blind, controlled clinical trial. It was approved by the Research Ethics Boards at the Shandong Provincial Third Hospital (KYLL-2023025) and registered at the Chinese Clinical Trial Registry (Trial registration number: ChiCTR2300071303). Inclusion criteria: ① Diagnosed with stroke according to the criteria set by the International Stroke Conference (Hellmich et al., 2020 ), confirmed by cranial CT or MRI; ② First-onset stroke, with duration > 1 week and ≤ 6 months; ③ Age between 20 and 70 years, right-handed; ④ Mini-Mental State Examination (MMSE) score ≥ 21 points (Yun & Han, 2024 ), capable of cooperating with treatment, and without severe cognitive impairment; ⑤ Diagnosed with dysphagia confirmed by videofluoroscopic swallowing study (VFSS), with NIH Stroke Scale (NIHSS) scores > 5 and < 15; ⑥ The participant or their family signed informed consent and agreed to participate in the clinical intervention. Exclusion criteria: ① Hemodynamic instability; ② Severe pain or intolerance to treatment; ③ Extensive scalp skin lesions or skull defects; ④ Presence of intracorporeal metal implants such as pacemakers or metallic skull implants; ⑤ Structural diseases of the oral cavity or pharynx. 2.2 Sample Size Sample size was estimated using G*Power 3.1.9.7 software. A two-tailed F-test was employed for a priori analysis. Assuming an effect size (d) of 0.5 (Drulia & Ludlow, 2013 ), with α = 0.05 and a statistical power (1-β) = 0.8, the minimum required sample size was calculated to be 34 patients. Considering a 20% dropout rate, the final sample size was set at 45 participants. 2.3 Randomization A total of 50 stroke patients with dysphagia during the recovery phase, who were hospitalized in the Department of Rehabilitation Medicine at Shandong Provincial Third Hospital between January 2023 and November 2024, were assessed for eligibility. Among them, 45 patients met the inclusion criteria. These participants were randomly assigned to one of three groups: a Control Group, a Sham-iTBS + SET Group, and an Active-iTBS + SET Group, according to a computer-generated randomization sequence.An independent supervisor, who was not involved in the trial, generated the random sequence and performed the group assignments. This ensured that the research staff remained unaware of and could not influence the allocation process.Blinding of participants was achieved as follows: in the control condition, the coil was rotated 90° and the intensity was set to 10% of the resting motor threshold (RMT), producing an equivalent somatosensory experience. Outcome assessors were also blinded: a neurorehabilitation physician who was unaware of group assignments and not involved in the intervention procedures performed all assessments, with no access to allocation information.All procedures—including the generation of the random sequence, the allocation process, and the identity of the supervisor—were thoroughly documented. A flowchart illustrating patient screening, randomization, assessment, and intervention is provided in Fig. 1 . 2.4 Interventions The Control Group received conventional swallowing training only. The Sham-iTBS + SET Group received sham cerebellar bilateral iTBS stimulation and strength-endurance swallowing exercise training (SET), in addition to conventional rehabilitation. The Active-iTBS + SET Group received active cerebellar bilateral iTBS combined with SET, along with the same conventional rehabilitation program. The intervention protocols are illustrated in Fig. 2 (a). 2.4.1 Conventional Swallowing Training The training included lingual muscle exercises, sensory stimulation, and swallowing reflex facilitation. Each session lasted 30 minutes, administered once per day, five days per week, for a total of four weeks. 2.4.2 Strength-Endurance Swallowing Exercise Training (SET) The training was conducted using a biofeedback-based strength-endurance swallowing exercise device (Model: LES100, South Korea). Participants were seated in a standard position and held a sensor placed under the tongue. Baseline muscle strength and endurance thresholds were automatically recorded based on three standard swallowing actions, with real-time swallowing dynamics curves generated by the system. The formal training consisted of two modules: (1) Isotonic Module: The intensity was set at 80% of the peak baseline value. The muscle strength threshold could be dynamically adjusted by ± 2% based on the participant’s performance. (2) Isometric Module: The intensity was set at 50% of the peak baseline value. Participants were required to maintain hyolaryngeal elevation for 60 seconds, with the endurance threshold fine-tuned dynamically by ± 2% according to performance. Both modules provided real-time feedback on task completion via an interactive interface. Each session lasted 30 minutes, conducted once daily, five days a week, for four weeks. The procedure is illustrated in Fig. 2 (b). 2.4.3 Cerebellar Bilateral iTBS Protocol All participants remained seated and relaxed during the transcranial magnetic stimulation session, which was delivered using a MagNeuro T140 device (3T, Weisiman Medical, Nanjing, China). An figure-of-eight coil was placed tangentially over the skull surface of the dominant hemisphere’s M1 area. The coil was finely adjusted by hand to identify the cortical site eliciting the maximal motor response and shortest latency in the first dorsal interosseous muscle, and the resting motor threshold (RMT) was determined accordingly. The iTBS protocol was applied at 100% RMT (Rao et al., 2022 ), with an intra-burst frequency of 50 Hz and an inter-burst frequency of 5 Hz. Each burst consisted of 3 consecutive pulses, delivered over 2 seconds, followed by an 8-second interval. This cycle was repeated 40 times, resulting in a total of 1200 pulses per session. A conical coil was positioned over the cerebellar pharyngeal representation area (2.5 cm below the inion and 4.3 cm laterally) (Sasegbon et al., 2020 ). Each cerebellar hemisphere received 600 pulses, beginning with the left side followed by the right. The sham group received placebo iTBS using the same coil positioning but with an intensity of 1% RMT, 100% auditory feedback, and the coil rotated 90°. iTBS was administered once daily, five days per week, for four weeks. See Fig. 2 (b) for details. 2.5 Assessment Using the Standardized Swallowing Assessment (SSA) as the primary indicator and the Penetration-Aspiration Scale (PAS) as the secondary indicator, hemodynamic changes were collected via fNIRS. The evaluation indicators for the three groups of patients were assessed in an orderly manner before treatment and after 4 weeks of treatment. All assessments for each patient were completed within one day of treatment, lasting 90 minutes, and were conducted by a swallowing therapist who was unaware of this experiment on homo sapiens. SSA: This swallowing function assessment scale consists of three components: ① Clinical examination (covering 8 indicators including pharyngeal reflex and cough, with a total score ranging from 8 to 23 points); ② Water drinking test (continuously swallowing 5ml of water three times, observing manifestations such as water leakage at the corners of the mouth and laryngeal movement, with a total score ranging from 5 to 11 points); ③ Eating assessment (those who meet the criteria in the first two components proceed to a 60ml water swallowing assessment, observing drinking status and aspiration, with a total score ranging from 5 to 12 points). The total score of the scale ranges from 18 to 46 points, with lower scores indicating milder swallowing dysfunction.(Pinho et al., 2024 )。 PAS: The total score is 8 points, based on the depth and location of food after swallowing. A score of 1 indicates no food entering the airway, while scores of 6–8 indicate tracheal aspiration below the true vocal cords of Phoxinus phoxinus subsp. phoxinus. Higher scores indicate a greater degree of aspiration (Benjapornlert et al., 2020 ). NIRS Assessment: This study utilized near-infrared brain functional imaging (Model: Huichuang, Danyang, China, NirSmart-3000B), employing two near-infrared wavelengths of 730 nm and 850 nm to measure changes in HbO2 concentration, with a sampling frequency of 11 Hz. A total of 14 light source emission points and 14 signal reception points were used, with a 30 mm distance between the probe and light sources, resulting in 35 channels. These channels overjet the subject's cerebral cortex, covering bilateral prefrontal lobes, bilateral motor areas, bilateral primary sensory cortices, and bilateral supplementary motor areas. For further data analysis, the channels were merged into regions of interest (ROI) according to relevant recommendations (Li et al., 2024 ): LPFC: left prefrontal cortex; RPFC: right prefrontal cortex; LPM: left supplementary motor cortex; RPM: right supplementary motor cortex; LS1: left primary somatosensory cortex; RS1: right primary somatosensory cortex. The assessment consists of two parts: resting state and task state. The patient first completes a 5-minute eyes-closed resting state test, avoiding head movements during this period. The task state adopts a continuous swallowing paradigm: the subject sits in front of a computer and performs operations according to on-screen instructions—when "Please start swallowing" appears, the subject continuously swallows 3ml of warm water with the therapist's assistance for 30 seconds; when "Please rest" appears, swallowing stops, and the subject closes their eyes to rest for 30 seconds. The experiment consists of 5 blocks of "swallowing-rest" cycles, with 10 seconds of resting data collected as a baseline before the formal task begins. The total duration of the task state is 310 seconds. The first 30 seconds of each cycle constitute the warm water swallowing task period. The summary of ROI and task procedure are shown in Fig. 2 (d). NIRS Data Processing: The near-infrared spectroscopy data were preprocessed using the HOMER2 toolbox, a graphical user interface program based on MATLAB 2013b (MathWorks, Inc.; Natick, USA). Initially, motion artifacts were eliminated using a method based on the standard deviation of motion and spline interpolation. Motion artifacts were identified by detecting sliding window standard deviations exceeding a specific threshold. Any signal variations in the data channels surpassing the threshold (standard deviation STD and amplitude AMP) were marked as motion artifacts. Spline interpolation was applied to remove these artifacts. Subsequently, a second-order Butterworth bandpass filter with cutoff frequencies of 0.01–0.1 Hz was employed to filter out physiological noise caused by heartbeat, respiration, and high-frequency noise. Finally, the filtered optical data were converted into oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) concentrations using the modified Beer-Lambert law. This study focused on the oxyhemoglobin signal (HbO2) as it better reflects cortical activity. NIRS Data Brain Network Construction of Broussonetia papyrifera: This paper employs graph theory to investigate the characteristics of resting-state brain networks. Thirty-five fNIRS channels serve as nodes in the network, with correlation coefficients between two channels calculated via Pearson correlation analysis acting as edges in the network, generating a corresponding correlation coefficient matrix. The matrix then undergoes Fisher R-to-Z transformation to enhance normality. A threshold range of 0.1–0.8 (with a step size of 0.01) is subsequently applied to sparsify the network, converting the Z-score matrix into absolute values and sorting them from largest to smallest. When the absolute value exceeds the threshold, the connection is assigned a value of 1; otherwise, it is assigned 0 to eliminate weakly correlated or irrelevant connections in the network, thereby obtaining a binary network at the corresponding threshold. We calculated small-world properties and six network parameters: clustering coefficient (Cp), characteristic path length (Lp), global efficiency (GE), local efficiency (LE), node degree (ND), and node efficiency (NE). 2.6 Statistical Analysis Data were analyzed using SPSS software (version 27.0). Normality and homogeneity of variance tests were conducted for all datasets. Continuous variables that satisfied both normality and homogeneity of variance assumptions are presented as mean ± standard deviation (SD). Categorical variables are summarized as counts and percentages. A two-way repeated-measures analysis of variance (ANOVA) was performed for SSA scores, PAS ratings, and cortical activation intensities, with two within-subject factors: time (pre-treatment vs. post-treatment) and group (Control, Sham-iTBS + SET, and Active-iTBS + SET). For any significant main effects or interactions, post-hoc tests with Bonferroni correction were applied to control for type I error. Effect sizes for all ANOVAs are reported as partial eta-squared (η²p), with values interpreted as follows: 0.0099 for small, 0.0588 for medium, and ≥ 0.1379 for large effects.Paired t-tests and one-way ANOVA were used to compare within- and between-group differences in functional connectivity across brain regions, with family-wise error (FWE) correction applied for multiple comparisons. One-way ANOVA was also used to examine between-group differences in brain network metrics, while paired t-tests assessed within-group changes over time.Pearson correlation analysis was conducted to evaluate the relationship between channels showing significant activation and swallowing function outcomes across groups. Demographic and baseline clinical data were compared using chi-square or F tests, as appropriate. Certainly! Here's a polished English translation of the provided text: Results 3.1 General Results During the treatment period, three patients dropped out: one from the Control group due to changes in their condition, one from the Sham-iTBS + SET group who transferred hospitals and interrupted treatment, and one from the Active-iTBS + SET group who voluntarily withdrew. Ultimately, a total of 42 patients were enrolled in the study. These included 14 patients in the Control group, 14 in the Sham-iTBS + SET group, and 14 in the Active-iTBS + SET group. No significant differences were observed among the three groups in baseline characteristics (P > 0.05). Please see Table 1 for details. This study was approved by the Ethics Committee of Shandong Provincial Third Hospital (Approval Number: KYLL-2025033). Table 1 Characteristics of demographic and swallowing function assessment at baseline Control group (n = 14) Sham-iTBS + SET Group (n = 14) Active-iTBS + SET Group (n = 14) F/ χ 2 p Gender 1.026 0.368 Male 9 (64.3%) 12 (85.7%) 9 (64.3%) Female 5 (35.7%) 2 (14.3%) 5 (35.7%) Age(years) 58.21 ± 13.02 51.43 ± 13.17 62.14 ± 7.81 3.055 0.059 Type of stroke 0.907 0.412 Hemorrhagic 10 (71.4%) 10 (71.4%) 7 (50%) Ischemic 4 (28.6%) 4 (28.6%) 7 (50%) Duration since stroke (months) 1.93 ± 0.92 1.50 ± 0.94 2.00 ± 0.78 1.312 0.281 MMSE 24.43 ± 3.11 23.79 ± 2.29 25.07 ± 2.87 0.750 0.479 NIHSS 12.00 ± 1.11 11.64 ± 0.75 11.71 ± 0.73 0.648 0.528 SSA 38.71 ± 1.98 38.86 ± 1.75 39.57 ± 1.65 0.914 0.409 PAS 5.93 ± 0.48 5.64 ± 0.63 5.43 ± 0.51 2.969 0.063 3.2 Clinic outcomes Before treatment, no significant differences were observed in SSA and PAS scores among the three groups. After 4 weeks of treatment, all three groups showed a significant reduction in SSA and PAS scores compared to baseline (p < 0.05). Post-treatment, both the Sham-iTBS + SET Group and the Active-iTBS + SET Group demonstrated significantly better SSA and PAS scores than the Control Group (p < 0.05). Moreover, the Active-iTBS + SET Group exhibited greater improvement in SSA and PAS scores compared to the Sham-iTBS + SET Group (p 0.05).Following treatment, a significant enhancement in activation was observed in the right premotor area (RPM) in the Active-iTBS + SET Group. A significant interaction effect between group and time was found (ch1: F(2, 39) = 5.131, p = 0.011, η²p = 0.208). A significant main effect of time was also observed, F(1, 39) = 8.687, p = 0.005, η²p = 0.182, with post-hoc tests revealing significantly increased activation in the Active-iTBS + SET Group after treatment compared to baseline (t = 11.794, p < 0.001, 95% CI: [-2.076E-06, -5.35E-07]). Furthermore, a significant main effect of group was identified, F(2, 39) = 5.275, p = 0.009, η²p = 0.213. Post-hoc analysis indicated that the Active-iTBS + SET Group exhibited significantly stronger activation than the Control Group (p = 0.009, 95% CI: [3.463E-07, 2.877E-06]) and the Sham-iTBS + SET Group (p = 0.038, 95% CI: [5.591E-08, 2.587E-06]) after treatment.Similarly, enhanced activation was detected in the right prefrontal cortex (RPFC), with a significant group × time interaction (ch20: F(2, 39) = 3.308, p = 0.047, η²p = 0.145). No significant main effect of time was observed. However, a significant main effect of group was found, F(2, 39) = 3.323, p = 0.046, η²p = 0.146. Multiple comparisons showed that the Active-iTBS + SET Group had significantly higher activation than the Sham-iTBS + SET Group after treatment (p = 0.026, 95% CI: [1.496E-07, 3.05E-06]). Table 3 Activated channels after treatment Group Pre-intervention Post-intervention Interaction effect Mean SD Mean SD F p η 2 p CH1 Control group 3.86831E-07 5.30302E-07 1.13116E-08 4.47166E-07 5.131 0.011 0.208 Sham-iTBS+SET Group 4.36587E-07 4.46871E-07 3.01704E-07 4.43627E-07 Active-iTBS+SET Group 3.20652E-07 3.22255E-07 1.62315E-06 2.23101E-06 CH20 Control group 6.08872E-07 1.02986E-06 1.58261E-07 8.73495E-07 3.308 0.047 0.145 Sham-iTBS+SET Group 6.55776E-07 1.08009E-06 5.48706E-09 3.89462E-07 Active-iTBS+SET Group 4.6792E-07 7.69878E-07 1.60646E-06 2.48076E-06 3.4 Function connection Before treatment, there were no statistically significant differences among the groups (P > 0.05). After treatment, all three groups showed improvements compared to before treatment (P < 0.05). According to Fig. 4 (1), the improvement was more pronounced in the Active-iTBS + SET group. Post-hoc analysis revealed that, compared to the Control group, the Active-iTBS + SET group significantly enhanced functional connectivity between the following brain regions:RPM and LS1 (channels 1–13, 1–14, 13–15);RPM and LPM (channels 1–29, 1–33, 1–35, 15–33, 15–35, 18–35, 30–34, 30–35)༛RPM and LM1 (channels 1–32, 15–32, 30–32)༛RPFC and LS1 (channels 5–14)༛RPFC and LM1 (channels 5–32, 19–32)༛LPFC and LS1 (channels 8–13, 10–13, 13–26, 13–33, 13–35)༛LPFC and RS1 (channels 9–16, 10–16, 10–18)༛LPFC and RPM (channels 9–18, 15–26, 15–27, 18–26)༛LPFC and LM1 (channels 10–32)༛LPFC and LPM (channels 10–33)༛LS1 and RM1 (channels 13–17, 14–17)༛LS1 and LM1 (channels 13–32)༛LS1 and RS1 (channels 14–16)༛LPM and RS1 (channels 16–29, 16–33, 16–34, 16–35)༛LM1 and RS1 (channels 16–32)༛RM1 and LPM (channels 17–29)༛LM1 and RM1 (channels 17–32)༛LPM and RM1 (channels 17–33, 17–34, 17–35)༛LPM and LM1 (channels 32–35).All these differences were statistically significant (P < 0.05). Compared to the Sham-iTBS + SET group, the Active-iTBS + SET group showed significantly increased functional connectivity between:RPM and LPFC (channels 1–26, 10–18, 10–31, 11–30, 15–26, 18–26, 26–30, 26–31, 26–34, 27–30);RPM and LPM (channels 1–35, 28–30, 30–35);LPFC and RPFC (channels 5–26, 9–19, 10–19, 19–25, 19–26);LS1 and RM1 (channels 13–17);LPFC and LS1 (channels 13–26, 14–26);RPM and LS1 (channels 13–30);LM1 and RM1 (channels 17–32);RPM and LM1 (channels 18–32, 30–32, 31–32);LPFC and LPM (channels 26–29, 26–34);LPFC and LM1 (channels 26–32).All these differences were statistically significant (P 1). Figure 5 displays the comparison of the areas under the curve (AUC) for six network topological properties before and after treatment within the threshold range of 0.1 to 0.8. From the topological maps of network properties, it can be observed that, after treatment, the brain network indices in the control group showed varying degrees of improvement, except for ND. The Sham-iTBS + SET group showed notable improvements in Cp, Lp, and ND, with a significant reduction in GE and NE. The Active-iTBS + SET group maintained better overall effects. One-way ANOVA results demonstrated significant differences in ND among the three groups before treatment (F(2, 39) = 46..486, p < 0.001, ω² = 0.684). After treatment, ND also showed significant differences among groups (F(2, 39) = 62.054, p < 0.001, ω² = 0.744). No significant differences were observed in other network properties. Since significant between-group differences in nodal degree (ND) were observed at baseline, we further analyzed the results of multiple comparisons. Post-hoc tests indicated that before treatment, the Sham-iTBS + SET Group exhibited a significantly higher nodal degree compared to the Control Group (p < 0.001, 95% CI = [-0.578, -0.342]). Similarly, the Active-iTBS + SET Group showed a higher nodal degree than the Control Group prior to treatment (p < 0.001, 95% CI = [-0.628, -0.392]).After treatment, the Sham-iTBS + SET Group continued to demonstrate a higher nodal degree relative to the Control Group (p < 0.001, 95% CI = [-0.621, -0.390]). The Active-iTBS + SET Group also maintained a higher nodal degree compared to the Control Group (p < 0.001, 95% CI = [-0.698, -0.468]).Within-group comparisons from pre- to post-treatment revealed no significant improvement in the Control Group (t(13) = -0.609, p = 0.553, d = -0.163, 95% CI = [-0.687, -0.368]). In contrast, the Sham-iTBS + SET Group showed significant improvement (t(13) = -2.658, p = 0.020, d = -0.710, 95% CI = [-1.289, -0.110]), as did the Active-iTBS + SET Group (t(13) = -2.572, p = 0.023, d = -0.687, 95% CI = [-1.262, -0.091]).These results indicate that both the Sham-iTBS + SET and Active-iTBS + SET groups exhibited enhanced connectivity in local brain regions following the intervention. 3.5 Correlation Between Cortical Activation and Behavioral To further investigate the association between treatment-induced changes in cortical activation intensity and swallowing function, Spearman correlation analysis was performed to assess the relationship between mean hemoglobin (HbO₂) concentration and SSA scores. The results revealed a significant positive correlation between activation in the RPM (ch1: r = 0.570, p < 0.001) and the RPFC (ch20: r = 0.468, p = 0.001) and SSA scores. As shown in Fig. 7 . 3.6 Adverse Events No major adverse events occurred during the clinical study. The reported adverse events involved transient palpitations in three participants from the experimental group during iTBS treatment, which did not affect the treatment process. This was foreseeable and had been communicated to all patients prior to treatment. Discussion This study innovatively combined cerebellar bilateral iTBS with strength-endurance swallowing exercise training (SET) to systematically investigate the effects of this combined intervention on swallowing function and cortical neuroplasticity in post-stroke dysphagia patients during recovery. The results demonstrated that the Active-iTBS + SET Group showed significantly greater improvements in SSA and PAS scores, activation levels in the RPFC and premotor areas, functional connectivity strength among multiple brain regions, and changes in brain network topology compared to both the Sham-iTBS + SET Group and the Control Group. These findings confirm the synergistic effect of targeted cerebellar neuromodulation and peripheral strength training. This discovery not only provides empirical support for multimodal rehabilitation of post-stroke dysphagia, but also reveals—at a neural mechanism level—the pathway through which combined intervention promotes whole-brain network functional reorganization. 4.1Neurobehavioral Changes The results of this study showed that both the Sham-iTBS + SET Group and the Active-iTBS + SET Group demonstrated significantly better SSA and PAS scores compared to the Control Group. This suggests that laryngeal elevation—as a key biomechanical event during the pharyngeal phase of swallowing—facilitates laryngeal closure by upward movement of the thyroid cartilage and opening of the upper esophageal sphincter (Park et al., 2012 ). Strength-endurance swallowing exercise training (SET), guided by real-time audiovisual biofeedback, enhances patients’ adherence and activates swallowing centers by training relevant muscle groups to improve tongue and laryngeal movement, thereby ameliorating dysphagia (Sasegbon et al., 2020 ). These findings are consistent with our previous research (Meng et al., 2023 ). Furthermore, the Active-iTBS + SET Group exhibited a 25% improvement in SSA scores, which was significantly greater than that in the other two groups. This result aligns with the findings of Rao et al. ( 2022 ), who reported that cerebellar bilateral iTBS alone led to a 20% improvement in swallowing function. The higher improvement observed in our study indicates a synergistic effect when central neuromodulation is combined with peripheral training. This enhanced efficacy may arise from dual-pathway cooperation:On one hand, cerebellar iTBS delivers high-frequency pulses that induce long-term potentiation (LTP), specifically modulating excitability along the dentato-thalamo-cortical pathway (Raies et al., 2024 ; Wang et al., 2023 ). This enhances cerebellar timing control over brainstem swallowing centers, improving core deficits such as delayed laryngeal elevation.On the other hand, SET dynamically regulates isotonic and isometric contraction intensities of the suprahyoid muscles and uses real-time biofeedback to optimize swallowing kinematics, thereby compensating for the limited effect of central intervention alone on muscular coordination. Together, these components form a positive feedback loop of “central timing modulation – peripheral muscle strengthening – closed-loop sensory feedback,” which aligns with the core framework of the CPC theory (Jia, 2022 ) 4.2 Cortical activation and changes in brain connectivy The results of this study using fNIRS indicated that the Active-iTBS + SET group exhibited significant activation of RPM and RPFC during swallowing tasks. This finding differs fundamentally from traditional interventions targeting the primary motor cortex (M1). Wang et al. previously found that pure cerebellar stimulation primarily activates the primary motor area (Wang et al., 2023 ). The innovation of our study lies in the observation that when cerebellar iTBS is combined with peripheral swallowing training, there is a notable advantage in RPM activation. This surpasses the effects of cerebellar stimulation alone and suggests that combined interventions may modulate the cerebellum-thalamus-prefrontal cortex pathway to alleviate compensatory inhibition of the prefrontal cortex post-stroke, thereby enhancing its regulation of swallowing planning and execution (Koch et al., 2019 ; Liao et al., 2024 ). Recent research (Ye et al., 2025 ) indicates that the cerebellum finely regulates human movement through highly organized internal circuits and extensive afferent and efferent connections. Information from motor-related cortical areas is transmitted via specific cerebellar loops, which input extensively into the cerebellar cortex. Functional connectivity analysis revealed that the combined group drove widespread brain network integration, notably enhancing bilateral hemispheric coordination, as well as strengthening the connections between RPFC and LPFC, and between RPM and LPM. These findings confirm that bilateral cerebellar iTBS stimulation promotes interhemispheric functional compensation (Rao et al., 2022 ). Furthermore, it was observed that connections between RPM and sensory and motor regions, as well as between LPFC-LPM and LPFC-LM1, were strengthened, reflecting that the cerebellum optimizes the temporal and spatial coupling of sensory inputs and motor outputs via cortico-brainstem circuits, thereby improving the neural conduction efficiency from swallowing planning to execution. This aligns with the conclusions of Koch’s JAMA study (Koch et al., 2019 ), which suggests that the auxiliary motor area, as a core hub of the swallowing network, directly influences the coordination of laryngeal movements and the risk of aspiration based on its level of activation. Additionally, in this study, the activation levels of RPM and RPFC were positively correlated with SSA scores, indicating that the right auxiliary motor cortex may serve as a potential target for improving swallowing function during stroke recovery. 4.3 Brain network reorganization The topological structure of brain functional networks plays a central role in stroke rehabilitation (Lefebvre et al., 2017 ; Salvalaggio et al., 2020 ). Studies have found that alterations in the topology of brain networks often involve reductions in efficiency and the disruption of local connections, which lead to motor and cognitive impairments (Bullmore & Bassett, 2011 ; Guggisberg et al., 2019 ). During the recovery process, the topology of brain networks tends to restore or optimize, forming the basis for neural function recovery (Bonnal et al., 2024 ; Iandolo et al., 2020 ; Shi et al., 2021 ). Our results show that the Active-iTBS + SET group significantly improved the small-world properties of brain networks, indicating that the brain tends toward a more optimized balance during recovery. This balance facilitates efficient information transfer and integration, essential for functional restoration. Preservation or enhancement of small-world network architecture plays a crucial role in supporting high-efficiency neural information processing (Wang et al., 2010 ). Across different threshold ranges, nodes’ connectivity in the Active-iTBS + SET and Sham-iTBS + SET groups was markedly increased following interventions, especially in key nodes such as RPM, LPFC, and LPM, where connections within essential neural pathways were strengthened. These changes demonstrate enhanced local and global information exchange capabilities. The intervention promotes local connectivity within brain regions, particularly those involved in swallowing motor control. These findings underscore that brain network reorganization is not merely a local phenomenon but involves improving overall connectivity and optimizing network topology, thereby elevating neural regulation capacity at the systemic level. This network-level transformation not only provides a neural basis for the effectiveness of the intervention but also offers potential biomarkers and targets for personalized rehabilitation strategies in the future. 4.4 Research Limitations and Prospects Despite the innovative findings of this study, there are some limitations to consider. First, the fNIRS technology cannot capture activity in deep brain structures such as the cerebellum and brainstem; future research should incorporate fMRI to elucidate the mechanisms of whole-loop pathways. Second, the lack of follow-up data after the intervention limits the assessment of the long-term sustainability of neural reorganization, which warrants further investigation. Additionally, this study did not explore the effects of different stimulation intensities and paradigms. Future studies could compare the therapeutic outcomes of iTBS versus cTBS at varying stimulation intensities in conjunction with peripheral training. Conclusion The combined use of bilateral cerebellar iTBS and pharyngeal elevation training significantly enhances swallowing recovery in post-stroke dysphagia through coordinated activation of the right premotor and prefrontal cortices and reorganization of the whole-brain network. This multimodal, closed-loop approach represents a promising direction for precision neurorehabilitation of dysphagia. Declarations Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships. Data availability The datasets generated during this study are available from the corresponding author upon reasonable request. Funding This study was supported by Jinan Clinical Science and Technology Innovation Program (No: 202328060) and Provincial Key Specialties Program of Shandong Provincial Third Hospital (No: SJZK002). Acknowledgments The authors would like to thank all of the clinicians and researchers who were involved with this study, and all of the participants who took part in this study. References Bath, P. M., Lee, H. S., & Everton, L. F. (2018). Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database of Systematic Reviews (10), Article Cd000323. https://doi.org/10.1002/14651858.CD000323.pub3 Benjapornlert, P., Kagaya, H., Inamoto, Y., Mizokoshi, E., Shibata, S., & Saitoh, E. (2020). The effect of reclining position on swallowing function in stroke patients with dysphagia. Journal of Oral Rehabilitation , 47 (9), 1120-1128. https://doi.org/10.1111/joor.13037 Bonnal, J., Ozsancak, C., Prieur, F., & Auzou, P. (2024). 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Journal of Oral Rehabilitation , 51 (11), 2368-2374. https://doi.org/10.1111/joor.13812 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Mar, 2026 Reviews received at journal 17 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviewers invited by journal 15 Jan, 2026 Editor assigned by journal 26 Dec, 2025 Submission checks completed at journal 11 Dec, 2025 First submitted to journal 11 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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14:10:09","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":350,"visible":true,"origin":"","legend":"","description":"","filename":"Onlineimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/8f14acfae05436d7f6589c0c.png"},{"id":100692240,"identity":"f3dec9cd-352a-41f7-8b6b-948072956c2b","added_by":"auto","created_at":"2026-01-20 14:11:11","extension":"xml","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":133451,"visible":true,"origin":"","legend":"","description":"","filename":"eb5988faa07a4275a64a3d7b93cdc7d01structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/51723ff26518e9954becc089.xml"},{"id":100692089,"identity":"a77c108d-8b5f-44fb-aed2-fddc6bbabe22","added_by":"auto","created_at":"2026-01-20 14:09:52","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":146693,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/9377c9c54899a68f776c116c.html"},{"id":100692090,"identity":"b502de2b-2491-4048-b27c-46b61783c71c","added_by":"auto","created_at":"2026-01-20 14:09:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46328,"visible":true,"origin":"","legend":"\u003cp\u003eThe CONSORT flow diagram of patient screening, randomization, assessment, and intervention.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/f73dde37491c4ed90bce9867.png"},{"id":100691898,"identity":"3b3a9b31-4d45-49c9-8c01-eed94ce251db","added_by":"auto","created_at":"2026-01-20 14:08:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":74118,"visible":true,"origin":"","legend":"\u003cp\u003eExperimental procedure and schematic of fNIRS channel locations on the head\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/63ccb22abff0c5534e0bccd2.png"},{"id":100691807,"identity":"a2df06e7-1846-4136-a8d9-c08dd5f3f5e6","added_by":"auto","created_at":"2026-01-20 14:07:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":26262,"visible":true,"origin":"","legend":"\u003cp\u003eNote: The brain activation maps from left to right represent the F-values of the time main effect, interaction effect, and group main effect, respectively. Redder colors indicate higher F-values, while bluer colors indicate lower values. The colorbar represents the range of F-values.\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/32d4ac0492cd74af87a4db83.png"},{"id":100692065,"identity":"f9a8d583-6ca1-40b1-a2c9-20e7180c7ec7","added_by":"auto","created_at":"2026-01-20 14:09:39","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":68826,"visible":true,"origin":"","legend":"\u003cp\u003eNote: Figure 4(1) shows the mean functional connectivity values and differences across all channels for the three patient groups before and after treatment. From left to right are the pre-treatment, post-treatment, and difference values. From top to bottom are the Control group, Sham-iTBS+SET Group, and Active-iTBS+SET Group. The colorbar indicates the range of Δr. Red represents post-treatment values greater than pre-treatment, while blue represents post-treatment values less than pre-treatment. Figure4 (2) displays the results of post-treatment intergroup multiple comparisons. From left to right are the topological and channel maps of significant channels where the Active-iTBS+SET Group differed from the Control group , followed by the topological and channel maps of significant channels where the Active-iTBS+SET Group differed from the Sham-iTBS+SET Group . FWE correction, p \u0026lt; 0.05.\u003c/p\u003e","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/c74b236df107f8ff9596149d.png"},{"id":100692123,"identity":"ac03f93f-b91c-45d6-bbba-ae294e3aab2e","added_by":"auto","created_at":"2026-01-20 14:10:07","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":14807,"visible":true,"origin":"","legend":"\u003cp\u003eNote:Clustering coefficient (Cp), characteristic path length (Lp), global efficiency (GE), local efficiency (LE), node efficiency (NE), node degree (ND). The topological diagrams of each network property depict the area under the curve within the relevant threshold range (0.1–0.8). The area under the curve is represented by the mean value of all subjects. Normalized mapping is adopted, with the colorbar indicating the normalized data values of network properties. Redder colors represent higher values, while bluer colors indicate lower values.\u003c/p\u003e","description":"","filename":"Onlinefloatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/3d47c02e8e938205c8eda111.png"},{"id":100692140,"identity":"a83c5c76-87b0-48f2-ab35-ba0f6a4c6585","added_by":"auto","created_at":"2026-01-20 14:10:13","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":15613,"visible":true,"origin":"","legend":"\u003cp\u003eMultiple comparisons of ND\u003c/p\u003e\n\u003cp\u003eNote:ND: Node degree. * indicates p \u0026lt; 0.001 compared with the Control group before treatment; # indicates p \u0026lt; 0.001 compared with the Control group after treatment.\u003c/p\u003e","description":"","filename":"Onlinefloatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/6d257a42996507018e4f61c3.png"},{"id":100692099,"identity":"bb20fd2b-20ed-46a7-8feb-935fb5741b45","added_by":"auto","created_at":"2026-01-20 14:09:57","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":25536,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation Analysis Between Behavioral Data and Activation Intensity\u003c/p\u003e","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/6703eee9aa504faa66f7d573.png"},{"id":100699476,"identity":"6606153d-45b6-42a1-8ffd-59e2941e729a","added_by":"auto","created_at":"2026-01-20 15:35:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1363637,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8315560/v1/bc074870-db8a-4cc1-8b04-45189ff5d0c0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Brain-Swallowing Network Modulation: Neurorestoration by Bilateral Cerebell ar iTBS and Laryngeal Elevation Training in Post-Stroke Dysphagia","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePost-stroke dysphagia presents a significant challenge in neurorehabilitation, with epidemiological data indicating a high prevalence of up to 30\u0026ndash;67% (Pinho et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This impairment not only increases the risk of aspiration pneumonia by over threefold (Karisik et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) but also often prevents rapid recovery of swallowing function, leading to secondary complications such as malnutrition and dehydration (Imaz-Higuera et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Kwakkel et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lee et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Tarvonen-Schroeder \u0026amp; Koivisto, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), significantly prolonging recovery time and elevating the 30-day readmission rate (Li et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). While conventional rehabilitation methods can offer short-term improvements in swallowing symptoms, they largely fail to restore the neuro-muscular coordination involved in swallowing initiation, execution, and cortical regulation\u0026mdash;including laryngeal movement\u0026mdash;leading to over 50% of patients experiencing delayed or insufficient laryngeal lift even in later stages of recovery (Ma et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This underscores the limitations of current interventions in modulating neuroplasticity within the corticobulbar-cerebellar pathways (Mottolese et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Fundamentally, this bottleneck stems from the difficulty peripheral training faces in reconstructing the dynamic coordination between swallowing initiation, execution, and cortical control (Everaert et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn recent years, non-invasive brain stimulation techniques have offered new avenues for reorganizing swallowing neural circuits. Numerous studies have confirmed that repetitive transcranial magnetic stimulation (rTMS) can improve swallowing function by modulating cortical excitability (Bath et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Cheng \u0026amp; Hamdy, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, current interventions primarily target the primary motor cortex, with limited research focusing on the cerebellum\u0026mdash;a crucial regulator in swallowing (Sasegbon et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Notably, JAMA studies have shown that the cerebellum, via the dentate nucleus-thalamus-cortex pathway, participates in temporal coordination of motor activities, with its neuroplasticity potentially providing new therapeutic targets for functional recovery (Koch et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Importantly, intermittent theta burst stimulation (iTBS), a novel rTMS protocol, can induce long-term potentiation-like effects to enhance synaptic plasticity. Related research indicates that bilateral cerebellar iTBS surpasses unilateral stimulation in improving cortical function (Rao et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMeanwhile, pharyngeal elevation training demonstrates unique peripheral intervention benefits. This training employs resistance swallowing, glottic elevation swallowing, and biofeedback techniques to precisely enhance the timely contraction of the thyrohyoid and mentalist muscles. Its mechanisms have evolved from anatomical studies to functional imaging evidence (Meng et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Our earlier research validates that pharyngeal elevation training, combined with conventional rehabilitation, effectively improves swallowing function in post-stroke dysphagia patients (Meng et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, isolated peripheral training encounters limitations in modulating the corticobulbar-cerebellar pathways (Huckabee et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Kagaya \u0026amp; Inamoto, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Whether a \u0026ldquo;closed-loop\u0026rdquo; approach\u0026mdash;integrating central nervous system stimulation with peripheral training\u0026mdash;can enhance therapeutic efficacy remains unclear.\u003c/p\u003e \u003cp\u003eBuilding on these limitations, our study adopts the \u0026ldquo;central-peripheral-central\u0026rdquo; (CPC) regulation theory (Jia, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). We innovatively establish a combined intervention paradigm targeting bilateral cerebellar iTBS and pharyngeal elevation training, with the addition of functional near-infrared spectroscopy (fNIRS) monitoring of cortical activity during rest and task states. The primary aim is to explore whether synergistic reinforcement through this combined approach can improve swallowing function in stroke patients during recovery, aiming to overcome the limitations of individual treatments. Additionally, we intend to assess cortical functional changes under the combined protocol to provide a theoretical basis for precision rehabilitation of dysphagia.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003eThis study is a randomized, single-blind, controlled clinical trial. It was approved by the Research Ethics Boards at the Shandong Provincial Third Hospital (KYLL-2023025) and registered at the Chinese Clinical Trial Registry (Trial registration number: ChiCTR2300071303).\u003c/p\u003e \u003cp\u003eInclusion criteria: ① Diagnosed with stroke according to the criteria set by the International Stroke Conference (Hellmich et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), confirmed by cranial CT or MRI; ② First-onset stroke, with duration\u0026thinsp;\u0026gt;\u0026thinsp;1 week and \u0026le;\u0026thinsp;6 months; ③ Age between 20 and 70 years, right-handed; ④ Mini-Mental State Examination (MMSE) score\u0026thinsp;\u0026ge;\u0026thinsp;21 points (Yun \u0026amp; Han, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), capable of cooperating with treatment, and without severe cognitive impairment; ⑤ Diagnosed with dysphagia confirmed by videofluoroscopic swallowing study (VFSS), with NIH Stroke Scale (NIHSS) scores\u0026thinsp;\u0026gt;\u0026thinsp;5 and \u0026lt;\u0026thinsp;15; ⑥ The participant or their family signed informed consent and agreed to participate in the clinical intervention.\u003c/p\u003e \u003cp\u003eExclusion criteria: ① Hemodynamic instability; ② Severe pain or intolerance to treatment; ③ Extensive scalp skin lesions or skull defects; ④ Presence of intracorporeal metal implants such as pacemakers or metallic skull implants; ⑤ Structural diseases of the oral cavity or pharynx.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Sample Size\u003c/h2\u003e \u003cp\u003eSample size was estimated using G*Power 3.1.9.7 software. A two-tailed F-test was employed for a priori analysis. Assuming an effect size (d) of 0.5 (Drulia \u0026amp; Ludlow, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), with α\u0026thinsp;=\u0026thinsp;0.05 and a statistical power (1-β)\u0026thinsp;=\u0026thinsp;0.8, the minimum required sample size was calculated to be 34 patients. Considering a 20% dropout rate, the final sample size was set at 45 participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Randomization\u003c/h2\u003e \u003cp\u003eA total of 50 stroke patients with dysphagia during the recovery phase, who were hospitalized in the Department of Rehabilitation Medicine at Shandong Provincial Third Hospital between January 2023 and November 2024, were assessed for eligibility. Among them, 45 patients met the inclusion criteria. These participants were randomly assigned to one of three groups: a Control Group, a Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group, and an Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group, according to a computer-generated randomization sequence.An independent supervisor, who was not involved in the trial, generated the random sequence and performed the group assignments. This ensured that the research staff remained unaware of and could not influence the allocation process.Blinding of participants was achieved as follows: in the control condition, the coil was rotated 90\u0026deg; and the intensity was set to 10% of the resting motor threshold (RMT), producing an equivalent somatosensory experience. Outcome assessors were also blinded: a neurorehabilitation physician who was unaware of group assignments and not involved in the intervention procedures performed all assessments, with no access to allocation information.All procedures\u0026mdash;including the generation of the random sequence, the allocation process, and the identity of the supervisor\u0026mdash;were thoroughly documented. A flowchart illustrating patient screening, randomization, assessment, and intervention is provided in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Interventions\u003c/h2\u003e \u003cp\u003eThe Control Group received conventional swallowing training only. The Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group received sham cerebellar bilateral iTBS stimulation and strength-endurance swallowing exercise training (SET), in addition to conventional rehabilitation. The Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group received active cerebellar bilateral iTBS combined with SET, along with the same conventional rehabilitation program. The intervention protocols are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e(a).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Conventional Swallowing Training\u003c/h2\u003e \u003cp\u003eThe training included lingual muscle exercises, sensory stimulation, and swallowing reflex facilitation. Each session lasted 30 minutes, administered once per day, five days per week, for a total of four weeks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Strength-Endurance Swallowing Exercise Training (SET)\u003c/h2\u003e \u003cp\u003eThe training was conducted using a biofeedback-based strength-endurance swallowing exercise device (Model: LES100, South Korea). Participants were seated in a standard position and held a sensor placed under the tongue. Baseline muscle strength and endurance thresholds were automatically recorded based on three standard swallowing actions, with real-time swallowing dynamics curves generated by the system. The formal training consisted of two modules:\u003c/p\u003e \u003cp\u003e(1) Isotonic Module: The intensity was set at 80% of the peak baseline value. The muscle strength threshold could be dynamically adjusted by \u0026plusmn;\u0026thinsp;2% based on the participant\u0026rsquo;s performance.\u003c/p\u003e \u003cp\u003e(2) Isometric Module: The intensity was set at 50% of the peak baseline value. Participants were required to maintain hyolaryngeal elevation for 60 seconds, with the endurance threshold fine-tuned dynamically by \u0026plusmn;\u0026thinsp;2% according to performance.\u003c/p\u003e \u003cp\u003eBoth modules provided real-time feedback on task completion via an interactive interface. Each session lasted 30 minutes, conducted once daily, five days a week, for four weeks. The procedure is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e(b).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3 Cerebellar Bilateral iTBS Protocol\u003c/h2\u003e \u003cp\u003eAll participants remained seated and relaxed during the transcranial magnetic stimulation session, which was delivered using a MagNeuro T140 device (3T, Weisiman Medical, Nanjing, China). An figure-of-eight coil was placed tangentially over the skull surface of the dominant hemisphere\u0026rsquo;s M1 area. The coil was finely adjusted by hand to identify the cortical site eliciting the maximal motor response and shortest latency in the first dorsal interosseous muscle, and the resting motor threshold (RMT) was determined accordingly. The iTBS protocol was applied at 100% RMT (Rao et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), with an intra-burst frequency of 50 Hz and an inter-burst frequency of 5 Hz. Each burst consisted of 3 consecutive pulses, delivered over 2 seconds, followed by an 8-second interval. This cycle was repeated 40 times, resulting in a total of 1200 pulses per session. A conical coil was positioned over the cerebellar pharyngeal representation area (2.5 cm below the inion and 4.3 cm laterally) (Sasegbon et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Each cerebellar hemisphere received 600 pulses, beginning with the left side followed by the right. The sham group received placebo iTBS using the same coil positioning but with an intensity of 1% RMT, 100% auditory feedback, and the coil rotated 90\u0026deg;. iTBS was administered once daily, five days per week, for four weeks. See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e(b) for details.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Assessment\u003c/h2\u003e \u003cp\u003eUsing the Standardized Swallowing Assessment (SSA) as the primary indicator and the Penetration-Aspiration Scale (PAS) as the secondary indicator, hemodynamic changes were collected via fNIRS. The evaluation indicators for the three groups of patients were assessed in an orderly manner before treatment and after 4 weeks of treatment. All assessments for each patient were completed within one day of treatment, lasting 90 minutes, and were conducted by a swallowing therapist who was unaware of this experiment on homo sapiens.\u003c/p\u003e \u003cp\u003eSSA: This swallowing function assessment scale consists of three components: ① Clinical examination (covering 8 indicators including pharyngeal reflex and cough, with a total score ranging from 8 to 23 points); ② Water drinking test (continuously swallowing 5ml of water three times, observing manifestations such as water leakage at the corners of the mouth and laryngeal movement, with a total score ranging from 5 to 11 points); ③ Eating assessment (those who meet the criteria in the first two components proceed to a 60ml water swallowing assessment, observing drinking status and aspiration, with a total score ranging from 5 to 12 points). The total score of the scale ranges from 18 to 46 points, with lower scores indicating milder swallowing dysfunction.(Pinho et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)。\u003c/p\u003e \u003cp\u003ePAS: The total score is 8 points, based on the depth and location of food after swallowing. A score of 1 indicates no food entering the airway, while scores of 6\u0026ndash;8 indicate tracheal aspiration below the true vocal cords of Phoxinus phoxinus subsp. phoxinus. Higher scores indicate a greater degree of aspiration (Benjapornlert et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNIRS Assessment: This study utilized near-infrared brain functional imaging (Model: Huichuang, Danyang, China, NirSmart-3000B), employing two near-infrared wavelengths of 730 nm and 850 nm to measure changes in HbO2 concentration, with a sampling frequency of 11 Hz. A total of 14 light source emission points and 14 signal reception points were used, with a 30 mm distance between the probe and light sources, resulting in 35 channels. These channels overjet the subject's cerebral cortex, covering bilateral prefrontal lobes, bilateral motor areas, bilateral primary sensory cortices, and bilateral supplementary motor areas. For further data analysis, the channels were merged into regions of interest (ROI) according to relevant recommendations (Li et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e): LPFC: left prefrontal cortex; RPFC: right prefrontal cortex; LPM: left supplementary motor cortex; RPM: right supplementary motor cortex; LS1: left primary somatosensory cortex; RS1: right primary somatosensory cortex.\u003c/p\u003e \u003cp\u003eThe assessment consists of two parts: resting state and task state. The patient first completes a 5-minute eyes-closed resting state test, avoiding head movements during this period. The task state adopts a continuous swallowing paradigm: the subject sits in front of a computer and performs operations according to on-screen instructions\u0026mdash;when \"Please start swallowing\" appears, the subject continuously swallows 3ml of warm water with the therapist's assistance for 30 seconds; when \"Please rest\" appears, swallowing stops, and the subject closes their eyes to rest for 30 seconds. The experiment consists of 5 blocks of \"swallowing-rest\" cycles, with 10 seconds of resting data collected as a baseline before the formal task begins. The total duration of the task state is 310 seconds. The first 30 seconds of each cycle constitute the warm water swallowing task period. The summary of ROI and task procedure are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e(d).\u003c/p\u003e \u003cp\u003eNIRS Data Processing: The near-infrared spectroscopy data were preprocessed using the HOMER2 toolbox, a graphical user interface program based on MATLAB 2013b (MathWorks, Inc.; Natick, USA). Initially, motion artifacts were eliminated using a method based on the standard deviation of motion and spline interpolation. Motion artifacts were identified by detecting sliding window standard deviations exceeding a specific threshold. Any signal variations in the data channels surpassing the threshold (standard deviation STD and amplitude AMP) were marked as motion artifacts. Spline interpolation was applied to remove these artifacts. Subsequently, a second-order Butterworth bandpass filter with cutoff frequencies of 0.01\u0026ndash;0.1 Hz was employed to filter out physiological noise caused by heartbeat, respiration, and high-frequency noise. Finally, the filtered optical data were converted into oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) concentrations using the modified Beer-Lambert law. This study focused on the oxyhemoglobin signal (HbO2) as it better reflects cortical activity.\u003c/p\u003e \u003cp\u003eNIRS Data Brain Network Construction of Broussonetia papyrifera: This paper employs graph theory to investigate the characteristics of resting-state brain networks. Thirty-five fNIRS channels serve as nodes in the network, with correlation coefficients between two channels calculated via Pearson correlation analysis acting as edges in the network, generating a corresponding correlation coefficient matrix. The matrix then undergoes Fisher R-to-Z transformation to enhance normality. A threshold range of 0.1\u0026ndash;0.8 (with a step size of 0.01) is subsequently applied to sparsify the network, converting the Z-score matrix into absolute values and sorting them from largest to smallest. When the absolute value exceeds the threshold, the connection is assigned a value of 1; otherwise, it is assigned 0 to eliminate weakly correlated or irrelevant connections in the network, thereby obtaining a binary network at the corresponding threshold. We calculated small-world properties and six network parameters: clustering coefficient (Cp), characteristic path length (Lp), global efficiency (GE), local efficiency (LE), node degree (ND), and node efficiency (NE).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS software (version 27.0). Normality and homogeneity of variance tests were conducted for all datasets. Continuous variables that satisfied both normality and homogeneity of variance assumptions are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Categorical variables are summarized as counts and percentages.\u003c/p\u003e \u003cp\u003eA two-way repeated-measures analysis of variance (ANOVA) was performed for SSA scores, PAS ratings, and cortical activation intensities, with two within-subject factors: time (pre-treatment vs. post-treatment) and group (Control, Sham-iTBS\u0026thinsp;+\u0026thinsp;SET, and Active-iTBS\u0026thinsp;+\u0026thinsp;SET). For any significant main effects or interactions, post-hoc tests with Bonferroni correction were applied to control for type I error. Effect sizes for all ANOVAs are reported as partial eta-squared (η\u0026sup2;p), with values interpreted as follows: 0.0099 for small, 0.0588 for medium, and \u0026ge;\u0026thinsp;0.1379 for large effects.Paired t-tests and one-way ANOVA were used to compare within- and between-group differences in functional connectivity across brain regions, with family-wise error (FWE) correction applied for multiple comparisons. One-way ANOVA was also used to examine between-group differences in brain network metrics, while paired t-tests assessed within-group changes over time.Pearson correlation analysis was conducted to evaluate the relationship between channels showing significant activation and swallowing function outcomes across groups. Demographic and baseline clinical data were compared using chi-square or F tests, as appropriate.\u003c/p\u003e \u003cp\u003eCertainly! Here's a polished English translation of the provided text:\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 General Results\u003c/h2\u003e\n \u003cp\u003eDuring the treatment period, three patients dropped out: one from the Control group due to changes in their condition, one from the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET group who transferred hospitals and interrupted treatment, and one from the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group who voluntarily withdrew. Ultimately, a total of 42 patients were enrolled in the study. These included 14 patients in the Control group, 14 in the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET group, and 14 in the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group. No significant differences were observed among the three groups in baseline characteristics (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Please see Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e for details.\u003c/p\u003e\n \u003cp\u003eThis study was approved by the Ethics Committee of Shandong Provincial Third Hospital (Approval Number: KYLL-2025033).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of demographic and swallowing function assessment at baseline\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSham-iTBS\u0026thinsp;+\u0026thinsp;SET Group (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eActive-iTBS\u0026thinsp;+\u0026thinsp;SET Group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eF/\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (85.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.21\u0026thinsp;\u0026plusmn;\u0026thinsp;13.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.43\u0026thinsp;\u0026plusmn;\u0026thinsp;13.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.14\u0026thinsp;\u0026plusmn;\u0026thinsp;7.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHemorrhagic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIschemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration since stroke\u003c/p\u003e\n \u003cp\u003e(months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMMSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.750\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNIHSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2.969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Clinic outcomes\u003c/h2\u003e\n \u003cp\u003eBefore treatment, no significant differences were observed in SSA and PAS scores among the three groups. After 4 weeks of treatment, all three groups showed a significant reduction in SSA and PAS scores compared to baseline (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Post-treatment, both the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group and the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group demonstrated significantly better SSA and PAS scores than the Control Group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group exhibited greater improvement in SSA and PAS scores compared to the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). See Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003cimg 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\"\u003e\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3\u003cstrong\u003eBrain cortical activity\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003ePrior to treatment, no statistically significant differences were observed in functional connectivity values between groups across any channel pairs (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).Following treatment, a significant enhancement in activation was observed in the right premotor area (RPM) in the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group. A significant interaction effect between group and time was found (ch1: F(2, 39)\u0026thinsp;=\u0026thinsp;5.131, p\u0026thinsp;=\u0026thinsp;0.011, \u0026eta;\u0026sup2;p\u0026thinsp;=\u0026thinsp;0.208). A significant main effect of time was also observed, F(1, 39)\u0026thinsp;=\u0026thinsp;8.687, p\u0026thinsp;=\u0026thinsp;0.005, \u0026eta;\u0026sup2;p\u0026thinsp;=\u0026thinsp;0.182, with post-hoc tests revealing significantly increased activation in the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group after treatment compared to baseline (t\u0026thinsp;=\u0026thinsp;11.794, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI: [-2.076E-06, -5.35E-07]). Furthermore, a significant main effect of group was identified, F(2, 39)\u0026thinsp;=\u0026thinsp;5.275, p\u0026thinsp;=\u0026thinsp;0.009, \u0026eta;\u0026sup2;p\u0026thinsp;=\u0026thinsp;0.213. Post-hoc analysis indicated that the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group exhibited significantly stronger activation than the Control Group (p\u0026thinsp;=\u0026thinsp;0.009, 95% CI: [3.463E-07, 2.877E-06]) and the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group (p\u0026thinsp;=\u0026thinsp;0.038, 95% CI: [5.591E-08, 2.587E-06]) after treatment.Similarly, enhanced activation was detected in the right prefrontal cortex (RPFC), with a significant group \u0026times; time interaction (ch20: F(2, 39)\u0026thinsp;=\u0026thinsp;3.308, p\u0026thinsp;=\u0026thinsp;0.047, \u0026eta;\u0026sup2;p\u0026thinsp;=\u0026thinsp;0.145). No significant main effect of time was observed. However, a significant main effect of group was found, F(2, 39)\u0026thinsp;=\u0026thinsp;3.323, p\u0026thinsp;=\u0026thinsp;0.046, \u0026eta;\u0026sup2;p\u0026thinsp;=\u0026thinsp;0.146. Multiple comparisons showed that the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group had significantly higher activation than the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group after treatment (p\u0026thinsp;=\u0026thinsp;0.026, 95% CI: [1.496E-07, 3.05E-06]).\u003c/p\u003e\n \u003cp\u003eTable 3 Activated channels after treatment\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"121%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 25px;\"\u003e\n \u003cp\u003ePre-intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 25px;\"\u003e\n \u003cp\u003ePost-intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 19px;\"\u003e\n \u003cp\u003eInteraction effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 7px;\"\u003e\n \u003cp\u003eCH1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.86831E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.30302E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.13116E-08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4.47166E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 6px;\"\u003e\n \u003cp\u003e5.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eSham-iTBS+SET Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4.36587E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4.46871E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3.01704E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4.43627E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eActive-iTBS+SET Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.20652E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3.22255E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.62315E-06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.23101E-06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 7px;\"\u003e\n \u003cp\u003eCH20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e6.08872E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.02986E-06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.58261E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e8.73495E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 6px;\"\u003e\n \u003cp\u003e3.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eSham-iTBS+SET Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e6.55776E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.08009E-06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.48706E-09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.89462E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eActive-iTBS+SET Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4.6792E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7.69878E-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e1.60646E-06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e2.48076E-06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 \u003cstrong\u003eFunction connection\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003eBefore treatment, there were no statistically significant differences among the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After treatment, all three groups showed improvements compared to before treatment (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). According to Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e(1), the improvement was more pronounced in the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group. Post-hoc analysis revealed that, compared to the Control group, the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group significantly enhanced functional connectivity between the following brain regions:RPM and LS1 (channels 1\u0026ndash;13, 1\u0026ndash;14, 13\u0026ndash;15);RPM and LPM (channels 1\u0026ndash;29, 1\u0026ndash;33, 1\u0026ndash;35, 15\u0026ndash;33, 15\u0026ndash;35, 18\u0026ndash;35, 30\u0026ndash;34, 30\u0026ndash;35)༛RPM and LM1 (channels 1\u0026ndash;32, 15\u0026ndash;32, 30\u0026ndash;32)༛RPFC and LS1 (channels 5\u0026ndash;14)༛RPFC and LM1 (channels 5\u0026ndash;32, 19\u0026ndash;32)༛LPFC and LS1 (channels 8\u0026ndash;13, 10\u0026ndash;13, 13\u0026ndash;26, 13\u0026ndash;33, 13\u0026ndash;35)༛LPFC and RS1 (channels 9\u0026ndash;16, 10\u0026ndash;16, 10\u0026ndash;18)༛LPFC and RPM (channels 9\u0026ndash;18, 15\u0026ndash;26, 15\u0026ndash;27, 18\u0026ndash;26)༛LPFC and LM1 (channels 10\u0026ndash;32)༛LPFC and LPM (channels 10\u0026ndash;33)༛LS1 and RM1 (channels 13\u0026ndash;17, 14\u0026ndash;17)༛LS1 and LM1 (channels 13\u0026ndash;32)༛LS1 and RS1 (channels 14\u0026ndash;16)༛LPM and RS1 (channels 16\u0026ndash;29, 16\u0026ndash;33, 16\u0026ndash;34, 16\u0026ndash;35)༛LM1 and RS1 (channels 16\u0026ndash;32)༛RM1 and LPM (channels 17\u0026ndash;29)༛LM1 and RM1 (channels 17\u0026ndash;32)༛LPM and RM1 (channels 17\u0026ndash;33, 17\u0026ndash;34, 17\u0026ndash;35)༛LPM and LM1 (channels 32\u0026ndash;35).All these differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Compared to the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET group, the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group showed significantly increased functional connectivity between:RPM and LPFC (channels 1\u0026ndash;26, 10\u0026ndash;18, 10\u0026ndash;31, 11\u0026ndash;30, 15\u0026ndash;26, 18\u0026ndash;26, 26\u0026ndash;30, 26\u0026ndash;31, 26\u0026ndash;34, 27\u0026ndash;30);RPM and LPM (channels 1\u0026ndash;35, 28\u0026ndash;30, 30\u0026ndash;35);LPFC and RPFC (channels 5\u0026ndash;26, 9\u0026ndash;19, 10\u0026ndash;19, 19\u0026ndash;25, 19\u0026ndash;26);LS1 and RM1 (channels 13\u0026ndash;17);LPFC and LS1 (channels 13\u0026ndash;26, 14\u0026ndash;26);RPM and LS1 (channels 13\u0026ndash;30);LM1 and RM1 (channels 17\u0026ndash;32);RPM and LM1 (channels 18\u0026ndash;32, 30\u0026ndash;32, 31\u0026ndash;32);LPFC and LPM (channels 26\u0026ndash;29, 26\u0026ndash;34);LPFC and LM1 (channels 26\u0026ndash;32).All these differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Brain Network Topological Properties\u003c/h2\u003e\n \u003cp\u003eWithin the threshold range of 0.1 to 0.8, all three groups\u0026apos; brain networks exhibited small-world characteristics (\u0026sigma;\u0026thinsp;\u0026gt;\u0026thinsp;1). Figure \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e displays the comparison of the areas under the curve (AUC) for six network topological properties before and after treatment within the threshold range of 0.1 to 0.8. From the topological maps of network properties, it can be observed that, after treatment, the brain network indices in the control group showed varying degrees of improvement, except for ND. The Sham-iTBS\u0026thinsp;+\u0026thinsp;SET group showed notable improvements in Cp, Lp, and ND, with a significant reduction in GE and NE. The Active-iTBS\u0026thinsp;+\u0026thinsp;SET group maintained better overall effects. One-way ANOVA results demonstrated significant differences in ND among the three groups before treatment (F(2, 39)\u0026thinsp;=\u0026thinsp;46..486, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u0026omega;\u0026sup2; = 0.684). After treatment, ND also showed significant differences among groups (F(2, 39)\u0026thinsp;=\u0026thinsp;62.054, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u0026omega;\u0026sup2; = 0.744). No significant differences were observed in other network properties.\u003c/p\u003e\n \u003cp\u003eSince significant between-group differences in nodal degree (ND) were observed at baseline, we further analyzed the results of multiple comparisons. Post-hoc tests indicated that before treatment, the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group exhibited a significantly higher nodal degree compared to the Control Group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI = [-0.578, -0.342]). Similarly, the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group showed a higher nodal degree than the Control Group prior to treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI = [-0.628, -0.392]).After treatment, the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group continued to demonstrate a higher nodal degree relative to the Control Group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI = [-0.621, -0.390]). The Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group also maintained a higher nodal degree compared to the Control Group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI = [-0.698, -0.468]).Within-group comparisons from pre- to post-treatment revealed no significant improvement in the Control Group (t(13) = -0.609, p\u0026thinsp;=\u0026thinsp;0.553, d = -0.163, 95% CI = [-0.687, -0.368]). In contrast, the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group showed significant improvement (t(13) = -2.658, p\u0026thinsp;=\u0026thinsp;0.020, d = -0.710, 95% CI = [-1.289, -0.110]), as did the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group (t(13) = -2.572, p\u0026thinsp;=\u0026thinsp;0.023, d = -0.687, 95% CI = [-1.262, -0.091]).These results indicate that both the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET and Active-iTBS\u0026thinsp;+\u0026thinsp;SET groups exhibited enhanced connectivity in local brain regions following the intervention.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Correlation Between Cortical Activation and Behavioral\u003c/h2\u003e\n \u003cp\u003eTo further investigate the association between treatment-induced changes in cortical activation intensity and swallowing function, Spearman correlation analysis was performed to assess the relationship between mean hemoglobin (HbO₂) concentration and SSA scores. The results revealed a significant positive correlation between activation in the RPM (ch1: r\u0026thinsp;=\u0026thinsp;0.570, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the RPFC (ch20: r\u0026thinsp;=\u0026thinsp;0.468, p\u0026thinsp;=\u0026thinsp;0.001) and SSA scores. As shown in Fig. \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003e3.6 Adverse Events\u003c/h2\u003e\n \u003cp\u003eNo major adverse events occurred during the clinical study. The reported adverse events involved transient palpitations in three participants from the experimental group during iTBS treatment, which did not affect the treatment process. This was foreseeable and had been communicated to all patients prior to treatment.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study innovatively combined cerebellar bilateral iTBS with strength-endurance swallowing exercise training (SET) to systematically investigate the effects of this combined intervention on swallowing function and cortical neuroplasticity in post-stroke dysphagia patients during recovery. The results demonstrated that the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group showed significantly greater improvements in SSA and PAS scores, activation levels in the RPFC and premotor areas, functional connectivity strength among multiple brain regions, and changes in brain network topology compared to both the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group and the Control Group. These findings confirm the synergistic effect of targeted cerebellar neuromodulation and peripheral strength training. This discovery not only provides empirical support for multimodal rehabilitation of post-stroke dysphagia, but also reveals\u0026mdash;at a neural mechanism level\u0026mdash;the pathway through which combined intervention promotes whole-brain network functional reorganization.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.1Neurobehavioral Changes\u003c/h2\u003e \u003cp\u003eThe results of this study showed that both the Sham-iTBS\u0026thinsp;+\u0026thinsp;SET Group and the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group demonstrated significantly better SSA and PAS scores compared to the Control Group. This suggests that laryngeal elevation\u0026mdash;as a key biomechanical event during the pharyngeal phase of swallowing\u0026mdash;facilitates laryngeal closure by upward movement of the thyroid cartilage and opening of the upper esophageal sphincter (Park et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Strength-endurance swallowing exercise training (SET), guided by real-time audiovisual biofeedback, enhances patients\u0026rsquo; adherence and activates swallowing centers by training relevant muscle groups to improve tongue and laryngeal movement, thereby ameliorating dysphagia (Sasegbon et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These findings are consistent with our previous research (Meng et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, the Active-iTBS\u0026thinsp;+\u0026thinsp;SET Group exhibited a 25% improvement in SSA scores, which was significantly greater than that in the other two groups. This result aligns with the findings of Rao et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), who reported that cerebellar bilateral iTBS alone led to a 20% improvement in swallowing function. The higher improvement observed in our study indicates a synergistic effect when central neuromodulation is combined with peripheral training.\u003c/p\u003e \u003cp\u003eThis enhanced efficacy may arise from dual-pathway cooperation:On one hand, cerebellar iTBS delivers high-frequency pulses that induce long-term potentiation (LTP), specifically modulating excitability along the dentato-thalamo-cortical pathway (Raies et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This enhances cerebellar timing control over brainstem swallowing centers, improving core deficits such as delayed laryngeal elevation.On the other hand, SET dynamically regulates isotonic and isometric contraction intensities of the suprahyoid muscles and uses real-time biofeedback to optimize swallowing kinematics, thereby compensating for the limited effect of central intervention alone on muscular coordination.\u003c/p\u003e \u003cp\u003eTogether, these components form a positive feedback loop of \u0026ldquo;central timing modulation \u0026ndash; peripheral muscle strengthening \u0026ndash; closed-loop sensory feedback,\u0026rdquo; which aligns with the core framework of the CPC theory (Jia, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Cortical activation and changes in brain connectivy\u003c/h2\u003e \u003cp\u003eThe results of this study using fNIRS indicated that the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group exhibited significant activation of RPM and RPFC during swallowing tasks. This finding differs fundamentally from traditional interventions targeting the primary motor cortex (M1). Wang et al. previously found that pure cerebellar stimulation primarily activates the primary motor area (Wang et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The innovation of our study lies in the observation that when cerebellar iTBS is combined with peripheral swallowing training, there is a notable advantage in RPM activation. This surpasses the effects of cerebellar stimulation alone and suggests that combined interventions may modulate the cerebellum-thalamus-prefrontal cortex pathway to alleviate compensatory inhibition of the prefrontal cortex post-stroke, thereby enhancing its regulation of swallowing planning and execution (Koch et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Liao et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent research (Ye et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) indicates that the cerebellum finely regulates human movement through highly organized internal circuits and extensive afferent and efferent connections. Information from motor-related cortical areas is transmitted via specific cerebellar loops, which input extensively into the cerebellar cortex. Functional connectivity analysis revealed that the combined group drove widespread brain network integration, notably enhancing bilateral hemispheric coordination, as well as strengthening the connections between RPFC and LPFC, and between RPM and LPM. These findings confirm that bilateral cerebellar iTBS stimulation promotes interhemispheric functional compensation (Rao et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Furthermore, it was observed that connections between RPM and sensory and motor regions, as well as between LPFC-LPM and LPFC-LM1, were strengthened, reflecting that the cerebellum optimizes the temporal and spatial coupling of sensory inputs and motor outputs via cortico-brainstem circuits, thereby improving the neural conduction efficiency from swallowing planning to execution. This aligns with the conclusions of Koch\u0026rsquo;s JAMA study (Koch et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), which suggests that the auxiliary motor area, as a core hub of the swallowing network, directly influences the coordination of laryngeal movements and the risk of aspiration based on its level of activation. Additionally, in this study, the activation levels of RPM and RPFC were positively correlated with SSA scores, indicating that the right auxiliary motor cortex may serve as a potential target for improving swallowing function during stroke recovery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Brain network reorganization\u003c/h2\u003e \u003cp\u003eThe topological structure of brain functional networks plays a central role in stroke rehabilitation (Lefebvre et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Salvalaggio et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Studies have found that alterations in the topology of brain networks often involve reductions in efficiency and the disruption of local connections, which lead to motor and cognitive impairments (Bullmore \u0026amp; Bassett, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Guggisberg et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). During the recovery process, the topology of brain networks tends to restore or optimize, forming the basis for neural function recovery (Bonnal et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Iandolo et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Shi et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Our results show that the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group significantly improved the small-world properties of brain networks, indicating that the brain tends toward a more optimized balance during recovery. This balance facilitates efficient information transfer and integration, essential for functional restoration. Preservation or enhancement of small-world network architecture plays a crucial role in supporting high-efficiency neural information processing (Wang et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAcross different threshold ranges, nodes\u0026rsquo; connectivity in the Active-iTBS\u0026thinsp;+\u0026thinsp;SET and Sham-iTBS\u0026thinsp;+\u0026thinsp;SET groups was markedly increased following interventions, especially in key nodes such as RPM, LPFC, and LPM, where connections within essential neural pathways were strengthened. These changes demonstrate enhanced local and global information exchange capabilities. The intervention promotes local connectivity within brain regions, particularly those involved in swallowing motor control. These findings underscore that brain network reorganization is not merely a local phenomenon but involves improving overall connectivity and optimizing network topology, thereby elevating neural regulation capacity at the systemic level. This network-level transformation not only provides a neural basis for the effectiveness of the intervention but also offers potential biomarkers and targets for personalized rehabilitation strategies in the future.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Research Limitations and Prospects\u003c/h2\u003e \u003cp\u003eDespite the innovative findings of this study, there are some limitations to consider. First, the fNIRS technology cannot capture activity in deep brain structures such as the cerebellum and brainstem; future research should incorporate fMRI to elucidate the mechanisms of whole-loop pathways. Second, the lack of follow-up data after the intervention limits the assessment of the long-term sustainability of neural reorganization, which warrants further investigation. Additionally, this study did not explore the effects of different stimulation intensities and paradigms. Future studies could compare the therapeutic outcomes of iTBS versus cTBS at varying stimulation intensities in conjunction with peripheral training.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe combined use of bilateral cerebellar iTBS and pharyngeal elevation training significantly enhances swallowing recovery in post-stroke dysphagia through coordinated activation of the right premotor and prefrontal cortices and reorganization of the whole-brain network. This multimodal, closed-loop approach represents a promising direction for precision neurorehabilitation of dysphagia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Jinan Clinical Science and Technology Innovation Program (No: 202328060) and Provincial Key Specialties Program of Shandong Provincial Third Hospital (No: SJZK002).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all of the clinicians and researchers who were involved with this study, and all of the participants who took part in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBath, P. 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PREDICTING INSTITUTIONALIZATION AFTER SUBACUTE STROKE REHABILITATION USING THE 12-ITEM WORLD HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE. \u003cem\u003eJournal of Rehabilitation Medicine\u003c/em\u003e,\u003cem\u003e\u0026nbsp;55\u003c/em\u003e, Article jrm6531. https://doi.org/10.2340/jrm.v55.6531\u003c/li\u003e\n \u003cli\u003eWang, B. Y., Sun, H., Pan, X. A., Ma, W. S., Dong, L. H., Wang, Q., \u0026amp; Meng, P. P. (2023). The effects of intermittent theta burst stimulation of the unilateral cerebellar hemisphere on swallowing-related brain regions in healthy subjects. \u003cem\u003eFrontiers in Human Neuroscience\u003c/em\u003e,\u003cem\u003e\u0026nbsp;17\u003c/em\u003e, Article 1100320. https://doi.org/10.3389/fnhum.2023.1100320\u003c/li\u003e\n \u003cli\u003eWang, L., Yu, C. S., Chen, H., Qin, W., He, Y., Fan, F. M., . . . Zhu, C. Z. (2010). Dynamic functional reorganization of the motor execution network after stroke. \u003cem\u003eBrain\u003c/em\u003e,\u003cem\u003e\u0026nbsp;133\u003c/em\u003e, 1224-1238. https://doi.org/10.1093/brain/awq043\u003c/li\u003e\n \u003cli\u003eYe, L. L., Zhao, W. Y., Zhang, Y. C., Song, W. Q., Xie, H. X., \u0026amp; Cao, L. (2025). Exploring Neurobiological Effects of Intermittent Theta-Burst Stimulation on the Left Cerebellum for Post-stroke Unilateral Neglect: A Preliminary Transcranial Magnetic Stimulation-Electroencephalography Investigation. \u003cem\u003eCerebellum\u003c/em\u003e,\u003cem\u003e\u0026nbsp;24\u003c/em\u003e(4), Article 103. https://doi.org/10.1007/s12311-025-01853-8\u003c/li\u003e\n \u003cli\u003eYun, Y. J., \u0026amp; Han, S. H. (2024). The relationship between swallowing oral hesitation and cognition in frontal lobe stroke. \u003cem\u003eJournal of Oral Rehabilitation\u003c/em\u003e,\u003cem\u003e\u0026nbsp;51\u003c/em\u003e(11), 2368-2374. https://doi.org/10.1111/joor.13812\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Stroke, Cortical function, Repetitive transcranial magnetic stimulation, Laryngeal ascending reinforcement training, Functional near-infrared spectroscopy","lastPublishedDoi":"10.21203/rs.3.rs-8315560/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8315560/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePrevious studies have shown that pharyngeal elevation training can improve swallowing function in stroke patients, but the central nervous system interventions have limited effects. Intermittent theta burst stimulation (iTBS) applied to bilateral cerebellar hemispheres may enhance cortical excitability. However, the efficacy and underlying mechanisms of combining bilateral cerebellar iTBS with real-time biofeedback-guided pharyngeal elevation training for post-stroke dysphagia remain unclear.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study investigates, for the first time, the combined effect of bilateral cerebellar iTBS and biofeedback-guided pharyngeal elevation training on swallowing function and cortical activity in stroke patients during the recovery phase.Methods:Forty-two stroke patients with dysphagia were enrolled based on hospital electronic screening; 3 dropped out, and 1 ceased due to condition change, another transferred hospitals, and 1 withdrew voluntarily, leaving 42 participants. They were randomly assigned to three groups (n\u0026thinsp;=\u0026thinsp;14 each): Control (conventional rehabilitation), Sham-iTBS\u0026thinsp;+\u0026thinsp;SET, and Active-iTBS\u0026thinsp;+\u0026thinsp;SET. The latter two groups received additional interventions: Sham or active bilateral cerebellar iTBS combined with swallowing exercises. Swallowing function was assessed using the Standardized Swallowing Assessment (SSA) and Penetration-Aspiration Scale (PAS) before and after 4 weeks of treatment. Functional near-infrared spectroscopy (fNIRS) recorded cortical activation during tasks and resting-state functional connectivity.Results:After 4 weeks, all groups exhibited significant improvements in SSA and PAS scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Compared to the control, both Sham-iTBS\u0026thinsp;+\u0026thinsp;SET and Active-iTBS\u0026thinsp;+\u0026thinsp;SET showed superior improvements (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group outperforming the Sham group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). fNIRS revealed that the Active-iTBS\u0026thinsp;+\u0026thinsp;SET group significantly activated the right prefrontal cortex (RPFC) and premotor areas (PM), enhancing interhemispheric and intra-network functional connectivity, including between the PFC and other regions, and between M1 and PM (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Local node connectivity was also increased (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Improvements in SSA scores correlated positively with activation in RPM and RPFC (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBilateral cerebellar iTBS combined with pharyngeal elevation training significantly improves swallowing function in post-stroke dysphagia patients, associated with increased activation of the right prefrontal cortex and premotor areas, and enhanced cortico-cortical connectivity. The RPM region may serve as a potential neural target for cerebellar iTBS in stroke rehabilitation.\u003c/p\u003e","manuscriptTitle":"Brain-Swallowing Network Modulation: Neurorestoration by Bilateral Cerebell ar iTBS and Laryngeal Elevation Training in Post-Stroke Dysphagia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-20 11:45:06","doi":"10.21203/rs.3.rs-8315560/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-23T09:06:50+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-17T14:23:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281493884713257155311440022159242844090","date":"2026-03-10T09:00:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201098179541237027130792214744677250042","date":"2026-02-27T15:17:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T06:57:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269535157565473686748117067293090765547","date":"2026-01-28T09:31:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-15T12:04:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-26T07:44:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-12T03:03:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-12T02:57:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f22bbe1a-b133-41d1-b9de-0aaaf715880b","owner":[],"postedDate":"January 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":61252720,"name":"Health sciences/Neurology"},{"id":61252721,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2026-05-11T10:09:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-20 11:45:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8315560","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8315560","identity":"rs-8315560","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}