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Eapen BC, Tran J, Ballard-Hernandez J, Buelt A, Hoppes CW, Matthews C, Pundik S, Reston J, Tchopev Z, Wayman LM, Koehn T. Stroke Rehabilitation: Synopsis of the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med 2025; 178:249-268. [PMID: 39832369 DOI: 10.7326/annals-24-02205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2025] Open
Abstract
DESCRIPTION In July 2024, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) released a joint update of their 2019 clinical practice guideline (CPG) for the management of stroke rehabilitation. This synopsis is a condensed version of the 2024 CPG, highlighting the key aspects of the guideline development process and describing the major recommendations. METHODS The VA/DOD Evidence-Based Practice Work Group convened a joint VA/DOD guideline development work group (WG) that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy CPGs. The guideline WG conducted a patient focus group, developed key questions, and systematically searched and evaluated the literature (English-language publications from 1 July 2018 to 2 May 2023). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to evaluate the evidence. The WG developed 47 recommendations along with algorithms for stroke rehabilitation in the inpatient and outpatient settings. Stakeholders outside the WG reviewed the CPG before approval by the VA/DOD Evidence-Based Practice Work Group. RECOMMENDATIONS This synopsis summarizes where evidence is strongest to support guidelines in crucial areas relevant to primary care physicians: transition to community (case management, psychosocial or behavioral interventions); motor therapy (task-specific practice, mirror therapy, rhythmic auditory stimulation, electrical stimulation, botulinum toxin for spasticity); dysphagia, aphasia, and cognition (chin tuck against resistance, respiratory muscle strength training); and mental health (selective serotonin reuptake inhibitor use, psychotherapy, mindfulness-based therapies for treatment but not prevention of depression).
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Affiliation(s)
- Blessen C Eapen
- Physical Medicine and Rehabilitation Services, Veterans Affairs Greater Los Angeles Health Care, and Division of Physical Medicine and Rehabilitation, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (B.C.E.)
| | - Johanna Tran
- Comprehensive Integrated Inpatient Rehabilitation Program, James A. Haley Veterans' Hospital, Tampa, Florida (J.T.)
| | - Jennifer Ballard-Hernandez
- Evidence-Based Practice, Office of Quality and Patient Safety, Veterans Affairs Central Office, Washington, DC (J.B.-H., L.M.W.)
| | - Andrew Buelt
- Bay Pines Veterans Affairs Healthcare System, Bay Pines, Florida (A.B.)
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, Texas (C.W.H.)
| | - Christine Matthews
- Audiology and Speech Pathology, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (C.M.)
| | - Svetlana Pundik
- Case Western Reserve University School of Medicine and Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio (S.P.)
| | | | - Zahari Tchopev
- 59th Medical Wing, U.S. Air Force, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas (Z.T.)
| | - Lisa M Wayman
- Evidence-Based Practice, Office of Quality and Patient Safety, Veterans Affairs Central Office, Washington, DC (J.B.-H., L.M.W.)
| | - Tyler Koehn
- 959 Medical Operations Squadron, U.S. Air Force, Department of Neurology, Brooke Army Medical Center, San Antonio, Texas (T.K.)
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Nakamori M, Toko M, Yamada H, Hayashi Y, Ushio K, Yoshikawa K, Hiraoka A, Yoshikawa M, Nagasaki T, Shimizu Y, Mikami Y, Maruyama H. Cervical percutaneous interferential current stimulation improves citric acid cough tests in patients with Parkinson's disease on medication. Sci Rep 2024; 14:11386. [PMID: 38762573 PMCID: PMC11102488 DOI: 10.1038/s41598-024-62460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/16/2024] [Indexed: 05/20/2024] Open
Abstract
Aspiration pneumonia is the leading cause of death in patients with Parkinson's disease. The incidence of silent aspiration is high in such patients owing to decreased pharyngeal and laryngeal sensation; thus, interventions for this condition may help prevent pneumonia. In this single-arm, open-label study, we used a cervical percutaneous interferential current stimulation device to activate pharyngeal and laryngeal sensory nerves. We evaluated its effectiveness in patients with Hoehn-Yahr stages 2-4 Parkinson's disease. The primary endpoint was the proportion of patients with a normal cough reflex after consuming 1% citric acid at the end of the intervention compared with baseline measurements. In total, 25 patients received neck percutaneous interferential current stimulation for 20 min twice weekly for 8 weeks. Afterward, the proportion of patients with a normal cough reflex after 1% citric acid consumption increased significantly (p = 0.001), whereas other indicators, such as tongue pressure, peak expiratory flow, and penetration or aspiration during videofluoroscopic examination, remained unchanged. A longer duration of illness, higher Unified Parkinson's Disease Rating Scale total scores, and higher levodopa equivalent daily doses were significantly associated with improved cough test outcomes. Hence, cervical percutaneous interferential current stimulation significantly improved cough reflexes and may improve silent aspiration. Trial Registration: Japan Registry of Clinical Trials, jRCTs062220013, first registered 09/05/2022.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kai Ushio
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Kohei Yoshikawa
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Najeeb H, Augenstein KJ, Yee J, Broman AT, Rogus-Pulia N, Namasivayam-MacDonald A. Predictors of Swallowing-Related Quality of Life in United States Veterans with Dysphagia. Dysphagia 2024; 39:150-158. [PMID: 37410172 DOI: 10.1007/s00455-023-10602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
While both dysphagia and poor health-related quality of life frequently occur in United States (US) Veterans, swallowing-related quality of life in this population has not been systematically examined. This retrospective clinical observation study aimed to determine the independent predictors of swallowing-related quality of life for a sample of US Veterans. We examined the following variables in a multivariate analysis to determine the predictors of Swallowing Quality of Life Questionnaire scores: demographic information, Modified Barium Swallow Impairment Profile (MBSImP) scores, Penetration-Aspiration Scale scores, anterior lingual pressures, and Functional Oral Intake Scale scores. MBSImP oral phase score was the only variable that reached statistical significance (p ≤ 0.01), demonstrating that a more severe physiologic impairment in the oral phase of swallowing was independently predictive of worse swallowing-related quality of life. These findings highlight the need for clinicians to consider how impairments in swallowing physiology may impact the quality of life more broadly for patients with dysphagia.
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Affiliation(s)
- Hiba Najeeb
- St. Mary's Hospital, Kitchener, Canada
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada
| | | | - Joanne Yee
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- University of Wisconsin-Madison, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | | | - Nicole Rogus-Pulia
- University of Wisconsin-Madison, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, USA
| | - Ashwini Namasivayam-MacDonald
- School of Rehabilitation Science, McMaster University, 1280 Main Street West, IAHS 403, Hamilton, ON, L8S 4L8, Canada.
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Chandrashekaraiah B, N S, K PT. Impact of Effortful Swallow with Progressive Resistance on Swallow Safety, Efficiency and Quality of Life in Individuals with Post-Stroke Dysphagia: Analysis Using DIGEST- FEES and SWAL-QOL. Indian J Otolaryngol Head Neck Surg 2023; 75:2836-2841. [PMID: 37974700 PMCID: PMC10645793 DOI: 10.1007/s12070-023-03846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 11/19/2023] Open
Abstract
Introduction: Effortful swallow with progressive resistance has a potential clinical implication in improving the oro-muscular strength, swallow safety, and efficiency in elderly individuals. But to date, no studies have explored its benefits in training individuals with post-stroke dysphagia. Aim: The present study investigated the long- term effect of effortful swallow with progressive resistance on swallow safety, efficiency and quality of life in persons with dysphagia following stroke. Method: The study consisted of 5 males (mean age: 41.80yrs ± 9.6yrs) diagnosed with dysphagia post-stroke. The participants underwent 20 sessions (5 days/week) of intensive effortful swallow with progressive training spread across four weeks. In the first two weeks, the participants performed 10 × 3 sets of effortful swallows with a 50% of resistance load, which was further increased to 15 × 3 sets with a 70% resistance load. Results: DIGEST-FEES safety and overall swallow quality of life significantly improved post-therapy, whereas DIGEST-FEES efficiency and overall swallow grades showed no significant changes. Inter-rater reliability of DIGEST-FEES revealed substantial agreement between judges. Conclusion: The results are promising as the technique improved swallow safety, and swallow quality of life in persons with dysphagia following stroke.
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Affiliation(s)
| | - Swapna N
- Centre for Swallowing Disorders, All India Institute of Speech and Hearing, Mysuru, India
| | - Prakash T. K
- Department of ENT, All India Institute of Speech and Hearing, Mysuru, India
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Nakamori M, Toko M, Yamada H, Hayashi Y, Haruta A, Hiraoka A, Yoshikawa M, Nagasaki T, Ushio K, Yoshikawa K, Shimizu Y, Mikami Y, Maruyama H. Detailed findings of videofluoroscopic examination among patients with Parkinson's disease on the effect of cervical percutaneous interferential current stimulation. Front Neurol 2023; 14:1279161. [PMID: 38020611 PMCID: PMC10664245 DOI: 10.3389/fneur.2023.1279161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Parkinson's disease (PD) leads to various types of swallowing disorders. We investigated the effect of cervical percutaneous interferential current stimulation on dysphagia. By conducting detailed qualitative and quantitative analysis of videofluoroscopic examination, we aimed to understand dysphagia in patients with PD and investigate its effects on swallowing function. Methods Patients received cervical percutaneous interferential current stimulation for 20 min twice a week for 8 weeks. In this exploratory study, we evaluated aspiration/laryngeal penetration, oral cavity residue, vallecular residue, and pharyngeal residue. In addition, we performed temporal analysis. Results Twenty-five patients were completely evaluated. At baseline, the proportions of laryngeal penetration/aspiration, oral cavity residue, epiglottic vallecula residue, and pharyngeal residue were 40.0, 88.0, 72.0, 60.0, and 16.0%, respectively. Conversely, pharyngeal transit time, laryngeal elevation delay time, pharyngeal delay time, and swallowing reflex delay were nearly within the normal ranges. Cervical percutaneous interferential current sensory stimulation improved only oral cavity residue at the end of the intervention, from 88.0 to 56.0%. Discussion Patients with PD demonstrated remarkably high frequencies of residues in the oral and pharyngeal regions. The usefulness of cervical interferential current stimulation was partially demonstrated for oral cavity residue. Considering that PD exhibits diverse symptoms, further accumulation of cases and knowledge is warranted. Trial registration jRCTs062220013.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Azusa Haruta
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kai Ushio
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Kohei Yoshikawa
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Yang S, Park JW, Min K, Lee YS, Song YJ, Choi SH, Kim DY, Lee SH, Yang HS, Cha W, Kim JW, Oh BM, Seo HG, Kim MW, Woo HS, Park SJ, Jee S, Oh JS, Park KD, Jin YJ, Han S, Yoo D, Kim BH, Lee HH, Kim YH, Kang MG, Chung EJ, Kim BR, Kim TW, Ko EJ, Park YM, Park H, Kim MS, Seok J, Im S, Ko SH, Lim SH, Jung KW, Lee TH, Hong BY, Kim W, Shin WS, Lee YC, Park SJ, Lim J, Kim Y, Lee JH, Ahn KM, Paeng JY, Park J, Song YA, Seo KC, Ryu CH, Cho JK, Lee JH, Choi KH. Clinical Practice Guidelines for Oropharyngeal Dysphagia. Ann Rehabil Med 2023; 47:S1-S26. [PMID: 37501570 PMCID: PMC10405672 DOI: 10.5535/arm.23069] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Song
- Department of Occupational Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Hee Choi
- Department Audiology and Speech-Language Pathology, Daegu Catholic University, Gyoungsan, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Seung Yang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Won Kim
- Department of Otolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hee-Soon Woo
- Department of Occupational Therapy, School of Medicine, Wonkwang University, Iksan, Korea
| | - Sung-Jong Park
- Department of Speech Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Sun Oh
- Department of Rehabilitation Medicine, Seoul Medical Center, Seoul, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Ju Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sungjun Han
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - DooHan Yoo
- Department of Occupational Therapy, Konyang University, Daejeon, Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Hyun Haeng Lee
- Deptartment of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gu Kang
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hanaro Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Department of Gastroenterology, Konyang University College of Medicine, Daejeon, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojeong Kim
- Deptartment of Nutrition & Food Control, Gangnam Severance Hospital, Seoul, Korea
| | - Weon-Sun Shin
- Deptartment of Food & Nutrition, College of Human Ecology, Hanyang University, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jeonghyun Lim
- Department of Food Service & Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| | - Young Ae Song
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Cheon Seo
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea
| | - Chang Hwan Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Nakamori M, Toko M, Yamada H, Hayashi Y, Yoshikawa K, Yoshikawa M, Nagasaki T, Hiraoka A, Shimizu Y, Mikami Y, Maruyama H. Impact of neck percutaneous interferential current sensory stimulation on swallowing function in patients with Parkinson's disease: A single-arm, open-label study protocol. Contemp Clin Trials Commun 2023; 33:101158. [PMID: 37342176 PMCID: PMC10277457 DOI: 10.1016/j.conctc.2023.101158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
Background Parkinson's disease (PD) can lead to swallowing dysfunction, resulting in aspiration pneumonia. Among the types of swallowing disorders, a characteristic and serious problem associated with PD is silent aspiration due to pharyngeal and laryngeal hypoesthesia. Methods This single-arm, open-label study aims to evaluate the effectiveness of percutaneous neck interferential current sensory stimulation in enhancing swallowing function in patients with PD. The efficacy and safety of percutaneous neck interferential current sensory stimulation will be investigated for patients diagnosed with PD, based on the Movement Disorder Society criteria, of Hoehn-Yahr stages 2-4. The patients will receive neck percutaneous interferential current sensory stimulation for 20 min twice a week for 8 weeks using a Gentle Stim® (FoodCare Co., Ltd., Kanagawa, Japan) device. Once the intervention is initiated, evaluations will be performed every 4 weeks for a 16-week period. The primary endpoint to be assessed is the proportion of patients with normal cough with 1% citric acid at the end of the intervention (8 weeks after intervention initiation) compared with that at the beginning. This clinical trial will examine the usefulness of percutaneous neck interferential current sensory stimulation in patients with PD. In addition, this study will use novel instruments, such as multichannel surface electromyography and electronic stethoscope, to evaluate swallowing function. Discussion This novel evaluation can provide insights into dysphagia in patients with PD and the usefulness of percutaneous neck interferential current stimulation. This exploratory study is limited by its single-arm, open-label design and small size. Trial registration number jRCTs062220013; pre-results.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kohei Yoshikawa
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Wang Y, Xu L, Wang L, Jiang M, Zhao L. Effects of transcutaneous neuromuscular electrical stimulation on post-stroke dysphagia: a systematic review and meta-analysis. Front Neurol 2023; 14:1163045. [PMID: 37228409 PMCID: PMC10203701 DOI: 10.3389/fneur.2023.1163045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023] Open
Abstract
Background Dysphagia is one of the common complications after stroke. It is closely related to lung infection and malnutrition. Neuromuscular electrical stimulation (NMES) is widely used in the treatment of post-stroke dysphagia, but the evidence-based medical evidence of NMES is limited. Therefore, this study aimed to evaluate the clinical efficacy of NMES in patients with post-stroke dysphagia by systematic review and meta-analysis. Methods We searched the CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases for all randomized controlled trials (RCTs) of NMES in the treatment of post-stroke dysphagia from the establishment of the database to 9 June 2022. The risk of bias assessment tool recommended by Cochrane and the GRADE method was used to assess the risk of bias and the quality of evidence. RevMan 5.3 was used for statistical analysis. Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically. Results A total of 46 RCTs and 3,346 patients with post-stroke dysphagia were included in this study. Our meta-analysis showed that NMES combined with routine swallowing therapy (ST) could effectively improve swallowing function in Penetration-Aspiration Scale (MD = -0.63, 95% CI [-1.15, -0.12], P = 0.01), Functional Oral Intake Scale (MD = 1.32, 95% CI [0.81, 1.83], P < 0.00001), Functional Dysphagia Scale (MD = - 8.81, 95% CI [-16.48, -1.15], P = 0.02), the Standardized Swallowing Assessment (MD = -6.39, 95% CI [-6.56, -6.22], P < 0.00001), the Videofluoroscopic Swallow Study (MD = 1.42, 95% CI [1.28, 1.57], P < 0.00001) and the Water swallow test (MD = -0.78, 95% CI [-0.84, -0.73], P < 0.00001). Furthermore, it could improve the quality of life (MD = 11.90, 95% CI [11.10, 12.70], P < 0.00001), increase the upward movement distance of hyoid bone (MD = 2.84, 95% CI [2.28, 3.40], P < 0.00001) and the forward movement distance of hyoid bone (MD = 4.28, 95% CI [3.93, 4.64], P < 0.00001), reduce the rate of complications (OR = 0.37, 95%CI [0.24, 0.57], P < 0.00001). Subgroup analyses showed that NMES+ST was more effective at 25 Hz, 7 mA or 0-15 mA, and at courses ( ≤ 4 weeks). Moreover, patients with an onset of fewer than 20 days and those older than 60 years appear to have more positive effects after treatment. Conclusion NMES combined with ST could effectively increase the forward and upward movement distance of the hyoid bone, improve the quality of life, reduce the rate of complications, and improve the swallowing function of patients with post-stroke dysphagia. However, its safety needs to be further confirmed. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022368416.
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Affiliation(s)
- Yuhan Wang
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lu Xu
- Gastroenterology Department, Yongchuan Traditional Chinese Medicine Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Linjia Wang
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Minjiao Jiang
- Acupuncture and Moxibustion College, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Ling Zhao
- Acupuncture and Moxibustion College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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9
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Iizumi Y, Ihara Y, Koike J, Takahashi K. Effects of interferential current electrical stimulation (IFCS) on mastication and swallowing function in healthy young adults: A preliminary study. Clin Exp Dent Res 2023. [PMID: 37158140 DOI: 10.1002/cre2.748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the effects of interferential current electrical stimulation (IFCS) on masticatory and swallowing function. MATERIALS AND METHODS Twenty healthy young adults were enrolled. The measurement items were spontaneous swallowing frequency (SSF), voluntary swallowing frequency (VSF), saliva secretion volume (SSV), glucose elution volume (GEV), and velocity of chew (VOC). All participants underwent both IFCS and sham stimulation (without stimulation, sham). Two sets of independent IFCS electrodes were placed on the bilateral neck. The precise location of the upper electrodes was just below the angle of the mandible, while the lower electrodes were placed at the anterior border of the sternocleidomastoid muscle. The intensity of IFCS was determined to be one level below the perceptual threshold that all participants felt discomfort. Statistical analysis was performed using a two-way repeated measures analysis of variance. RESULTS For IFCS, the results of each measurement before and during stimulation were SSF: 1.16 and 1.46, VSF: 8.05 and 8.45, SSV: 5.33 and 5.56 g, GEV: 171.75 and 208.60 mg/dL, and VOC: 87.20 and 95.20, respectively. SSF, GEV, and VOC during stimulation were significantly increased by IFCS (SSF, p = .009; GEV, p = .048; and VOC, p = .007). Following sham stimulation, the results were SSF: 1.24 and 1.34, VSF: 7.75 and 7.90, SSV: 5.65 and 6.04 g, GEV: 176.45 and 187.35 mg/dL, and VOC: 91.35 and 88.25, respectively. CONCLUSION While no significant differences were observed in the sham group, our findings suggest that IFCS of the superior laryngeal nerve may impact not only the swallowing function but also the masticatory function.
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Affiliation(s)
- Yoshiki Iizumi
- Department of Special Needs Dentistry, Division of Oral Functional Rehabilitation Medicine, School of Dentistry, Showa University, Tokyo, Japan
| | - Yoshiaki Ihara
- Department of Special Needs Dentistry, Division of Oral Functional Rehabilitation Medicine, School of Dentistry, Showa University, Tokyo, Japan
| | - Joji Koike
- Department of Special Needs Dentistry, Division of Oral Functional Rehabilitation Medicine, School of Dentistry, Showa University, Tokyo, Japan
| | - Koji Takahashi
- Department of Special Needs Dentistry, Division of Oral Functional Rehabilitation Medicine, School of Dentistry, Showa University, Tokyo, Japan
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Assoratgoon I, Shiraishi N, Tagaino R, Ogawa T, Sasaki K. Sensory neuromuscular electrical stimulation for dysphagia rehabilitation: A literature review. J Oral Rehabil 2023; 50:157-164. [PMID: 36357332 DOI: 10.1111/joor.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/23/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Dysphagia is a common disorder following a cerebrovascular accident. It can cause detrimental effects on patient's quality of life and nutrition intake, especially in older adults. Neuromuscular electrical stimulation has been one of the management strategies for acceleration of the recovery. This review summarises the current evidence on sensory threshold stimulation of the procedure. METHOD This review compiled data from the Internet database PubMed, Cochrane Library and Scopus using combination of MeSH thesaurus: 'Sensory threshold', 'electrical stimulation', 'neuromuscular stimulation', 'Deglutition', 'Dysphagia'. Eleven studies were intergraded into the review. RESULTS Most of the studies show significant improvement to the outcomes of sensory neuromuscular electrical stimulation treatment. In many cases, the results of the treatment are comparable or superior to motor threshold stimulation and conventional therapy. However, the study design and parameters of the procedure varied greatly without conclusive standardised guidelines. CONCLUSION The sensory neuromuscular electrical stimulation (SNMES) is a viable treatment option for treating oropharyngeal dysphagia. The most suggested application parameters are an intensity at sensory threshold, a frequency of 80 Hz, an impulse time of 700 μs, a combined total duration of 20 h of stimulation in a 2-week period, and placing the electrodes in the submental area of the neck. However, further research is necessary to construct a definitive guideline for clinicians.
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Affiliation(s)
- Itt Assoratgoon
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Chulalongkorn University, Bangkok, Thailand
| | - Naru Shiraishi
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Center for Dysphagia of Tohoku University Hospital, Sendai, Japan
| | - Ryo Tagaino
- Center for Dysphagia of Tohoku University Hospital, Sendai, Japan.,Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Sendai, Japan
| | - Toru Ogawa
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
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11
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Funato M, Maruta K, Yano M, Kai M, Umezawa Y, Yasuda K, Ohta-Noda E, Gen K. Efficacy of interferential current transcutaneous electrical sensory stimulation through the neck skin for treating dysphagia in children with disabilities: A case series. SAGE Open Med Case Rep 2023; 11:2050313X221149527. [PMID: 36686208 PMCID: PMC9850127 DOI: 10.1177/2050313x221149527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
Finding a suitable treatment for dysphagia has been challenging and the efficacy of neuromuscular electrical stimulation has been recognized. Moreover, the beneficial effect of interferential current transcutaneous electrical sensory stimulation has recently been described. However, the efficacy of interferential current transcutaneous electrical sensory stimulation in children with disabilities is unknown. Therefore, the aim of this study was to confirm the efficacy of interferential current transcutaneous electrical sensory stimulation in children with disabilities. Four children with disabilities of various types underwent interferential current transcutaneous electrical sensory stimulation once a week. All patients showed improved symptoms after interferential current transcutaneous electrical sensory stimulation treatment. Videoendoscopic examination showed reduced accumulation of secretion in all patients and decreased residual bolus in two. We also felt an increased forcefulness when swallowing in two. In addition, the questionnaire results regarding dysphagia indicated improvements. No significant side effects were observed. The interferential current transcutaneous electrical sensory stimulation treatment may be effective and safe in children with disabilities. The effect of this treatment on swallowing ability needs to be further investigated by studying more cases.
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Affiliation(s)
- Michinori Funato
- Department of Pediatric Neurology,
National Hospital Organization Nagara Medical Center, Gifu, Japan,Michinori Funato, Department of Pediatric
Neurology, National Hospital Organization Nagara Medical Center, 1300-7 Nagara,
Gifu 502-8558, Japan.
| | - Kanako Maruta
- Department of Pediatrics, National
Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Mitsuru Yano
- Department of Pediatrics, National
Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Mitsue Kai
- Department of Rehabilitation, National
Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Yaeko Umezawa
- Department of Rehabilitation, National
Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Kunihiko Yasuda
- Department of Pediatric Surgery,
National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Emi Ohta-Noda
- Department of Dentistry for Disability
and Oral Health, Asahi University School of Dentistry, Gifu, Japan
| | - Keika Gen
- Department of Dentistry for Disability
and Oral Health, Asahi University School of Dentistry, Gifu, Japan
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12
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Howard MM, Block ES, Mishreki D, Kim T, Rosario ER. The Effect of Sensory Level Versus Motor Level Electrical Stimulation of Pharyngeal Muscles in Acute Stroke Patients with Dysphagia: A Randomized Trial. Dysphagia 2022; 38:943-953. [PMID: 36127447 PMCID: PMC9488887 DOI: 10.1007/s00455-022-10520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022]
Abstract
Dysphagia is a serious cause of morbidity and mortality in stroke survivors. Electrical stimulation is often included as part of the treatment plan for dysphagia and can be applied at a sensory or motor level intensity. However, evidence to support these different modes of stimulation is lacking. This study compared the effectiveness of sensory and motor level stimulation on post-stroke dysphagia. This is a randomized trial conducted in an inpatient rehabilitation facility. Thirty-one participants who had dysphagia caused by stroke within 6 months prior to enrolment were included. Participants were excluded if they had a contraindication for electrical stimulation, previous stroke, psychiatric disorder, contraindications for modified barium swallow study (MBSS), or pre-morbid dysphagia. Each patient received ten sessions that included 45 min of anterior neck sensory or motor level electrical stimulation in addition to traditional dysphagia therapy. Motor stimulation was administered at an intensity sufficient to produce muscle contractions. Sensory stimulation was defined as the threshold at which the patient feels a tingling sensation on their skin. Swallow functional assessment measure (FAM), dysphagia outcome severity scale (DOSS), national outcome measurement system (NOMS), penetration aspiration scale (PAS), diet change, and the swallowing quality of life questionnaire (SWAL-QOL). Clinical outcomes were analyzed using a Wilcoxon signed-rank test, Mann–Whitney U test, RM ANOVA, or chi-square analysis. There was no significant difference in age, length of stay, or initial swallow FAM between groups. Patients in the sensory group showed significant improvement on swallow FAM, DOSS, and NOMS, while those in the motor group did not (Sensory: Swallow FAM (S = 48, p = 0.01), DOSS (S = 49.5, p = 0.001), NOMS (S = 52.5, p = 0.006); Motor: Swallow FAM (S = 20.5, p = 0.2), DOSS (S = 21, p = 0.05), NOMS (S = 29.5, p = 0.2)). When the groups were combined, there was statistically significant improvement on all measures except the PAS (Swallow FAM (S = 138.5, p = 0.003), DOSS (S = 134.5, p < 0.001), NOMS (S = 164, p = 0.0004)). When comparing motor to sensory NMES, there was no significant difference between groups for Swallow FAM (p = .12), DOSS (p = 0.52), or NOMS (p = 0.41). There was no significant difference in diet change for solid food or liquids among the groups, although 50% more participants in the sensory group saw improvement in diet. This study supports the use of electrical stimulation as part of the treatment plan for post-stroke dysphagia. Sensory-level stimulation was associated with greater improvement on outcome measures compared to motor level stimulation.
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Affiliation(s)
- Melissa M Howard
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA
| | - Elliott S Block
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA
| | - Demiana Mishreki
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA
| | - Tom Kim
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA
| | - Emily R Rosario
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA.
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13
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Tarihci Cakmak E, Sen EI, Doruk C, Sen C, Sezikli S, Yaliman A. The Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Post-stroke Dysphagia: A Randomized Controlled Trial. Dysphagia 2022; 38:874-885. [PMID: 35986170 DOI: 10.1007/s00455-022-10512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
The study aimed to evaluate the effects of traditional dysphagia therapy (TDT) and neuromuscular electrical stimulation (NMES) combined with TDT on functionality of oral intake, dysphagia symptom severity, swallowing- and voice-related quality of life, leakage, penetration-aspiration, and residue levels in patients with post-stroke dysphagia (PSD). Thirty-four patients with PSD were included in our prospective, randomized, controlled, and single-blind study. The patients were divided into two groups: (1) TDT only (control group, n = 17) and (2) TDT with NMES (experimental group, n = 17). TDT was applied to both groups for three consecutive weeks, 5 days a week, 45 min a day. Sensory NMES was applied to the experimental group for 45 min per session. Patients were evaluated by the functional oral intake scale (FOIS), the eating assessment tool (EAT-10), the swallowing quality of life questionnaire (SWAL-QOL), and the voice-related quality of life questionnaire (VRQOL) at baseline, immediately post-intervention, and at the 3rd month post-intervention. Fiberoptic endoscopic evaluation of swallowing (FEES) with liquid and semi-solid food was performed pre- and post-intervention. A significant post-intervention improvement was observed on all scales in both groups, and these improvements were maintained 3 months post-intervention. Leakage and penetration-aspiration levels with semi-solid food declined only in the experimental group. In conclusion, TDT is a non-invasive and inexpensive method that leads to improvement in many swallowing-related features in stroke patients; however, NMES as an adjunct therapy is costly but can provide additional benefits for improving features, such as penetration-aspiration and residue levels.
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14
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Miller S, Peters K, Ptok M. Review of the effectiveness of neuromuscular electrical stimulation in the treatment of dysphagia - an update. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc08. [PMID: 35875244 PMCID: PMC9284430 DOI: 10.3205/000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/20/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) has been used as a treatment option in the therapy of dysphagia for several years. In a previous review of the literature, it was concluded that NMES might be a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. However, due to different stimulation protocols, electrode positioning and various underlying pathological conditions, it was difficult to compare the studies which were identified and it was concluded that more empirical data is needed to fully understand the benefits provided by NMES. The purpose of this systematic review is, therefore, to evaluate recent studies regarding a potential effectiveness of transcutaneous NMES applied to the anterior neck as a treatment for dysphagia considering these different aspects. METHOD For this systematic review, a selective literature research in PubMed has been carried out on 5th May 2021 using the terms electrical stimulation AND dysphagia and screened for inclusion criteria by two reviewers in Rayyan. The search resulted in 62 hits. RESULTS Studies were excluded due to their publication language; because they did not meet inclusion criteria; because the topical focus was a different one; or because they did not qualify as level 2 studies. Eighteen studies were identified with varying patient groups, stimulation protocols, electrode placement and therapy settings. However, 16 studies have reported of beneficial outcomes in relation with NMES. DISCUSSION The purpose of this systematic review was to evaluate the most recent studies regarding a potential effectiveness of NMES as a treatment for oropharyngeal dysphagia considering different aspects. It could generally be concluded that there is a considerable amount of level 2 studies which suggest that NMES is an effective treatment option, especially when combined with TDT for patients with dysphagia after stroke and patients with Parkinson's disease, or with different kinds of brain injuries. Further research is still necessary in order to clarify which stimulation protocols, parameters and therapy settings are most beneficial for certain patient groups and degrees of impairment.
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Affiliation(s)
- Simone Miller
- Klinik für Phoniatrie und Pädaudiologie, Hannover, Germany,*To whom correspondence should be addressed: Simone Miller, Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623 Hannover, Germany, Phone: +49 511 532-5778, Fax: +49 511 532-4609, E-mail:
| | | | - Martin Ptok
- Klinik für Phoniatrie und Pädaudiologie, Hannover, Germany
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Doan TN, Ho WC, Wang LH, Chang FC, Tran TTQ, Chou LW. Therapeutic Effect and Optimal Electrode Placement of Transcutaneous Neuromuscular Electrical Stimulation in Patients with Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Life (Basel) 2022; 12:life12060875. [PMID: 35743906 PMCID: PMC9225155 DOI: 10.3390/life12060875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background: To date, there is no conclusive evidence that transcutaneous neuromuscular electrical stimulation (TNMES) benefits patients with post-stroke dysphagia (PSD). In addition, the optimal TNMES electrode placement has not been well-established. This systematic review and meta-analysis were conducted to investigate these two research gaps. Methods: Five major databases were systematically searched for randomized controlled trials (RCTs) through January 2022. Effect sizes were computed using Hedges’ g statistic, which were then entered into the random-effects model to obtain pooled effect estimates. Results: Twenty-four RCTs met the eligibility criteria. On the improvement of swallowing function, TNMES alone was not superior to conventional swallowing therapies (CSTs); combined therapy of TNMES and CSTs significantly surpassed CSTs alone (standardized mean difference (SMD) = 0.91, 95% confidence interval (95% CI): 0.68 to 1.14, p < 0.0001; I2 = 63%). Moreover, significant pooled effect sizes were observed in subgroups with horizontal electrode placement above the hyoid bone (SMD = 0.94, 95% CI: 0.72 to 1.16; I2 = 0%) and horizontal electrode placement just above and below the hyoid bone (SMD = 0.87, 95% CI: 0.59 to 1.14; I2 = 0%). The largest pooled effect size was observed in the subgroup that individualized electrode placement according to dysphagia evaluation (SMD = 1.65, 95% CI: 0.38 to 2.91; I2 = 90%). Conclusion: TNMES should be used in combination with CSTs for PSD. Horizontal electrode placement should target suprahyoid muscles or both suprahyoid and thyrohyoid muscles.
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Affiliation(s)
- Thanh-Nhan Doan
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (T.-N.D.); (W.-C.H.)
- Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Quang Nam 560000, Vietnam
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (T.-N.D.); (W.-C.H.)
| | - Liang-Hui Wang
- Department of Speech Language Pathology and Auditory, HungKuang University, Taichung 433304, Taiwan;
- Ph.D. Program for Aging, China Medical University, Taichung 404332, Taiwan;
| | - Fei-Chun Chang
- Ph.D. Program for Aging, China Medical University, Taichung 404332, Taiwan;
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
| | - Trang Thi Quynh Tran
- Faculty of Rehabilitation, University of Medicine and Pharmacy, Hue University, Thành phố Huế 530000, Vietnam;
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413505, Taiwan
- Correspondence: or
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Namasivayam-MacDonald AM, Ayub A, Najeeb H, Shune SE. Understanding the Independent Predictors of Dysphagia-Related Quality of Life in Stroke Survivors. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1697-1723. [PMID: 35344388 DOI: 10.1044/2022_jslhr-21-00502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE It is important to pinpoint modifiable factors contributing to reduced dysphagia-related quality of life (QoL) in order to improve treatment outcomes and patient health given that a large proportion of stroke survivors experience dysphagia. The purpose of this exploratory study was to identify the independent predictors of dysphagia-related QoL in community-dwelling stroke survivors. METHOD A sample of 31 adult stroke survivors with dysphagia (M age = 62 years; 23 males) and their partners (M age = 57 years; seven males) participated in the study. Survivors were > 3 months poststroke and living with their partner. Backward regression analysis methods were employed to determine independent predictors of dysphagia-related QoL using scores from the Swallowing-Related Quality of Life questionnaire. Independent variables tested included age, employment status, receiving dysphagia treatment, number of medical conditions, level of diet modification, Stroke Impact Scale (SIS) scores, relationship with partner, partner age, partner employment status, partner burden, and partner depression. RESULTS Results indicated that number of survivor medical conditions, degree of diet modification, SIS emotional subscale score, and partner employment status significantly predicted dysphagia-related QoL (p < .001). More specifically, stroke survivors with more medical conditions or a partner who worked outside of the home had worse dysphagia-related QoL, and those with better mental health or a less modified diet had better dysphagia-related QoL. CONCLUSION Factors related to dysphagia-related QoL are multifactorial and include both survivor and spousal variables. The results of this exploratory study highlight the need for clinicians and researchers to consider patient function and needs more wholistically to maximize perceived QoL.
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Affiliation(s)
| | - Aaliyeh Ayub
- California State University, Northridge
- Communication Disorders and Sciences Program, University of Oregon, Eugene
| | - Hiba Najeeb
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Samantha E Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
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He K, Wu L, Huang Y, Chen Q, Qiu B, Liang K, Ma R. Efficacy and Safety of Transcranial Direct Current Stimulation on Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:2297. [PMID: 35566421 PMCID: PMC9102865 DOI: 10.3390/jcm11092297] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/14/2022] [Accepted: 04/14/2022] [Indexed: 12/12/2022] Open
Abstract
Dysphagia is one of the most common symptoms in patients after stroke onset, which has multiple unfavorable effects on quality of life and functional recovery. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation that is widely used to improve deglutition function. Recently, some studies have confirmed that tDCS enhances deglutition function after stroke. However, the number of evaluation indexes used in those studies was small, and the number of trials included was limited. Most importantly, the optimal stimulation protocol is still uncertain and the safety of tDCS has not been reviewed. Therefore, we conducted a systematic review and meta-analysis to address these shortcomings. METHODS Seven databases were searched entirely, including Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wan-fang database, and the Chinese Scientific Journals Database (VIP) from inception to 31 December 2021. Two reviewers independently evaluated the eligibility of retrieved data according to the selection criteria and assessed the methodological quality of the studies using the Cochrane risk of bias tool. Outcomes, measures, and indicators used in this study included the dysphagia outcome and severity scale (DOSS), modified Mann assessment of swallowing ability (MMASA), functional oral intake scale (FOIS), functional dysphagia scale (FDS), and Kubota's water-drinking test (KWDT). Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically. RESULTS Fifteen trials with a total of 787 participants (394 subjects in the tDCS groups were treated with true tDCS, and 393 subjects in the control groups were wait-listed or treated with sham tDCS) involving tDCS for dysphagia after stroke and were included in the meta-analysis. Results of this meta-analysis confirmed that tDCS had a positive effect on post-stroke dysphagia. Subgroup analyses revealed that bilateral and high-intensity stimulation with tDCS had a more significant impact on post-stroke dysphagia. Furthermore, no adverse events occurred during the application of tDCS for post-stroke dysphagia. CONCLUSION tDCS can promote the recovery of deglutition function in patients with dysphagia after stroke. In addition, bilateral stimulation and high-intensity stimulation may have better effects. However, the safety evidence for tDCS and post-stroke dysphagia is insufficient.
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Affiliation(s)
- Kelin He
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 310005, China; (K.H.); (L.W.); (K.L.)
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
| | - Lei Wu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 310005, China; (K.H.); (L.W.); (K.L.)
| | - Yi Huang
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
| | - Qinqin Chen
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
| | - Bei Qiu
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
| | - Kang Liang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 310005, China; (K.H.); (L.W.); (K.L.)
| | - Ruijie Ma
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 310005, China; (K.H.); (L.W.); (K.L.)
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
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18
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Speyer R, Sutt AL, Bergström L, Hamdy S, Heijnen BJ, Remijn L, Wilkes-Gillan S, Cordier R. Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials-Part I: Pharyngeal and Neuromuscular Electrical Stimulation. J Clin Med 2022; 11:jcm11030776. [PMID: 35160228 PMCID: PMC8836998 DOI: 10.3390/jcm11030776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 12/22/2022] Open
Abstract
Objective. To assess the effects of neurostimulation (i.e., neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES)) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted to retrieve randomised controlled trials in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of included studies was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Results. In total, 42 studies reporting on peripheral neurostimulation were included: 30 studies on NMES, eight studies on PES, and four studies on combined neurostimulation interventions. When conducting meta analyses, significant, large and significant, moderate pre-post treatment effects were found for NMES (11 studies) and PES (five studies), respectively. Between-group analyses showed small effect sizes in favour of NMES, but no significant effects for PES. Conclusions. NMES may have more promising effects compared to PES. However, NMES studies showed high heterogeneity in protocols and experimental variables, the presence of potential moderators, and inconsistent reporting of methodology. Therefore, only conservative generalisations and interpretation of meta-analyses could be made. To facilitate comparisons of studies and determine intervention effects, there is a need for more randomised controlled trials with larger population sizes, and greater standardisation of protocols and guidelines for reporting.
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Affiliation(s)
- Renée Speyer
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 ZA Leiden, The Netherlands;
- Correspondence:
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD 4032, Australia;
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Liza Bergström
- Remeo Stockholm, 128 64 Stockholm, Sweden;
- Speech Therapy Clinic, Danderyd University Hospital, 182 88 Stockholm, Sweden
| | - Shaheen Hamdy
- GI Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Bas Joris Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 ZA Leiden, The Netherlands;
| | - Lianne Remijn
- School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands;
| | - Sarah Wilkes-Gillan
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK;
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19
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Ebihara S, Naito T. A Systematic Review of Reported Methods of Stimulating Swallowing Function and their Classification. TOHOKU J EXP MED 2022; 256:1-17. [DOI: 10.1620/tjem.256.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College
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20
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Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava EM, Bath PM, Clavé P, Glahn J, Hamdy S, Pownall S, Schindler A, Walshe M, Wirth R, Wright D, Verin E. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6:LXXXIX-CXV. [PMID: 34746431 DOI: 10.1177/23969873211039721] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece.,Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades, Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Jörg Glahn
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospital Ruhr-University Bochum, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Sue Pownall
- Department of Speech & Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, Sacco Hospital Milano, University of Milano, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-University Bochum, Germany
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, Rouen, France
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21
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Oh DH, Park JS, Kim HJ, Chang MY, Hwang NK. The effect of neuromuscular electrical stimulation with different electrode positions on swallowing in stroke patients with oropharyngeal dysphagia: A randomized trial. J Back Musculoskelet Rehabil 2020; 33:637-644. [PMID: 31594198 DOI: 10.3233/bmr-181133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the effects of neuromuscular electrical stimulation (NMES) on oropharyngeal swallowing function according to 2 types of placement, acting as assistance and as resistance, in stroke patients with dysphagia. METHODS Thirty-eight stroke patients with dysphasia were randomly assigned to the suprahyoid group (SMG), or infrahyoid muscle group (IMG); 26 patients completed the intervention and were included in the analysis. In the SMG, the electrodes were placed on the region between the jaw and the hyoid bone, whereas in the IMG, the electrodes were placed on the region below the hyoid for the targeted infrahyoid muscles. Both groups received NMES for 30 min/d, 5 d/wk, for 4 weeks and conventional dysphagia therapy. Swallowing function was measured using the Videofluoroscopic Dysphagia Scale and Penetration-Aspiration Scale based on videofluoroscopic swallowing study. Oral dietary intake was measured using the Functional Oral Intake Scale. RESULTS Both groups showed significant improvements in oropharyngeal function and level of functional oral intake, but there was no significant difference between the two groups. However, the SMG showed a more reduced penetration-aspiration, compared with the IMG. CONCLUSIONS Altogether, these data demonstrate that 2 types of NMES placements have a similar effect on improving swallowing function and oral diet intake in patients with dysphagia.
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Affiliation(s)
- Dong-Hwan Oh
- Department of Occupational Therapy, Kyung-Dong University, Korea
| | - Ji-Su Park
- Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, DongSeo University, Korea
| | - Hee-Jeong Kim
- Department of Occupational Therapy, Kyung-Dong University, Korea
| | - Moon-Young Chang
- Department of Occupational Therapy, College of Healthcare Medical Science and Engineering, Inje University, Korea
| | - Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Korea
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22
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Hossain MZ, Ando H, Unno S, Kitagawa J. Targeting Chemosensory Ion Channels in Peripheral Swallowing-Related Regions for the Management of Oropharyngeal Dysphagia. Int J Mol Sci 2020; 21:E6214. [PMID: 32867366 PMCID: PMC7503421 DOI: 10.3390/ijms21176214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
Oropharyngeal dysphagia, or difficulty in swallowing, is a major health problem that can lead to serious complications, such as pulmonary aspiration, malnutrition, dehydration, and pneumonia. The current clinical management of oropharyngeal dysphagia mainly focuses on compensatory strategies and swallowing exercises/maneuvers; however, studies have suggested their limited effectiveness for recovering swallowing physiology and for promoting neuroplasticity in swallowing-related neuronal networks. Several new and innovative strategies based on neurostimulation in peripheral and cortical swallowing-related regions have been investigated, and appear promising for the management of oropharyngeal dysphagia. The peripheral chemical neurostimulation strategy is one of the innovative strategies, and targets chemosensory ion channels expressed in peripheral swallowing-related regions. A considerable number of animal and human studies, including randomized clinical trials in patients with oropharyngeal dysphagia, have reported improvements in the efficacy, safety, and physiology of swallowing using this strategy. There is also evidence that neuroplasticity is promoted in swallowing-related neuronal networks with this strategy. The targeting of chemosensory ion channels in peripheral swallowing-related regions may therefore be a promising pharmacological treatment strategy for the management of oropharyngeal dysphagia. In this review, we focus on this strategy, including its possible neurophysiological and molecular mechanisms.
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Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Hiroshi Ando
- Department of Biology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
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23
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Li H, Fan W, Zhu X. Three‐dimensional printing: The potential technology widely used in medical fields. J Biomed Mater Res A 2020; 108:2217-2229. [DOI: 10.1002/jbm.a.36979] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hongjian Li
- Southern Marine Science and Engineering Guangdong Laboratory ZhanjiangMarine Medical Research Institute of Guangdong Zhanjiang (GDZJMMRI), Guangdong Medical University Zhanjiang China
| | - Wenguo Fan
- Department of Anesthesiology, Guanghua School of StomatologyHospital of Stomatology, Sun Yat‐sen University Guangzhou China
| | - Xiao Zhu
- Southern Marine Science and Engineering Guangdong Laboratory ZhanjiangMarine Medical Research Institute of Guangdong Zhanjiang (GDZJMMRI), Guangdong Medical University Zhanjiang China
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24
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Swallowing Outcomes and Discharge Destinations in Acute Stroke Tube-Feeding Dependent Dysphagia Patients Treated With Neuromuscular Electrical Stimulation During Inpatient Rehabilitation. Am J Phys Med Rehabil 2020; 99:487-494. [DOI: 10.1097/phm.0000000000001353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Jiang YE, Lyu QQ, Lin F, You XT, Jiang ZL. Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports. World J Clin Cases 2020; 8:1142-1149. [PMID: 32258085 PMCID: PMC7103971 DOI: 10.12998/wjcc.v8.i6.1142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/24/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A swallowing disorder may occur following a brainstem stroke, especially one that occurs in the swallowing centers. Lateral medullary syndrome (referred to as LMS), a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery, has been reported to lead to more severe and longer lasting dysphagia.
CASE SUMMARY We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique (known as HEST). The two patients had no other functional incapacity back into life, but nasogastric feeding was the only possible way for nutrition because of severe aspirations. Swallowing function was evaluated by functional oral intake scale, modified water swallow test, surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration, pharyngeal residue, pharyngeal peristalsis, upper esophageal opening and the ability of deglutition. Both patients were treated with the HEST method for dysphagia and recovered quickly.
CONCLUSION HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.
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Affiliation(s)
- Yu-Er Jiang
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Qian-Qian Lyu
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Feng Lin
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Xue-Ting You
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhong-Li Jiang
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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26
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Wang ZY, Chen JM, Lin ZK, Ni GX. Transcranial direct current stimulation improves the swallowing function in patients with cricopharyngeal muscle dysfunction following a brainstem stroke. Neurol Sci 2020; 41:569-574. [PMID: 31713753 DOI: 10.1007/s10072-019-04120-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/20/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study investigated the effects of transcranial direct current stimulation (tDCS) combined with conventional swallowing training on the swallowing function in brainstem stroke patients with cricopharyngeal muscle dysfunction (CPD). METHODS Twenty-eight brainstem stroke patients with CPD were assigned randomly to an anodal tDCS group or a sham tDCS group. The patients received anodal tDCS or sham tDCS over the bilateral oesophageal cortical area combined with simultaneous catheter balloon dilatation and conventional swallowing therapy for 20 days. Swallowing function was assessed using the functional oral intake scale (FOIS) and the functional dysphagia scale (FDS) and by measuring the pharyngoesophageal Segment Opening (PESO) before and immediately after the intervention. RESULTS Both groups showed a significant improvement in the FDS, FOIS and PESO scores immediately after the intervention (all p < .005). However, compared with the sham stimulation group, the anodal tDCS group showed greater improvements in the FDS, FOIS and PESO scores immediately after the intervention (all p < .005). CONCLUSION The bihemispheric anodal tDCS combined with simultaneous catheter balloon dilatation and conventional swallowing therapy effectively improves the swallowing function in patients with CPD caused by a brainstem stroke. tDCS may be an effective adjuvant therapy in CPD rehabilitation.
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Affiliation(s)
- Zhi-Yong Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jian-Min Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Zheng-Kun Lin
- Department of Rehabilitation Medicine, The 909th Hospital, 269 Zhanghua Middle Road, Zhangzhou, 363000, China
| | - Guo-Xin Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
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Li XW, Li LY. Efficacy of neuromuscular electrical stimulation on Wilson's disease patients with dysphagia. J Phys Ther Sci 2019; 31:971-974. [PMID: 32038066 PMCID: PMC6893162 DOI: 10.1589/jpts.31.971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Dysphagia is a neurological symptom that is observed in more than half of
patients with Wilson’s disease. It is often associated with aspiration pneumonia,
dehydration, and malnutrition, resulting in drastic reduction of the quality of life.
Neuromuscular electrical stimulation could be an adjunct therapy for dysphagia treatment.
However, there is limited data about the application of NMES for dysphagia in Wilson’s
disease. Thus, we explored the potential application of NMES for dysphagia treatment in
Wilson’s disease. [Participants and Methods] Sixty Wilson’s disease patients who suffered
from dysphagia were randomized into two groups. Swallowing function training was taught to
the control group (n=30) while Neuromuscular electrical stimulation therapy was given to
treatment group (n=30). Eight weeks post treatment, using the water swallow test and the
Standardized Swallowing Assessment, the swallowing function was determined. [Results] None
of the patients experienced discomfort before, during or after the intervention. After 8
weeks of therapy, when compared to the control, an increased improvement in swallowing
function was noted for the treatment group. [Conclusion] Neuromuscular electrical
stimulation treatment can improve swallowing function in Wilson’s disease patients
afflicted with dysphagia. Therefore, it has the potential to be a form of therapy in
clinical practice.
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Affiliation(s)
- Xue-Wei Li
- Department of Neurology, The First Affiliated Hospital of Nanhua University, China
| | - Liang-Yong Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine: Meishan Road 117, Hefei 230031, China
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28
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Yuan Y, Wang J, Wu D, Zhang D, Song W. Effect of Transcutaneous Vagus Nerve Stimulation in Dysphagia After Lateral Medullary Infarction: A Case Report. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1381-1387. [PMID: 31498703 DOI: 10.1044/2019_ajslp-18-0262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Severe dysphagia with weak pharyngeal peristalsis after dorsal lateral medullary infarction (LMI) requires long-term tube feeding. However, no study is currently available on therapeutic effectiveness in severe dysphagia caused by nuclear damage of vagus nerve after dorsal LMI. The purpose of the present investigation was to explore the potential of transcutaneous vagus nerve stimulation (tVNS) to improve severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Method We assessed the efficacy of 6-week tVNS in a 28-year-old woman presented with persisting severe dysphagia after dorsal LMI who had been on nasogastric feeding for 6 months. tVNS was applied for 20 min twice a day, 5 days a week, for 6 weeks. The outcome measures included saliva spitted, Swallow Function Scoring System, Functional Oral Intake Scale, Clinical Assessment of Dysphagia With Wallenberg Syndrome, Yale Pharyngeal Residue Severity Rating Scale, and upper esophagus X-ray examination. Results After tVNS, the patient was advanced to a full oral diet without head rotation or spitting. No saliva residue was found in the valleculae and pyriform sinuses. Contrast medium freely passed through the upper esophageal sphincter. Conclusion Our findings suggest that tVNS might provide a useful means for recovery of severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Supplemental Material https://doi.org/10.23641/asha.9755438.
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Affiliation(s)
- Ying Yuan
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jie Wang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing
| | - Dahua Zhang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
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Chiang CF, Lin MT, Hsiao MY, Yeh YC, Liang YC, Wang TG. Comparative Efficacy of Noninvasive Neurostimulation Therapies for Acute and Subacute Poststroke Dysphagia: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil 2019; 100:739-750.e4. [DOI: 10.1016/j.apmr.2018.09.117] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Dysphagia (swallowing problems), which is common after stroke, is associated with increased risk of death or dependency, occurrence of pneumonia, poor quality of life, and longer hospital stay. Treatments provided to improve dysphagia are aimed at accelerating recovery of swallowing function and reducing these risks. This is an update of the review first published in 1999 and updated in 2012. OBJECTIVES To assess the effects of swallowing therapy on death or dependency among stroke survivors with dysphagia within six months of stroke onset. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (26 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 26 June 2018), MEDLINE (26 June 2018), Embase (26 June 2018), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (26 June 2018), Web of Science Core Collection (26 June 2018), SpeechBITE (28 June 2016), ClinicalTrials.Gov (26 June 2018), and the World Health Organization International Clinical Trials Registry Platform (26 June 2018). We also searched Google Scholar (7 June 2018) and the reference lists of relevant trials and review articles. SELECTION CRITERIA We sought to include randomised controlled trials (RCTs) of interventions for people with dysphagia and recent stroke (within six months). DATA COLLECTION AND ANALYSIS Two review authors independently applied the inclusion criteria, extracted data, assessed risk of bias, used the GRADE approach to assess the quality of evidence, and resolved disagreements through discussion with the third review author (PB). We used random-effects models to calculate odds ratios (ORs), mean differences (MDs), and standardised mean differences (SMDs), and provided 95% confidence intervals (CIs) for each.The primary outcome was functional outcome, defined as death or dependency (or death or disability), at the end of the trial. Secondary outcomes were case fatality at the end of the trial, length of inpatient stay, proportion of participants with dysphagia at the end of the trial, swallowing ability, penetration aspiration score, or pneumonia, pharyngeal transit time, institutionalisation, and nutrition. MAIN RESULTS We added 27 new studies (1777 participants) to this update to include a total of 41 trials (2660 participants).We assessed the efficacy of swallowing therapy overall and in subgroups by type of intervention: acupuncture (11 studies), behavioural interventions (nine studies), drug therapy (three studies), neuromuscular electrical stimulation (NMES; six studies), pharyngeal electrical stimulation (PES; four studies), physical stimulation (three studies), transcranial direct current stimulation (tDCS; two studies), and transcranial magnetic stimulation (TMS; nine studies).Swallowing therapy had no effect on the primary outcome (death or dependency/disability at the end of the trial) based on data from one trial (two data sets) (OR 1.05, 95% CI 0.63 to 1.75; 306 participants; 2 studies; I² = 0%; P = 0.86; moderate-quality evidence). Swallowing therapy had no effect on case fatality at the end of the trial (OR 1.00, 95% CI 0.66 to 1.52; 766 participants; 14 studies; I² = 6%; P = 0.99; moderate-quality evidence). Swallowing therapy probably reduced length of inpatient stay (MD -2.9, 95% CI -5.65 to -0.15; 577 participants; 8 studies; I² = 11%; P = 0.04; moderate-quality evidence). Researchers found no evidence of a subgroup effect based on testing for subgroup differences (P = 0.54). Swallowing therapy may have reduced the proportion of participants with dysphagia at the end of the trial (OR 0.42, 95% CI 0.32 to 0.55; 1487 participants; 23 studies; I² = 0%; P = 0.00001; low-quality evidence). Trial results show no evidence of a subgroup effect based on testing for subgroup differences (P = 0.91). Swallowing therapy may improve swallowing ability (SMD -0.66, 95% CI -1.01 to -0.32; 1173 participants; 26 studies; I² = 86%; P = 0.0002; very low-quality evidence). We found no evidence of a subgroup effect based on testing for subgroup differences (P = 0.09). We noted moderate to substantial heterogeneity between trials for these interventions. Swallowing therapy did not reduce the penetration aspiration score (i.e. it did not reduce radiological aspiration) (SMD -0.37, 95% CI -0.74 to -0.00; 303 participants; 11 studies; I² = 46%; P = 0.05; low-quality evidence). Swallowing therapy may reduce the incidence of chest infection or pneumonia (OR 0.36, 95% CI 0.16 to 0.78; 618 participants; 9 studies; I² = 59%; P = 0.009; very low-quality evidence). AUTHORS' CONCLUSIONS Moderate- and low-quality evidence suggests that swallowing therapy did not have a significant effect on the outcomes of death or dependency/disability, case fatality at the end of the trial, or penetration aspiration score. However, swallowing therapy may have reduced length of hospital stay, dysphagia, and chest infections, and may have improved swallowing ability. However, these results are based on evidence of variable quality, involving a variety of interventions. Further high-quality trials are needed to test whether specific interventions are effective.
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Affiliation(s)
- Philip M Bath
- University of Nottingham, City HospitalStroke Trials Unit, Division of Clinical NeuroscienceNottinghamUKNG5 1PB
| | - Han Sean Lee
- University of Nottingham, City HospitalStroke Trials Unit, Division of Clinical NeuroscienceNottinghamUKNG5 1PB
| | - Lisa F Everton
- University of Nottingham, City HospitalStroke Trials Unit, Division of Clinical NeuroscienceNottinghamUKNG5 1PB
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Inoue K, Yoshioka M, Yagi N, Nagami S, Oku Y. Using Machine Learning and a Combination of Respiratory Flow, Laryngeal Motion, and Swallowing Sounds to Classify Safe and Unsafe Swallowing. IEEE Trans Biomed Eng 2018; 65:2529-2541. [PMID: 29993526 DOI: 10.1109/tbme.2018.2807487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this research was to develop a swallowing assessment method to help prevent aspiration pneumonia. The method uses simple sensors to monitor swallowing function during an individual's daily life. METHODS The key characteristics of our proposed method are as follows. First, we assess swallowing function by using respiratory flow, laryngeal motion, and swallowing sound signals recorded by simple sensors. Second, we classify whether the recorded signals correspond to healthy subjects or patients with dysphagia. Finally, we analyze the recorded signals using both a feature extraction method (linear predictive coding) and a machine learning method (support vector machine). RESULTS Based on our experimental results for 140 healthy subjects (54.5 32.5 years old) and 52 patients with dysphagia (75.5 20.5 years old), our proposed method could achieve 82.4% sensitivity and 86.0% specificity. CONCLUSION Although 20% of testing sample sets were erroneously classified, we conclude that our proposed method may facilitate screening examinations of swallowing function. SIGNIFICANCE In combination with the portable sensors, our proposed method is worth utilizing for noninvasive swallowing assessment.
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Zeng Y, Yip J, Cui H, Guan L, Zhu H, Zhang W, Du H, Geng X. Efficacy of neuromuscular electrical stimulation in improving the negative psychological state in patients with cerebral infarction and dysphagia. Neurol Res 2018; 40:473-479. [PMID: 29726748 DOI: 10.1080/01616412.2018.1451015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective To observe the improvement of negative affect disorders in patients with cerebral infarction and dysphagia by neuromuscular electrical stimulation. Methods One hundred and twelve patients with cerebral infarction and dysphagia were selected and randomized into treatment (n = 59) and control (n = 53) groups. Similar swallowing function was found in both groups before treatment: (1) Water-drinking test in the treatment group proved swallowing function Level III in 24 cases, Level IV in 22 cases and Level V in 13 cases; (2) in the control group, swallowing function was Level III in 21 cases, Level IV in 20 cases and Level V in 12 cases. Both groups received conventional drug therapy and swallowing training. The treatment group additionally received neuromuscular electrical stimulation. Both groups underwent water-drinking test evaluation, Hamilton Anxiety Scale test, and Hamilton Depression Scale test before and after treatment. Results After two courses of treatment, the rate of improvement in swallowing function was 88.1% in the treatment group while 69.8% in the control group. Somatic anxiety, psychogenic anxiety and total scores in the Hamilton Anxiety Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.01). Anxiety, cognitive disorder, psychomotor retardation and total scores in the Hamilton Depression Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.05). Conclusion Patients with cerebral infarction and dysphagia have varying degrees of anxiety, depression, and other negative affect disorders, which could be minimized by neuromuscular electrical stimulation in conjunction with conventional therapy.
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Affiliation(s)
- Yanfang Zeng
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - James Yip
- b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA
| | - Hongli Cui
- c Department of General Surgery , Beijing Chuiyangliu Hospital , Beijing , China
| | - Longfei Guan
- d China-America Institute of Neuroscience , Beijing Luhe Hospital , Beijing , China
| | - Haomeng Zhu
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Weidong Zhang
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Huishan Du
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Xiaokun Geng
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.,b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA.,d China-America Institute of Neuroscience , Beijing Luhe Hospital , Beijing , China
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Sproson L, Pownall S, Enderby P, Freeman J. Combined electrical stimulation and exercise for swallow rehabilitation post-stroke: a pilot randomized control trial. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:405-417. [PMID: 29288590 DOI: 10.1111/1460-6984.12359] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Dysphagia is common after stroke, affecting up to 50% of patients initially. It can lead to post-stroke pneumonia, which causes 30% of stroke-related deaths, a longer hospital stay and poorer health outcomes. Dysphagia care post-stroke generally focuses on the management of symptoms, via modified oral intake textures and adapted posture, rather than direct physical rehabilitation of the swallowing function. Transcutaneous neuromuscular electrical stimulation (NMES) is a promising rehabilitation technology that can be used to stimulate swallowing; however, findings regarding efficacy have been conflicting. AIMS This pilot randomized controlled study involving three UK sites compared the efficacy of the Ampcare Effective Swallowing Protocol (ESP), combining NMES with swallow-strengthening exercises, with usual care in order to clarify evidence on NMES in the treatment of dysphagia post-stroke. A further objective was to pilot recruitment procedures and outcome measures in order to inform the design of a full-scale trial. METHODS & PROCEDURES Thirty patients were recruited and randomized into either (1) usual speech and language therapy dysphagia care; or (2) Ampcare ESP, receiving treatment 5 days/week for 4 weeks. Outcome measures included: the Functional Oral Intake Scale (FOIS), the Rosenbek Penetration-Aspiration Scale (PAS) and patient-reported outcomes (Swallow Related Quality of Life-SWAL-QOL). OUTCOMES & RESULTS Thirty patients were recruited; 15 were randomized to the Ampcare ESP intervention arm and 15 to usual care. A greater proportion (75%, or 9/12) of patients receiving Ampcare ESP improved compared with 57% (or 8/14) of the usual-care group. Patients receiving Ampcare ESP also made clinically meaningful change (a comparative benefit of 1.5 on the FOIS, and on the PAS: 1.35 for diet and 0.3 for fluids) compared with usual care. The intervention group also reported much better outcome satisfaction. CONCLUSIONS & IMPLICATIONS The pilot demonstrated successful recruitment, treatment safety and tolerability and clinically meaningful outcome improvements, justifying progression to a fully powered study. It also showed clinically meaningful treatment trends for the Ampcare ESP intervention.
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Affiliation(s)
- Lise Sproson
- NIHR Devices for Dignity HTC, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sue Pownall
- Speech & Language Therapy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pam Enderby
- School of Health and Related Research, Sheffield University, Western Bank, Sheffield, UK
| | - Jenny Freeman
- Faculty of Medicine and Health, Leeds University, Leeds, UK
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Maeda K, Koga T, Akagi J. Interferential current sensory stimulation, through the neck skin, improves airway defense and oral nutrition intake in patients with dysphagia: a double-blind randomized controlled trial. Clin Interv Aging 2017; 12:1879-1886. [PMID: 29158670 PMCID: PMC5683771 DOI: 10.2147/cia.s140746] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Neuromuscular electrical stimulation with muscle contraction, administered through the skin of the neck, improves a patient’s swallowing ability. However, the beneficial effects of transcutaneous electrical sensory stimulation (TESS), without muscle contraction, are controversial. We investigated the effect of TESS, using interferential current, in patients undergoing dysphagia rehabilitation. Methods This double-blind, randomized controlled trial involved 43 patients who were prescribed in-hospital dysphagia rehabilitation for ≥3 weeks. Patients were randomly assigned to the sensory stimulation (SS) or sham groups; all received usual rehabilitative care plus 2 weeks of SS or sham intervention. Outcome measures included cough latency times against a 1% citric acid mist, functional oral intake scale (FOIS) scores, and oral nutritional intake – each determined after the second and third week following treatment initiation. Results Mean patient age was 84.3±7.5 years; 58% were women. The SS and sham groups had similar baseline characteristics. Changes in cough latency time at 2 weeks (−14.1±14.0 vs −5.2±14.2 s, p=0.047) and oral nutrition intake at 3 weeks (437±575 vs 138±315 kcal/day, p=0.042) improved more in the SS group than in the sham group. Changes in cough frequency and FOIS scores indicated better outcomes in the SS group, based on substantial effect sizes. Conclusion TESS, using interferential current through the neck, improved airway defense and nutrition in patients suffering from dysphagia. Further large-scale studies are needed to confirm the technique’s effect on swallowing ability.
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Affiliation(s)
- Keisuke Maeda
- Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Kumamoto.,Palliative Care Center, Aichi Medical University, Nagakute
| | | | - Junji Akagi
- Department of Surgery, Tamana Regional Health Medical Center, Tamana, Tamana City, Kumamoto, Japan
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Yagi N, Oku Y, Nagami S, Yamagata Y, Kayashita J, Ishikawa A, Domen K, Takahashi R. Inappropriate Timing of Swallow in the Respiratory Cycle Causes Breathing-Swallowing Discoordination. Front Physiol 2017; 8:676. [PMID: 28970804 PMCID: PMC5609438 DOI: 10.3389/fphys.2017.00676] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/24/2017] [Indexed: 01/13/2023] Open
Abstract
Rationale: Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing–swallowing discoordination occurs are not well-understood. Objectives: We hypothesized that breathing–swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system. Measurements and Main Results: The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow), pause duration (duration of respiratory pause for swallowing), and the breathing–swallowing coordination pattern. We classified swallows that closely follow inspiration (I) as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing–swallows discoordination. Conclusions: We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing–swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.
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Affiliation(s)
- Naomi Yagi
- Department of Swallowing Physiology, Hyogo College of MedicineNishinomiya, Japan.,Department of Neurology, Graduate School of Medicine, Kyoto UniversityKyoto, Japan.,Clinical Research Center for Medical Equipment Development, Kyoto University HospitalKyoto, Japan
| | - Yoshitaka Oku
- Department of Swallowing Physiology, Hyogo College of MedicineNishinomiya, Japan.,Department of Physiology, Hyogo College of MedicineNishinomiya, Japan
| | - Shinsuke Nagami
- Department of Neurology, Graduate School of Medicine, Kyoto UniversityKyoto, Japan.,Clinical Research Center for Medical Equipment Development, Kyoto University HospitalKyoto, Japan.,Department of Physiology, Hyogo College of MedicineNishinomiya, Japan
| | - Yoshie Yamagata
- Department of Health Sciences, Prefectural University of HiroshimaHiroshima, Japan
| | - Jun Kayashita
- Department of Health Sciences, Prefectural University of HiroshimaHiroshima, Japan
| | - Akira Ishikawa
- Graduate School of Health Sciences, Kobe UniversityKobe, Japan
| | - Kazuhisa Domen
- Department of Physical Medicine & Rehabilitation, Hyogo College of MedicineNishinomiya, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto UniversityKyoto, Japan
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Hong DG, Yoo DH. A comparison of the swallowing function and quality of life by oral intake level in stroke patients with dysphagia. J Phys Ther Sci 2017; 29:1552-1554. [PMID: 28931986 PMCID: PMC5599819 DOI: 10.1589/jpts.29.1552] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/05/2017] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study was conducted to compare the swallowing function and quality of life
(QOL) in stroke patients with dysphagia by oral intake level. [Subjects and Methods]
Seventy-nine stroke patients with dysphagia were enrolled. All subjects were evaluated by
using the Swallowing Function Test (SFT) and the Swallowing Quality of Life (SWAL-QOL)
questionnaire. The subjects were divided into two group based on the SFT score: oral
intake (OI) and non-oral intake (NOI) groups. The SFT and SWAL-QOL scores were then
compared between the groups. [Results] There were significant differences in items in the
SFT, except for the respiratory item, between the OI group and the NOI group. There were
significant differences in all items on the SWAL-QOL, except for the sleep item, between
the OI group and the NOI group. [Conclusion] Oral intake was positively associated the
swallowing function and QOL in stroke patients with dysphagia. Safe intervention using
oral intake treatments during dysphagia rehabilitation may have a positive effect on the
patients’ swallowing function and QOL.
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Affiliation(s)
- Deok Gi Hong
- Department of Occupational Therapy, Wonkwang University, Republic of Korea
| | - Doo Han Yoo
- Department of Occupational Therapy, Konyang University: 158 Gwanjeodong-ro, Seo-gu, Daejeon 302-832, Republic of Korea
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Jones E, Speyer R, Kertscher B, Denman D, Swan K, Cordier R. Health-Related Quality of Life and Oropharyngeal Dysphagia: A Systematic Review. Dysphagia 2017; 33:141-172. [DOI: 10.1007/s00455-017-9844-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 08/21/2017] [Indexed: 12/14/2022]
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Rogus-Pulia N, Connor NP. Muscle Strengthening Approaches to Dysphagia Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0136-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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