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Du L, He X, Xiong X, Zhang X, Jian Z, Yang Z. Vagus nerve stimulation in cerebral stroke: biological mechanisms, therapeutic modalities, clinical applications, and future directions. Neural Regen Res 2024; 19:1707-1717. [PMID: 38103236 PMCID: PMC10960277 DOI: 10.4103/1673-5374.389365] [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: 06/11/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023] Open
Abstract
Stroke is a major disorder of the central nervous system that poses a serious threat to human life and quality of life. Many stroke victims are left with long-term neurological dysfunction, which adversely affects the well-being of the individual and the broader socioeconomic impact. Currently, post-stroke brain dysfunction is a major and difficult area of treatment. Vagus nerve stimulation is a Food and Drug Administration-approved exploratory treatment option for autism, refractory depression, epilepsy, and Alzheimer's disease. It is expected to be a novel therapeutic technique for the treatment of stroke owing to its association with multiple mechanisms such as altering neurotransmitters and the plasticity of central neurons. In animal models of acute ischemic stroke, vagus nerve stimulation has been shown to reduce infarct size, reduce post-stroke neurological damage, and improve learning and memory capacity in rats with stroke by reducing the inflammatory response, regulating blood-brain barrier permeability, and promoting angiogenesis and neurogenesis. At present, vagus nerve stimulation includes both invasive and non-invasive vagus nerve stimulation. Clinical studies have found that invasive vagus nerve stimulation combined with rehabilitation therapy is effective in improving upper limb motor and cognitive abilities in stroke patients. Further clinical studies have shown that non-invasive vagus nerve stimulation, including ear/cervical vagus nerve stimulation, can stimulate vagal projections to the central nervous system similarly to invasive vagus nerve stimulation and can have the same effect. In this paper, we first describe the multiple effects of vagus nerve stimulation in stroke, and then discuss in depth its neuroprotective mechanisms in ischemic stroke. We go on to outline the results of the current major clinical applications of invasive and non-invasive vagus nerve stimulation. Finally, we provide a more comprehensive evaluation of the advantages and disadvantages of different types of vagus nerve stimulation in the treatment of cerebral ischemia and provide an outlook on the developmental trends. We believe that vagus nerve stimulation, as an effective treatment for stroke, will be widely used in clinical practice to promote the recovery of stroke patients and reduce the incidence of disability.
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Affiliation(s)
- Li Du
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xuan He
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xu Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhihong Jian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhenxing Yang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Chen J, Zhao F, Hong J, Li C, Zhang J, Shan Y, Ye Q, Wen H. Effect of high-frequency repetitive transcranial magnetic stimulation on swallowing function and pneumonia in poststroke dysphagia in rats. Brain Res 2024; 1832:148846. [PMID: 38432259 DOI: 10.1016/j.brainres.2024.148846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/17/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Post-stroke dysphagia (PSD) is a common symptom of stroke. Clinical complications of PSD include malnutrition and pneumonia. Clinical studies have shown that high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) can improve the swallowing function in stroke patients. However, few studies have elucidated the underlying molecular mechanisms. METHODS A PSD rat model was established using transient middle cerebral artery occlusion (tMCAO). Rats were randomly divided into sham-operated groups, PSD groups, PSD + sham-rTMS groups, PSD + 5 Hz-rTMS groups, PSD + 10 Hz-rTMS groups and PSD + 20 Hz-rTMS groups. Rats were weighed and videofluoroscopic swallowing studies were conducted. Pulmonary inflammation, levels of substance P (SP) and calcitonin gene-related peptide (CGRP) in the serum, lung, and nucleus tractus solitarius (NTS), brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine (5HT) in NTS were evaluated. RESULTS Rats in the PSD group experienced weight loss, reduced bolus area and pharyngeal bolus speed, and increased pharyngeal transit time (PTT) and inter-swallow interval (ISI) on day 7 and day 14 after operation. Moreover, PSD rats showed pulmonary inflammation, reduced levels of SP in the lung and serum, increased levels of CGRP in the lung and NTS, reduced levels of BDNF and 5HT in the NTS. There was no significant difference between the PSD group and the PSD + sham-rTMS group in the results of weight and VFSS. Comparing with the PSD group, there significant increases in the bolus area, decreases in PTT of rats following 5 Hz rTMS intervention. HF-rTMS at 10 Hz significantly increased the weight, bolus area, pharyngeal bolus speed and decreased the PTT and ISI of rats. There were also significant increases in the bolus area (p < 0.01) and pharyngeal bolus speed, decreases in PTT and ISI of rats following 20 Hz rTMS intervention. Furthermore, compared with the PSD + 5 Hz-rTMS group, there were significant increases in the bolus area and pharyngeal bolus speed, decreases in ISI in the swallowing function of rats in the PSD + 10 Hz-rTMS group. Besides, compared with the PSD + 5 Hz-rTMS group, there were significant decreases in ISI in the swallowing function of rats in the PSD + 20 Hz-rTMS group. HF-rTMS at 10 Hz alleviated pulmonary inflammation, increased the levels of SP in the lung, serum, and NTS, CGRP in the serum and NTS, 5HT in the NTS of PSD rats. CONCLUSION Compared with 5 Hz and 20 Hz rTMS, 10 Hz rTMS more effectively improved the swallowing function of rats with PSD. HF-rTMS at 10 Hz improved the swallowing function and alleviated pneumonia in PSD rats. The mechanism may be related to increased levels of SP in the lung, serum and NTS, levels of CGRP in the serum and NTS, 5HT in the NTS after HF-rTMS treatment.
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Affiliation(s)
- Jiemei Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China.
| | - Fei Zhao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China.
| | - Jiena Hong
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China.
| | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China.
| | - Jiantao Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China.
| | - Yilong Shan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China.
| | - Qiuping Ye
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China; Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Traditional Chinese Medicine, 232 East Waihuan Road, Guangzhou 510006, Guangdong Province, China.
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China.
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Jiang W, Zou Y, Huang L, Zeng Y, Xiao LD, Chen Q, Zhang F. Gustatory stimulus interventions for older adults with dysphagia: a scoping review. Aging Clin Exp Res 2023:10.1007/s40520-023-02437-4. [PMID: 37209267 DOI: 10.1007/s40520-023-02437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Gustatory stimulus interventions have been shown to improve swallowing function in older adults with dysphagia. However, the optimal intervention strategies as well as their effects and safety remain unclear. AIMS To explore current evidence regarding gustatory stimulus interventions for dysphagia in older adults. METHODS Nine electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Sinomed) were searched from their inception to August 2022. RESULTS This review identified 263 articles, and 15 met the inclusion criteria. The types of gustatory stimulus interventions included spicy (n = 10), sour (n = 3), and mixed (sour-sweet) stimuli (n = 2), with most studies focusing on spicy stimuli. The most frequently reported spicy stimulus was capsaicin. Further, the most commonly reported intervention frequency was thrice a day before meals for 1-4 weeks. The stimuli concentrations and dosages could not be standardized due to the among-study heterogeneity. These studies reported 16 assessment tools and 42 outcomes, which mainly included videofluoroscopy and swallowing response time respectively. More than half of the included studies reported no adverse effects of gustatory stimulus interventions. CONCLUSION AND DISCUSSIONS Gustatory stimulus interventions improved swallowing function in older adults with dysphagia. However, assessment tools and outcomes for dysphagia should be standardized in the future, and explore personalized interventions based on different diseases and their stages, to determine the most cost-effective interventions, and to prevent its complications.
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Affiliation(s)
- Wenyi Jiang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ying Zou
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Lei Huang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Yanli Zeng
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lily Dongxia Xiao
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Qian Chen
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Fengying Zhang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
- Nursing Key Laboratory of Sichuan Province, Chengdu, China.
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China.
- West China Hospital, Sichuan University, Chengdu, China.
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Zhong L, Wen X, Liu Z, Li F, Ma X, Liu H, Chen H. Effects of bilateral cerebellar repetitive transcranial magnetic stimulation in poststroke dysphagia: A randomized sham-controlled trial. NeuroRehabilitation 2023; 52:227-234. [PMID: 36641691 DOI: 10.3233/nre-220268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although increasing evidence indicates that cerebellar repetitive transcranial magnetic stimulation (rTMS) may be beneficial in the treatment of dysphagia, its clinical efficacy is still uncertain. OBJECTIVE To evaluate the effect of high-frequency cerebellar rTMS on poststroke dysphagia. METHODS This was a randomized, sham-controlled, double-blind trial. A total of eighty-four study participants were randomly assigned into the cerebellum and control groups. The cerebellum group received bilateral 10 Hz rTMS treatment of the pharyngeal motor area of the cerebellum. The control group was administered with sham rTMS of the pharyngeal motor area of the cerebellum. All patients underwent the same conventional swallowing rehabilitation training after the intervention 5 days a week for a total of 10 days. Assessment of swallowing function was done before treatment (baseline), after treatment (2 weeks), and during follow-up (2 weeks after treatment) using the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and the Penetration-Aspiration Scale (PAS). RESULTS The interaction between time and intervention had a significant effect on PAS (P < 0.001) and FEDSS (P < 0.001). Compared to the control group, the cerebellum group exhibited significantly improved clinical swallowing function scores (PAS: P = 0.007, FEDSS: P = 0.002). CONCLUSION Bilateral cerebellar rTMS is a potential new neurorehabilitation technique for post-stroke dysphagia. Studies should aim at investigating the therapeutic mechanism of cerebellar rTMS and improve this technique.
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Affiliation(s)
- Lida Zhong
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Xin Wen
- Rehabilitation College of Gannan Medical University, Ganzhou, China
| | - Zicai Liu
- Rehabilitation College of Gannan Medical University, Ganzhou, China
| | - Fang Li
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Xiancong Ma
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Hongxia Chen
- Department of Rehabilitation, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Fang WJ, Zheng F, Zhang LZ, Wang WH, Yu CC, Shao J, Wu YJ. Research progress of clinical intervention and nursing for patients with post-stroke dysphagia. Neurol Sci 2022; 43:5875-5884. [PMID: 35661279 PMCID: PMC9166186 DOI: 10.1007/s10072-022-06191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Post-stroke dysphagia (PSD) is a common and costly complication of stroke and is associated with increased mortality, morbidity, and hospitalization. Although most patients can spontaneously resume swallowing, there are still many patients who do not recover and even die. Despite multiple advances in the acute treatment and secondary prevention of stroke, the effective treatment of PSD remains a neglected area. Studies have shown that repair mechanisms of neurostimulation techniques and increased cortical activity play an important role in the treatment of PSD. In addition, nutritional interventions are also crucial for the treatment of malnutrition in PSD patients. Therefore, this article reviews the effects of the current main clinical treatment methods and nutritional interventions on the treatment and rehabilitation of PSD patients. It also emphasized the necessity of developing an individualized care plan for PSD patients, which is of great significance to promote the clinical treatment, nutritional status, prognosis, and quality of life of PSD patients.
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Affiliation(s)
- Wen-Juan Fang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Fei Zheng
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Lin-Zhi Zhang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Wen-Hui Wang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Cheng-Chen Yu
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Juan Shao
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Yi-Jin Wu
- The Second Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, China.
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Liu K, Yin M, Cai Z. Research and application advances in rehabilitation assessment of stroke. J Zhejiang Univ Sci B 2022; 23:625-641. [PMID: 35953757 DOI: 10.1631/jzus.b2100999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stroke has a high incidence and disability rate, and rehabilitation is an effective means to reduce the disability rate of patients. To systematize rehabilitation assessment, which is the foundation for rehabilitation therapy, we summarize the assessment methods commonly used in research and clinical applications, including the various types of stroke rehabilitation scales and their applicability, and related biomedical detection technologies, including surface electromyography (sEMG), motion analysis systems, transcranial magnetic stimulation (TMS), magnetic resonance imaging (MRI), and combinations of different techniques. We also introduce some assessment techniques that are still in the experimental phase, such as the prospective application of artificial intelligence (AI) with optical correlation tomography (OCT) in stroke rehabilitation. This review provides a useful bibliography for the assessment of not only the severity of stroke injury, but also the therapeutic effects of stroke rehabilitation, and establishes a solid base for the future development of stroke rehabilitation skills.
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Affiliation(s)
- Kezhou Liu
- Department of Biomedical Engineering, School of Automation (Artificial Intelligence), Hangzhou Dianzi University, Hangzhou 310018, China.
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Liu H, Peng Y, Liu Z, Wen X, Li F, Zhong L, Rao J, Li L, Wang M, Wang P. Hemodynamic signal changes and swallowing improvement of repetitive transcranial magnetic stimulation on stroke patients with dysphagia: A randomized controlled study. Front Neurol 2022; 13:918974. [PMID: 36034299 PMCID: PMC9403609 DOI: 10.3389/fneur.2022.918974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveOur study aims to measure the cortical correlates of swallowing execution in patients with dysphagia after repetitive transcranial magnetic stimulation (rTMS) therapy using functional near-infrared spectroscopy (fNIRS), and observe the change of pattern of brain activation in stroke patients with dysphagia after rTMS intervention. In addition, we tried to analyze the effect of rTMS on brain activation in dysphagia patients with different lesion sides. This study also concentrated on the effect of stimulating the affected mylohyoid cortical region by 5 Hz rTMS, providing clinical evidence for rTMS therapy of dysphagia in stroke patients.MethodsThis study was a sham-controlled, single-blind, randomized controlled study with a blinded observer. A total of 49 patients completed the study, which was randomized to the rTMS group (n = 23) and sham rTMS group (n = 26) by the random number table method. The rTMS group received 5 Hz rTMS stimulation to the affected mylohyoid cortical region of the brain and the sham rTMS group underwent rTMS using the same parameters as the rTMS group, except for the position of the coil. Each patient received 2 weeks of stimulation followed by conventional swallowing therapy. Standardized Swallowing Assessment (SSA), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), Penetration-Aspiration Scale (PAS), and functional oral intake status were assessed at two times: baseline (before treatment) and 2 weeks (after intervention). Meanwhile, we use the fNIRS system to measure the cerebral hemodynamic changes during the experimental procedure.ResultsThe rTMS group exhibited significant improvement in the SSA scale, FEDSS scale, and PAS scale after rTMS therapy (all P < 0.001). The sham rTMS group had the same analysis on the same scales (all P < 0.001). There was no significant difference observed in clinical assessments at 2 weeks after baseline between the rTMS group and sham rTMS group (all P > 0.05). However, there were statistically significant differences between the two groups in the rate of change in the FEDSS score (P = 0.018) and PAS score (P = 0.004), except for the SSA score (P = 0.067). As for the removal rate of the feeding tube, there was no significant difference between the rTMS group and sham rTMS group (P = 0.355), but there was a significant difference compared with the baseline characteristics in both groups (PrTMS < 0.001, PshamrTMS = 0.002). In fNIRS analysis, the block average result showed differences in brain areas RPFC (right prefrontal cortex) and RMC (right motor cortex) significantly between the rTMS group and sham rTMS group after intervention (Pchannel30 = 0.046, Pchannel16 = 0.006). In the subgroup analysis, rTMS group was divided into left-rTMS group and right-rTMS group and sham rTMS group was divided into sham left-rTMS group and sham right-rTMS group. The fNIRS results showed no significance in block average and block differential after intervention between the left-rTMS group and sham left-rTMS group, but differences were statistically significant between the right-rTMS group and sham right-rTMS group in block average: channel 30 (T = −2.34, P = 0.028) in LPFC (left prefrontal cortex) and 16 (T = 2.54, P = 0.018) in RMC. After intervention, there was no significance in left-rTMS group compared with baseline, but in right-rTMS group, channel 27 (T = 2.18, P = 0.039) in LPFC and 47 (T = 2.17, P = 0.039) in RPFC had significance in block differential. In the sham rTMS group, neither sham left-rTMS group and sham right-rTMS group had significant differences in block average and block differential in each brain area after intervention (P > 0.05).ConclusionsThe present study confirmed that a 5-Hz rTMS is feasible at the affected mylohyoid cortical region in post-stroke patients with dysphagia and rTMS therapy can alter cortical excitability. Based on previous studies, there is a dominant hemisphere in swallowing and the results of our fNIRS analysis seemed to show a better increase in cortical activation on the right side than on the left after rTMS of the affected mylohyoid cortical region. However, there was no difference between the left and right hemispheres in the subgroup analysis. Nevertheless, the present study provides a novel and feasible method of applying fNIRS to assessment in stroke patients with dysphagia.
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Affiliation(s)
- Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Yang Peng
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Zicai Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Xin Wen
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Fang Li
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Lida Zhong
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Jinzhu Rao
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Li Li
- Yue Bei People's Hospital, Shaoguan, China
- *Correspondence: Li Li
| | - Minghong Wang
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
- Minghong Wang
| | - Pu Wang
- Department of Rehabilitation Medicine, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
- Pu Wang
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Yang C, Pan Y. Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review. PLoS One 2022; 17:e0270096. [PMID: 35709228 PMCID: PMC9202855 DOI: 10.1371/journal.pone.0270096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Dysphagia is a common yet serious complication in stroke patients. We aimed to conduct a meta-analysis and systematic review to evaluate the risk factors of dysphagia in patients with ischemic stroke, to provide insights to the clinical treatment and nursing care of dysphagia. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Database, China Biomedical Literature Database (CBM) for studies on dysphagia in patients with ischemic stroke up to January 31, 2022. The quality of the literature was evaluated using the Newcastle-Ottawa scale. Meta-analysis was performed using RevMan 5.3 software. Results A total of 10 studies involving 4637 ischemic stroke patients were included, 1183(25.51%) patients had dysphagia after stroke. The synthesized outcomes showed that elder age (SMD = 0.42, 95%CI:0.34–0.50), hypertension (OR = 1.96, 95%CI:1.48–2.61), diabetes (OR = 1.83, 95%CI:1.47–2.28), brainstem stroke (OR = 2.12, 95%CI:1.45–3.09) were associated with dysphagia in patients with ischemic stroke (all P<0.05). There was no significant difference in the gender between dysphagia and no dysphagia patients (OR = 1.07, 95%CI:0.91–1.27, P = 0.40). Egger regression tests indicated there were no significant publication biases in the synthesized outcomes (all P>0.05). Conclusions Elder age, hypertension, diabetes and brainstem stroke are associated with the development of dysphagia in patients with ischemic stroke. Attention should be paid to the assessment and early intervention of those risk factors for dysphagia to improve the prognosis of stroke patients.
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Affiliation(s)
- Cui Yang
- Department of Neurology, The First People's Hospital of Lianyungang, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, China
| | - Yun Pan
- Division of Rheumatology, The First People's Hospital of Lianyungang, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, China
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Qiu X, Yao XJ, Han SN, Wu YY, Ou ZJ, Li TS, Zhang H. Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study. Front Neurosci 2022; 15:791964. [PMID: 35069105 PMCID: PMC8770751 DOI: 10.3389/fnins.2021.791964] [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: 10/09/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Post-stroke dysphagia (PSD) affects the quality of life in stroke patients, impairs their rehabilitation ability, and causes other complications following stroke. Currently, there is currently some understanding of PSD risk factors, but its protective factors remain largely unknown. Objective: To analyze the effects of acupuncture (AP) on dysphagia in stroke patients and explore its potential as a preventive therapy. Methods: Patients with a diagnosis of stroke from 2010 to 2019 were selected and followed until 2020, utilizing factors such as age, gender, stroke location, stroke type, and baseline comorbidity. To compare the incidence of dysphagia, equal numbers of stroke patients treated with and without AP (n = 1,809) were matched by 1:1 propensity scoring. The Cox proportional hazards model and Kaplan-Meier method were used to assess the risk of dysphagia as an outcome measure. Results: The stroke patients treated with AP had a lower risk of dysphagia after adjusting for age, gender, stroke location, stroke type, and baseline comorbidity [adjusted hazard ratio (AHR) = 0.43, 95% confidence interval = 0.37-0.49] compared with those in the non-AP cohort. AP also decreased the risk of PSD among different gender groups. The risk ratios were AHR = 0.45 and AHR = 0.33 for males and females, respectively. AP also reduced the risk for PSD among different age groups. The risk ratios were AHR = 0.20, AHR = 0.37, AHR = 0.41, and AHR = 0.45 for the 18-39, 40-59, 60-79, and >80 years-old groups. Regarding stroke types (ischemic, hemorrhagic, and mixed type), patients treated with AP had a lower risk (AHR = 0.47, 0.28 and 0.17, respectively). With respect to stroke location, the risk of PSD in AP-treated patients was decreased regardless of location: brain stem (AHR = 0.41), diencephalon (AHR = 0.13), or multiple lesions (AHR = 0.40), the risk of PSD in AP-treated patients was decreased. For all baseline comorbidities, AP attenuated the risk of dysphagia. The cumulative incidence of dysphagia was remarkably lower in the AP group than in the non-AP group (log-rank test, P = 0.000). Limitations: First, this was a single-center clinical retrospective study. Second, we did not classify the severity of stroke and dysphagia. Third, all data were extracted manually. Lastly, the sample size was relatively small. Thus, future studies with larger sample sizes are warranted to verify our findings. Conclusion: Acupuncture treatment attenuates the risk of dysphagia in stroke patients. Future research should increase the sample size and elaborate further on the details of the AP protocol.
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Affiliation(s)
- Xuan Qiu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Jie Yao
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sheng-Nan Han
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yun-Yun Wu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zeng-Jian Ou
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tian-Shi Li
- First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hong Zhang
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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10
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Prosiegel M. Neuroanatomie des Schluckens. SCHLUCKSTÖRUNGEN 2022:53-66. [DOI: 10.1016/b978-3-437-44418-0.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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11
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Zhang D, Li Y, Li H, Fu W, Zeng J, Zeng X. Analysis of Factors That Influence the Prognosis of Swallowing Function Rehabilitation Therapy in Patients with Dysphagia After Medullary Infarction. Neuropsychiatr Dis Treat 2022; 18:97-107. [PMID: 35079218 PMCID: PMC8776725 DOI: 10.2147/ndt.s341353] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study investigated the factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. PATIENTS AND METHODS This retrospective study was conducted using the clinical data of 51 patients who were diagnosed with dysphagia after medullary infarction and hospitalized at our institution between January 2019 and January 2021. As per the water swallow test (WST) grade at 1 month after rehabilitation treatment, patients were classified into the good prognosis group and the poor prognosis group. Univariate analysis as well as univariate and multivariate logistic regression analysis were used to analyze factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. Receiver operating characteristic (ROC) curves were then used to test the predictive ability of the significant parameters to predict the prognosis of the rehabilitation therapy in these patients. RESULTS Univariate analysis and univariate logistic regression analysis showed that previous stroke (odds ratio [OR] = 1.361), dysarthria (OR = 3.771), disease course (OR = 1.112), National Institutes of Health Stroke Scale (NIHSS) score at admission (OR = 2.596), and infarct site (OR = 11.071) were all significantly correlated with the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction (P < 0.05). Multivariate logistic regression analysis showed that dysarthria (OR = 5.519, 95% confidence interval (CI) 1.413-21.566), infarct site (OR = 18.634, 95% CI 1.696-204.73), and the NIHSS score (OR = 1.001, 95% CI 1.536-4.820) were independent influencing factors of the prognosis of swallowing function rehabilitation therapy in these patients. The ROC curve showed that the area under the curve for the combined prediction of the three indicators was 0.943. CONCLUSION The NIHSS score, dysarthria, and infarct site are independent influencing factors for the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction.
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Affiliation(s)
- Di Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yi Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Heping Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Weifeng Fu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Jing Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Xi Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
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12
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Morrison RA, Hays SA, Kilgard MP. Vagus Nerve Stimulation as a Potential Adjuvant to Rehabilitation for Post-stroke Motor Speech Disorders. Front Neurosci 2021; 15:715928. [PMID: 34489632 PMCID: PMC8417469 DOI: 10.3389/fnins.2021.715928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023] Open
Abstract
Stroke often leaves lasting impairments affecting orofacial function. While speech therapy is able to enhance function after stroke, many patients see only modest improvements after treatment. This partial restoration of function after rehabilitation suggests that there is a need for further intervention. Rehabilitative strategies that augment the effects of traditional speech therapy hold promise to yield greater efficacy and reduce disability associated with motor speech disorders. Recent studies demonstrate that brief bursts of vagus nerve stimulation (VNS) can facilitate the benefits of rehabilitative interventions. VNS paired with upper limb rehabilitation enhances recovery of upper limb function in patients with chronic stroke. Animal studies reveal that these improvements are driven by VNS-dependent synaptic plasticity in motor networks. Moreover, preclinical evidence demonstrates that a similar strategy of pairing VNS can promote synaptic reorganization in orofacial networks. Building on these findings, we postulate that VNS-directed orofacial plasticity could target post-stroke motor speech disorders. Here, we outline the rationale for pairing VNS with traditional speech therapy to enhance recovery in the context of stroke of speech motor function. We also explore similar treatments that aim to enhance synaptic plasticity during speech therapy, and how VNS differs from these existing therapeutic strategies. Based on this evidence, we posit that VNS-paired speech therapy shows promise as a means of enhancing recovery after post-stroke motor speech disorders. Continued development is necessary to comprehensively establish and optimize this approach, which has the potential to increase quality of life for the many individuals suffering with these common impairments.
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Affiliation(s)
- Robert A Morrison
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States
| | - Seth A Hays
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States.,Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX, United States
| | - Michael P Kilgard
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States.,Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, United States
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13
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Kim JY, Yoon SY, Kim J, Wook Kim Y. Neural correlates of cricopharyngeal dysfunction after supratentorial stroke: A voxel-based lesion-symptom mapping with propensity score matched case-control. Int J Stroke 2021; 17:207-217. [PMID: 33724099 DOI: 10.1177/17474930211006300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poststroke cricopharyngeal dysfunction has been reported to occur in 50% of brainstem strokes; however, cricopharyngeal dysfunction also occurs commonly in patients with supratentorial stroke. The hemispheric neuroanatomical location of this dysfunction has not been clearly identified. AIM We aimed to analyze the relationship between cricopharyngeal dysfunction and supratentorial lesion location in poststroke patients through this retrospective case-control voxel-based lesion-symptom mapping study. METHODS Cricopharyngeal dysfunction was diagnosed when the residue after swallowing (pyriform sinus) accounted for more than 25% of volume of pyriform sinus. Medical records and the video fluoroscopic swallowing studies of first-ever stroke patients who were admitted to our hospital during acute to subacute phase from 2009 to 2019 were reviewed. After propensity score matching to reduce the likelihood of selection bias, 50 patients per group were included in the cricopharyngeal dysfunction and control groups. We used a P threshold of 0.01 corrected for multiple comparisons with permutation thresholding (5000 permutations). Dichotomized diagnosis of cricopharyngeal dysfunction and the magnitude of pyriform sinus were used as dependent variables. RESULTS Analysis using the Liebermeister statistics indicated that lesions of the right lentiform nucleus were associated with the development of cricopharyngeal dysfunction. After adjustment for age and total lesion volume, which are known effectors for the development of dysphagia, statistically significant correlations were found between pyriform sinus and lesions of the right lentiform nucleus and anterior corona radiata beneath the right middle frontal gyrus. CONCLUSION Thus, our study demonstrated for the first time that damages to the right lentiform nucleus, especially globus pallidus externa, and anterior corona radiata beneath the right middle frontal gyrus are associated with the development and severity of cricopharyngeal dysfunction.
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Affiliation(s)
- Jun Yup Kim
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea.,Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Yeon Yoon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, Seongnam-si, Republic of Korea
| | - Jinna Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Nagappan PG, Chen H, Wang DY. Neuroregeneration and plasticity: a review of the physiological mechanisms for achieving functional recovery postinjury. Mil Med Res 2020; 7:30. [PMID: 32527334 PMCID: PMC7288425 DOI: 10.1186/s40779-020-00259-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/24/2020] [Indexed: 12/12/2022] Open
Abstract
Neuronal networks, especially those in the central nervous system (CNS), evolved to support extensive functional capabilities while ensuring stability. Several physiological "brakes" that maintain the stability of the neuronal networks in a healthy state quickly become a hinderance postinjury. These "brakes" include inhibition from the extracellular environment, intrinsic factors of neurons and the control of neuronal plasticity. There are distinct differences between the neuronal networks in the peripheral nervous system (PNS) and the CNS. Underpinning these differences is the trade-off between reduced functional capabilities with increased adaptability through the formation of new connections and new neurons. The PNS has "facilitators" that stimulate neuroregeneration and plasticity, while the CNS has "brakes" that limit them. By studying how these "facilitators" and "brakes" work and identifying the key processes and molecules involved, we can attempt to apply these theories to the neuronal networks of the CNS to increase its adaptability. The difference in adaptability between the CNS and PNS leads to a difference in neuroregenerative properties and plasticity. Plasticity ensures quick functional recovery of abilities in the short and medium term. Neuroregeneration involves synthesizing new neurons and connections, providing extra resources in the long term to replace those damaged by the injury, and achieving a lasting functional recovery. Therefore, by understanding the factors that affect neuroregeneration and plasticity, we can combine their advantages and develop rehabilitation techniques. Rehabilitation training methods, coordinated with pharmacological interventions and/or electrical stimulation, contributes to a precise, holistic treatment plan that achieves functional recovery from nervous system injuries. Furthermore, these techniques are not limited to limb movement, as other functions lost as a result of brain injury, such as speech, can also be recovered with an appropriate training program.
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Affiliation(s)
| | - Hong Chen
- Shengli Clinical College of Fujian Medical University; Department of Neurology, Fujian Provincial Hospital, Fuzhou, Fujian, 350001, China.
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
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15
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Morrison RA, Danaphongse TT, Pruitt DT, Adcock KS, Mathew JK, Abe ST, Abdulla DM, Rennaker RL, Kilgard MP, Hays SA. A limited range of vagus nerve stimulation intensities produce motor cortex reorganization when delivered during training. Behav Brain Res 2020; 391:112705. [PMID: 32473844 DOI: 10.1016/j.bbr.2020.112705] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 01/01/2023]
Abstract
Pairing vagus nerve stimulation (VNS) with rehabilitation has emerged as a potential strategy to improve recovery after neurological injury, an effect ascribed to VNS-dependent enhancement of synaptic plasticity. Previous studies demonstrate that pairing VNS with forelimb training increases forelimb movement representations in motor cortex. However, it is not known whether VNS-dependent enhancement of plasticity is restricted to forelimb training or whether VNS paired with other movements could induce plasticity of other motor representations. We tested the hypothesis that VNS paired with orofacial movements associated with chewing during an unskilled task would drive a specific increase in jaw representation in motor cortex compared to equivalent behavioral experience without VNS. Rats performed a behavioral task in which VNS at a specified intensity between 0 and 1.2 mA was paired with chewing 200 times per day for five days. Intracortical microstimulation (ICMS) was then used to document movement representations in motor cortex. VNS paired with chewing at 0.8 mA significantly increased motor cortex jaw representation compared to equivalent behavioral training without stimulation (Bonferroni-corrected unpaired t-test, p < 0.01). Higher and lower intensities failed to alter cortical plasticity. No changes in other movement representations or total motor cortex area were observed between groups. These results demonstrate that 0.8 mA VNS paired with training drives robust plasticity specific to the paired movement, is not restricted to forelimb representations, and occurs with training on an unskilled task. This suggests that moderate intensity VNS may be a useful adjuvant to enhance plasticity and support benefits of rehabilitative therapies targeting functions beyond upper limb movement.
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Affiliation(s)
- Robert A Morrison
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States.
| | - Tanya T Danaphongse
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - David T Pruitt
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Katherine S Adcock
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Jobin K Mathew
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Stephanie T Abe
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Dina M Abdulla
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Robert L Rennaker
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Michael P Kilgard
- The University of Texas at Dallas, School of Behavioral Brain Sciences, Richardson, TX, United States; The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States
| | - Seth A Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, TX, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Richardson, TX, United States
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16
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Jang SH, Kwak SY, Chang CH, Jung YJ, Kim J, Kim SH, Kim JY. Prognostic Prediction of Dysphagia by Analyzing the Corticobulbar Tract in the Early Stage of Intracerebral Hemorrhage. Dysphagia 2020; 35:985-992. [PMID: 32040613 DOI: 10.1007/s00455-020-10093-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
We investigated the predictive value of the corticobulbar tract (CBT) for dysphagia using diffusion tensor tractography in the early stage of intracerebral hemorrhage (ICH) for dysphagia. Forty-two patients with spontaneous ICH ± intraventricular hemorrhage (IVH) and 22 control subjects were recruited. The patients were classified into three groups: group A-could remove nasogastric tube (NGT) in the acute stage of ICH, group B-could remove NGT within 6 months after onset, and group C-could not remove NGT until 6 months after onset. The CBT were reconstructed, and fractional anisotropy (FA) and tract volume (TV) values were determined. The FA of the CBT in the affected hemisphere in group A was lower than in the control group (p < 0.05). The FA and TV of the CBT in the affected hemisphere in group B were lower than those in the control group (p < 0.05). In group C, the FA and TV in the affected hemisphere and unaffected hemispheres were lower than in the control group (p < 0.05). The TV of the CBT in the affected hemisphere in group B showed a moderate negative correlation with the length of time until NGT removal (r = 0.430, p < 0.05). We found that patients with CBT injuries in both hemispheres were not able to remove the NGT until 6 months after onset, whereas patients who were injured only in the affected hemisphere were able to remove NGT within 6 months of onset. The severity of injury to the CBT in the affected hemisphere appeared to be related to the length of time until NGT removal.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - So Young Kwak
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Young Jin Jung
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - JongHoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Seong Ho Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea
| | - Jun Young Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyung dong, Namgu, Taegu, 705-717, Republic of Korea.
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17
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Pedra EDFP, Pontes VL, Mourão AM, Braga MA, Vicente LCC. Post-stroke patients with and without thrombolysis: analysis of deglutition in the acute phase of the disease. Codas 2020; 32:e20180229. [PMID: 32022220 DOI: 10.1590/2317-1782/20192018229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/03/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To verify the frequency and severity of dysphagia after ischemic stroke with or without thrombolysis in the acute phase; and the association among dysphagia, demographic characteristics, neurological and functional impairments and thrombolysis. METHODS A retrospective study of the medical records of 94 patients who suffered from ischemic stroke during the acute phase of the disease. From these, 52 patients received thrombolytic therapy and 42 patients did not receive such therapy. We collected data on age, sex, comorbidities, therapeutic time window of thrombolytic therapy, level of consciousness, degree of neurological impairment, level of functional dependency and clinical swallowing examination. A descriptive analysis included categorical and continuous variables, and an analysis of the association using the Pearson's Chi-Square Test, in which the value of p ≤ 0.05 was considered as a statistically significant association. RESULTS The frequency of dysphagia in the thrombolytic patients was 67.3%, the odds ratio was 4.6 higher than the non-thrombolysed patients. The severity of dysphagia was not associated with thrombolysis. There was an association between the presence of dysphagia and functional dependence. Demographic characteristics and neurological impairment were not associated with dysphagia. CONCLUSION Thrombolytic patients were more likely to develop dysphagia than non-thrombolysed patients in the acute phase of stroke, with dysphagia associated to functional dependence.
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Affiliation(s)
| | - Vanessa Laís Pontes
- Hospital das Clínicas, Universidade Federal Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
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Castagna A, Ferrara L, Asnaghi E, Rega V, Fiorini G. Functional limitations and cognitive impairment predict the outcome of dysphagia in older patients after an acute neurologic event. NeuroRehabilitation 2019; 44:413-418. [PMID: 31177241 DOI: 10.3233/nre-182635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Dysphagia prevalence increases with age and a significant contribution is given by stroke survivors; its treatment is mainly based on rehabilitation, but outcome cannot be easily predicted. OBJECTIVE The aim of this study is to detect possible predictors of the outcome of dysphagia in patients beginning rehabilitation after a major Central Nervous System injury. METHODS Dysphagia severity was measured in 95 consecutive patients (71 with ischemic or hemorrhagic stroke) upon admission to our neurorehabilitation unit and at discharge, during the year 2017. The initial evaluation included also demographic data, functional and geriatric multidimensional assessment, laboratory test results and comorbidities. Their possible predictive value on the degree of recovery of the swallowing process at discharge has been analyzed. RESULTS Poor functional conditions and the presence of cognitive impairment on admission appear to be associated with a worse outcome of dysphagia at discharge. A significant correlation exists between scores at functional scales at the beginning of rehabilitation and dysphagia score at discharge. Patients with cognitive impairment at the beginning (n = 60) showed a significantly lower degree of recovery of dysphagia at discharge. CONCLUSION Other factors, beside the degree of dysphagia itself, are important to predict its outcome. Their knowledge not only allows an initial prognostic assessment; it can also be useful to decide which aspects should receive greater attention when treating patients with dysphagia.
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Affiliation(s)
- Alberto Castagna
- Neurorehabilitation Unit, Istituti Clinici Zucchi, Gruppo San Donato, Carate, Italy
| | - Lucia Ferrara
- Neurorehabilitation Unit, Istituti Clinici Zucchi, Gruppo San Donato, Carate, Italy
| | - Emanuela Asnaghi
- Neurorehabilitation Unit, Istituti Clinici Zucchi, Gruppo San Donato, Carate, Italy
| | - Vincenzo Rega
- Neurorehabilitation Unit, Istituti Clinici Zucchi, Gruppo San Donato, Carate, Italy.,School of Medicine, Università Statale di Milano Bicocca, Monza, Italy
| | - Gianfrancesco Fiorini
- Neurorehabilitation Unit, Istituti Clinici Zucchi, Gruppo San Donato, Carate, Italy.,School of Medicine, Università Statale di Milano, Milan, Italy
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Shi J, Ye Q, Zhao J, Liu J, Xu Z, Yi W, Xu N. EA promotes swallowing via activating swallowing-related motor neurons in the nucleus ambiguus. Brain Res 2018; 1718:103-113. [PMID: 30537518 DOI: 10.1016/j.brainres.2018.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 11/18/2022]
Abstract
To observe the effect of electroacupuncture (EA) on swallowing and its underlying mechanism, 32 Sprague-Dawley (SD) rats were chose and the electrophysiology was used to detect the discharge of nucleus ambiguus (NA) after EA at CV23 (Lianquan), GV16 (Fengfu), and other acupoints. The swallowing-related motor neuron was identified by antidromic stimulation through recurrent laryngeal nerve. Meanwhile, the swallowing numbers were induced by Double-distilled water (DDW) and the neuron discharges were recorded before and after EA. Beside, 50 SD rats were used for testing the c-fos expressions in NA after EA at different acupoints and the other 80 SD rats were used for chemical damage through the microinjection to bilateral NA. 58 neurons provided complete data after histological identification. And two types of swallowing-related (SR) motor neurons were identified, named spontaneous and silent neurons. We found that the onset latency of the first swallow was shorter and the swallowing numbers were increased after EA at CV23 than the other acupoints (P < 0.01). The excitatory neuron response rates were 66.67%, 71.11%, 42.22% and 35.56% for CV23, GV16, PC6 (Neiguan), and ST36 (Zusanli), respectively. The c-fos expressions on CV23 and GV16 groups were significantly higher than the other groups (P < 0.05). After chemical damage, the swallowing numbers could not be regulated by EA, but could be regulated by EA after fake damage. The results of the present study demonstrate that EA at CV23 and GV16 could regulate swallowing function via activating swallowing-related motor neurons in NA.
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Affiliation(s)
- Junheng Shi
- Guangzhou University of Chinese Medicine, No. 232 Waihuan East Road, Panyu District, Guangzhou, Guangdong Province 510006, China
| | - Qiuping Ye
- Guangzhou University of Chinese Medicine, No. 232 Waihuan East Road, Panyu District, Guangzhou, Guangdong Province 510006, China
| | - Jiaying Zhao
- Guangzhou University of Chinese Medicine, No. 232 Waihuan East Road, Panyu District, Guangzhou, Guangdong Province 510006, China
| | - Jianhua Liu
- Guangdong Provincial Hospital of Chinese Medicine, Yide Road, Yuexiu District, Guangzhou, Guangdong Province 510006, China
| | - Zhenhua Xu
- Guangdong Provincial Hospital of Chinese Medicine, Yide Road, Yuexiu District, Guangzhou, Guangdong Province 510006, China
| | - Wei Yi
- Guangzhou University of Chinese Medicine, No. 232 Waihuan East Road, Panyu District, Guangzhou, Guangdong Province 510006, China
| | - Nenggui Xu
- Guangzhou University of Chinese Medicine, No. 232 Waihuan East Road, Panyu District, Guangzhou, Guangdong Province 510006, China.
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Effects of Fluoxetine on Poststroke Dysphagia: A Clinical Retrospective Study. J Stroke Cerebrovasc Dis 2018; 27:3320-3327. [PMID: 30174226 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/25/2018] [Accepted: 07/21/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To investigate whether fluoxetine improves poststroke dysphagia and to detect the potential relationship between serum brain-derived neurotrophic factor (BDNF) levels and fluoxetine effects. METHODS In this retrospective study, 159 stroke patients who met our study criteria were included. In total, 110 patients were placed in the control group, and 49 patients were placed in the fluoxetine group. Demographic and clinical characteristics of the patients were collected for the baseline assessment. Functional independence measure scores and American speech-language-hearing association/functional communication measures scores for swallowing were collected to evaluate the patients' swallowing function. Patients' serums were collected at weeks 1 and 3 after admission, and serum BDNF levels were measured by enzyme-linked immunosorbent assay. T test, chi-squared test, and general linear model analysis were performed to determine the differences between the two groups. RESULTS A significantly higher improvement of swallowing function was observed in the fluoxetine group compared with that of the control group (P = .023). In addition, a general linear model analysis showed that the treatment of fluoxetine has a statistically significant effect on swallowing improvement after adjustment of swallowing score on admission, stroke types, and interval between the onset of stroke and admission (P = .022, R2 = .46, adjusted R2 = .446). There is no significant difference in the change of serum BDNF levels in the two groups (P = .269). CONCLUSIONS This study suggests that treatment with fluoxetine in stroke patients with dysphagia may improve swallowing function. A placebo-controlled, randomized clinical trial is warranted to confirm this finding.
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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: 1.5] [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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Caldas ASC, Coelho WK, Ribeiro RFG, Cunha DAD, Silva HJD. Motor imagery and swallowing: a systematic literature review. REVISTA CEFAC 2018. [DOI: 10.1590/1982-0216201820214317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objetive: to identify, in the literature, studies that address the use of motor imagery of swallowing. Methods: a systematic review in SCOPUS databases, Science Direct and Medline, with descriptors and free terms "Motor Imagery"; "Swallow"; "Feeding"; "Stomatognathic System"; "mastication ", "Chew "; "Deglutition "; "Deglutition Disorders "; and "Mental Practice". Original articles using the motor imagery of swallowing were included, while reviews were excluded. For data analysis, at the first and second steps, the reading of titles and abstracts of the studies was carried out. In the third step, all studies that were not excluded were read in full. Results: four manuscripts were selected. The use of motor imagery in the rehabilitation of swallowing shows to be a recent proposal (2014-2015). The sample was reduced and comprised mainly healthy individuals. The EMG of the supra-hyoid muscles was used in two manuscripts. The most used neuroimaging technique was the Near-Infrared Spectroscopy, demonstrating the occurrence of hemodynamic changes during motor imagery and motor execution of swallowing. Conclusion: the motor imagery produces brain response in the motor area of the brain, suggesting that mentalization of actions related to swallowing is effective. However, further studies are needed for the application of this approach in the swallowing rehabilitation.
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Affiliation(s)
- David G Smithard
- Consultant in Elderly and Stroke Medicine. King's College Hospital NHS Foundation Trust
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Prosiegel M. Neuroanatomie des Schluckens. SCHLUCKSTÖRUNGEN 2018:47-60. [DOI: 10.1016/b978-3-437-44417-3.00003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Prosiegel M, Weber S. Vorstellung verschiedener Therapiekonzepte. DYSPHAGIE 2018:215-229. [DOI: 10.1007/978-3-662-56132-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Diendéré J, Millogo A, Preux PM, Jésus P, Desport JC. Changes in nutritional state and dysphagia in stroke patients monitored during a 14-d period in a Burkina Faso hospital setting. Nutrition 2017; 48:55-60. [PMID: 29469020 DOI: 10.1016/j.nut.2017.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/13/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Dysphagia and undernourishment are common in cerebrovascular accident (stroke) patients in developed countries. Despite the dietary transition, there is little information available in Africa on this topic. This study aims to assess the prevalence of undernourishment and dysphagia in stroke patients in two Burkina Faso teaching hospitals at a starting point (D0), on the eighth day, and on the 14th (D14) and to specify factors related to undernourishment at day 14. METHODOLOGY The nutritional state of the patients was assessed using body mass index, triceps skinfold thickness, and mid-upper arm circumference. Dysphagia was identified using the Practical Aspiration Screening Schema. RESULTS A total of 222 patients were included in the study. From D0 to D14, the prevalence of undernourishment increased from 25.2% to 31.0% and the prevalence of dysphagia decreased from 37.4% to 15.8%. All nutritional criteria worsened. In a multivariate analysis, undernourishment was more present at D14 for women (odds ratio [OR] = 7.01; 95% confidence interval [CI]: 1.51-32.56, P = 0.01) and was less present if weight (OR = 0.69; 95% CI: 0.60-0.79, P = 0.0001) or triceps skinfold thickness (OR = 0.85; 95% CI: 0.74-0.99, P = 0.03) were high at D0. CONCLUSION The prevalence of undernourishment was high at D0 and increased during the monitoring period. It would be advisable to monitor patients' weight and triceps skinfold thickness, to optimize care for women and patients with low weight or triceps skinfold thickness at D0, to monitor dysphagia, and to inform patients, families, and relevant staff of nutritional concerns after a cerebrovascular accident.
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Affiliation(s)
- Jeoffray Diendéré
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France; Research Institute of Health Sciences/Centre MURAZ, Bobo-Dioulasso, Burkina Faso; Université Ouaga I Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Athanase Millogo
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France; Université Ouaga I Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Medicine Department, Souro Sanou University Hospital, Bobo-Dioulasso, Burkina Faso
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France
| | - Pierre Jésus
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France; Nutrition Unit and Specialized Centre for Obesity, Dupuytren University Hospital, Limoges, France
| | - Jean-Claude Desport
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France; Nutrition Unit and Specialized Centre for Obesity, Dupuytren University Hospital, Limoges, France.
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Smithard DG. Stroke in Frail Older People. Geriatrics (Basel) 2017; 2:E24. [PMID: 31011034 PMCID: PMC6371123 DOI: 10.3390/geriatrics2030024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 02/01/2023] Open
Abstract
The population is ageing, with the greatest proportional increase in those >80 years of age. Many of these people will be frail and at risk of stroke. Research has shown that the very old have much to benefit from hyperacute stroke intervention, but at the same time they suffer increased mortality. Their outcome following stroke and intervention is more often predicted by the presence of frailty rather than age alone. Intervention both in primary prevention and hyperacute stroke management needs to allow for preexisting morbidity and frailty in deciding what is and what is not appropriate, rather than an arbitrary decision on age. Frail older people are more likely to develop delirium and dysphagia combined with poor mouthcare and die, yet all of these issues are managed badly. An increased awareness of these complications of stroke in the frail older person is necessary.
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Affiliation(s)
- David G Smithard
- Department of Electronic and Digital Arts, University of Kent, Canterbury CT2 7NZ, UK.
- Clinical Gerontology, King's College Hospital, London SE5 9RS, UK.
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The Role of the Corpus Callosum in Pediatric Dysphagia: Preliminary Findings from a Diffusion Tensor Imaging Study in Children with Unilateral Spastic Cerebral Palsy. Dysphagia 2017; 32:703-713. [DOI: 10.1007/s00455-017-9816-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
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Avelino MR, Montibeller CG, Luchesi KF, Mituuti CT, Ribeiro PW, Fagundes DA, Furkim AM. Oral dietary intake level in thrombolysed and non-thrombolysed patients after ischemic stroke. NeuroRehabilitation 2017; 40:49-55. [DOI: 10.3233/nre-161389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marcella Rachadel Avelino
- Department of Speech-Language Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Karen Fontes Luchesi
- Department of Speech-Language Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Cláudia Tiemi Mituuti
- Department of Speech-Language Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | | | - Ana Maria Furkim
- Department of Speech-Language Pathology, Federal University of Santa Catarina, Florianópolis, Brazil
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Prosiegel M. Neurology of Swallowing and Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abul-Kasim K. Neuroimaging in Patients with Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Dysphagia is one of the many complications of stroke. It is common and is an independent marker of outcome. Dysphagia management is important. Although the speech and language pathologist is the key worker in dysphagia management, they are supported by all members of the multi-disciplinary team. Stroke patients should be screened on admission for the presence of dysphagia and assessed by the speech and language therapist (or appropriate professional), where indicated investigation should be undertaken to understand the swallowing physiology and to guide treatment. Management, at present, is based around texture modification of food/liquids and swallowing manoeuvres. Rehabilitation of swallowing remains in its infancy, but there is a lot of promising research with neurostimulation, medication and devices to strengthen muscles involved in swallowing.
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Affiliation(s)
- David G. Smithard
- Department of Electronics and Digital Arts, University of Kent, Canterbury, UK
- Princess Royal University Hospital, King’s College Hospital, London, UK
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Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: A prospective cohort study. Chin J Integr Med 2016; 22:525-31. [PMID: 27339160 DOI: 10.1007/s11655-016-2457-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the therapeutic effect of acupuncture combining standard swallowing training for patients with dysphagia after stroke. METHODS A total of 105 consecutively admitted patients with post-stroke dysphagia in the Affiliated Hospital of Gansu University of Chinese Medicine were included: 50 patients from the Department of Neurology and Rehabilitation received standard swallowing training and acupuncture treatment (acupuncture group); 55 patients from the Department of Neurology received standard swallowing training only (control group). Participants in both groups received 5-day therapy per week for a 4-week period. The primary outcome measures included the scores of Videofluoroscopic Swallow Study (VFSS) and the Standardized Swallowing Assessment (SSA); the secondary outcome measure was the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), all of which were assessed before and after the 4-week treatment. RESULTS A total of 98 subjects completed the study (45 in the acupuncture group and 53 in the control group). Significant differences were seen in VFSS, SSA and RBHOMS scores in each group after 4-week treatment as compared with before treatment (P<0.01). Comparison between the groups after 4-week treatment showed that the VFSS P=0.007) and SSA scores (P=0.000) were more significantly improved in the acupuncture group than the control group. However, there was no statistical difference (P=0.710) between the acupuncture and the control groups in RBHOMS scores. CONCLUSIONS Acupuncture combined with the standard swallowing training was an effective therapy for post-stroke dysphagia, and acupuncture therapy is worth further investigation in the treatment of post-stroke dysphagia.
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Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, Havard D, McFarlane M, McLauglin C, Randall M, Robson K, Scutt P, Smith C, Smithard D, Sprigg N, Warusevitane A, Watkins C, Woodhouse L, Bath PM. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke 2016; 11:399-411. [PMID: 27006423 DOI: 10.1177/1747493016639057] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022]
Abstract
Post-stroke dysphagia (a difficulty in swallowing after a stroke) is a common and expensive complication of acute stroke and is associated with increased mortality, morbidity, and institutionalization due in part to aspiration, pneumonia, and malnutrition. Although most patients recover swallowing spontaneously, a significant minority still have dysphagia at six months. Although multiple advances have been made in the hyperacute treatment of stroke and secondary prevention, the management of dysphagia post-stroke remains a neglected area of research, and its optimal management, including diagnosis, investigation and treatment, have still to be defined.
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Affiliation(s)
| | - Christine Roffe
- Stroke Research, University Hospital of North Midlands, Keele University, UK
| | | | | | - Carol A Fairfield
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Shaheen Hamdy
- Institute of Inflammation and Repair, University of Manchester, UK
| | - Di Havard
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | | | | | | | - Katie Robson
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Polly Scutt
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Craig Smith
- Stroke and Vascular Research Centre, University of Manchester, UK
| | - David Smithard
- Elderly Medicine, Princess Royal University Hospital, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | | | - Caroline Watkins
- College of Health and Wellbeing, University of Central Lancashire, UK
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
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DI Roio C, Faye-Guillot T, Dailler F. Troubles de la déglutition à la phase aiguë des accidents vasculaires cérébraux. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lamvik K, Jones R, Sauer S, Erfmann K, Huckabee ML. The capacity for volitional control of pharyngeal swallowing in healthy adults. Physiol Behav 2015; 152:257-63. [PMID: 26432453 DOI: 10.1016/j.physbeh.2015.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/16/2015] [Accepted: 09/28/2015] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Previous research has documented that pressure and duration of brainstem-generated pharyngeal swallowing can be cortically modulated. But there is a commonly held belief that the sequence of pharyngeal pressure remains constant. However, Huckabee et al. [19] reported a patient cohort who demonstrated reduced latency of peak pressure in the proximal and distal pharynx, disproportionate and sometimes inversely correlated with overall swallowing duration, suggesting independent timing of underlying muscle contraction within the overall pharyngeal response. This study examined if healthy adults can volitionally produce altered latency of pharyngeal closure in isolation following intensive training, thereby evaluating the capacity for pharyngeal adaptation in a healthy system. METHOD Six healthy participants were seen for intensive training, consisting of daily one-hour sessions over two weeks (10 days) using pharyngeal manometry as a visual biofeedback modality. The participants were instructed to produce simultaneous pressure in the pharyngeal sensors when swallowing. The temporal separation of peak proximal and distal pharyngeal pressure was measured with discrete-sensor pharyngeal manometry at baseline, during training with biofeedback, and following training without biofeedback. RESULTS Following intensive training, participants were able to reduce temporal separation of peak pressure between the proximal and distal pharyngeal sensors from a baseline median of 188 ms (IQR=231 ms) to 68 ms (IQR=92 ms; p=0.002). In contrast, there was no significant change in overall swallowing duration during training (p=0.41). However, change in pharyngeal pressure latency was moderately correlated with both change in swallowing duration (r=0.444) and amplitude (r=0.571) during training, and there was a reduction in swallowing duration post-training (p=0.03). CONCLUSION Given intensive manometric biofeedback training, participants substantially reduced temporal separation of peak proximal and distal pharyngeal pressure when volitionally swallowing. However, correlation with overall pressure and duration measures suggest the adaptation was one of modulating the cumulative pharyngeal response rather than altering discrete components of timing of pharyngeal pressure in isolation. This is inconsistent with the pattern of behaviour documented by Huckabee et al. [19] in the patient population. Further research on modulatory control over targeted aspects of the pharyngeal swallow is needed, and may provide avenues for rehabilitative treatment of patients with dysphagia.
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Affiliation(s)
- Kristin Lamvik
- The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand.
| | - Richard Jones
- The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medical Physics & Bioengineering, Christchurch Hospital, Christchurch, New Zealand
| | - Sonja Sauer
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Kerstin Erfmann
- The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Maggie-Lee Huckabee
- The University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
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Raginis-Zborowska A, Mekli K, Payton A, Ollier W, Hamdy S, Pendleton N. Genetic determinants of swallowing impairments among community dwelling older population. Exp Gerontol 2015; 69:196-201. [PMID: 26116289 DOI: 10.1016/j.exger.2015.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 05/28/2015] [Accepted: 06/12/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Swallowing difficulties (dysphagia) affect a significant proportion of community dwelling older individuals, being more prevalent in age-associated neurological conditions such as stroke and Parkinson's disease. The genetic determinants of dysphagia are still being explored and have largely been studied through candidate gene analysis approaches. The aim of the study was to perform a genome-wide association study (GWAS) of common genetic single nucleotide polymorphisms (SNP) and self-reported swallowing impairments in a longitudinal cohort of community dwelling older adults. MATERIALS AND METHODS We performed a case-control genome-wide association study of self-reported swallowing symptoms using the Sydney Swallow Questionnaire. The analysis included 555 community dwelling, unrelated, older adults (mean years of age=81.4; SD=5.349) with known phenotype and genetic information consisting of 512,806 single nucleotide polymorphisms. Gene-based association analysis of these traits was also conducted. RESULTS Analysis of the cohort confirmed European ancestry with no major population stratification. Further analysis for association with swallowing impairment identified one SNP rs17601696 which achieved genome-wide significance (P-value=5×10(-8)) within a non-coding region of chromosome 10. Gene-based analysis did not result in any genome-wide significant association. CONCLUSION SNP rs17601696 may have an impact on swallowing impairment among elderly individuals. The results require replication in an independent cohort with appropriate phenotype/genotype data.
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Affiliation(s)
- Alicja Raginis-Zborowska
- Clinical and Cognitive Neuroscience, Institute Brain Behaviour and Mental Health, University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Salford, UK.
| | - Krisztina Mekli
- Cathie Marsh Institute for Social Research, School of Social Sciences, University of Manchester, Manchester, UK
| | - Antony Payton
- Centre for Integrated Genomic Medical Research, University of Manchester, Stopford Building, Oxford Road, Manchester, UK
| | - William Ollier
- Centre for Integrated Genomic Medical Research, University of Manchester, Stopford Building, Oxford Road, Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Part of the Manchester Academic Health Sciences Centre [MAHSC], Clinical Sciences Building, Salford Royal NHS Foundation Trust, Salford, UK
| | - Neil Pendleton
- Clinical and Cognitive Neuroscience, Institute Brain Behaviour and Mental Health, University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Salford, UK
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Xia W, Zheng C, Zhu S, Tang Z. Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke? a randomized controlled trial. Clin Rehabil 2015; 30:237-46. [PMID: 25819076 PMCID: PMC4767143 DOI: 10.1177/0269215515578698] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/27/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the effect of adding acupuncture to standard swallowing training for patients with dysphagia after stroke. DESIGN Single-blind randomized controlled trial. SETTING Inpatient and outpatient clinics. SUBJECTS A total of 124 patients with dysphagia after stroke were randomly divided into two groups: acupuncture and control. INTERVENTIONS The acupuncture group received standard swallowing training and acupuncture treatment. In comparison, the control group only received standard swallowing training. Participants in both groups received six days of therapy per week for a four-week period. MAIN MEASURES The primary outcome measures included the Standardized Swallowing Assessment and the Dysphagia Outcome Severity Scale. The secondary outcome measures included the Modified Barthel Index and Swallowing-Related Quality of Life, which were assessed before and after the four-week therapy period. RESULTS A total of 120 dysphagic subjects completed the study (60 in acupuncture group and 60 in control group). Significant differences existed in the Standardized Swallowing Assessment, Dysphagia Outcome Severity Scale, Modified Barthel Index, and Swallowing-Related Quality of Life scores of each group after the treatment (P < 0.01). After the four-week treatment, the Standardized Swallowing Assessment (mean difference - 2.9; 95% confidence interval (CI) - 5.0 to - 0.81; P < 0.01), Dysphagia Outcome Severity Scale (mean difference 2.3; 95% CI 0.7 to 1.2; P < 0.01), Modified Barthel Index (mean difference 17.2; 95% CI 2.6 to 9.3; P < 0.05) and Swallowing-Related Quality of Life scores (mean difference 31.4; 95% CI 3.2 to 11.4; P < 0.01) showed more significant improvement in the acupuncture group than the control group. CONCLUSIONS Acupuncture combined with the standard swallowing training may be beneficial for dysphagic patients after stroke.
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Affiliation(s)
- Wenguang Xia
- Department of Physical Medicine and Rehabilitation, Hubei Xinhua Hospital, Wuhan, China
| | - Chanjuan Zheng
- Department of Physical Medicine and Rehabilitation, Hubei Xinhua Hospital, Wuhan, China
| | - Suiqiang Zhu
- Department of Neurology, University of Science and Technology, Wuhan, China
| | - Zhouping Tang
- Department of Neurology, University of Science and Technology, Wuhan, China
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Prosiegel M. Diagnostik und Therapie neurogener Dysphagien. DNP - DER NEUROLOGE UND PSYCHIATER 2014; 15:43-52. [DOI: 10.1007/s15202-014-0808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Ribeiro PW, Cola PC, Gatto AR, da Silva RG, Luvizutto GJ, Braga GP, Schelp AO, Henry MACDA, Bazan R. The Incidence of Dysphagia in Patients Receiving Cerebral Reperfusion Therapy Poststroke. J Stroke Cerebrovasc Dis 2014; 23:1524-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022] Open
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Macrae PR, Jones RD, Huckabee ML. The effect of swallowing treatments on corticobulbar excitability: a review of transcranial magnetic stimulation induced motor evoked potentials. J Neurosci Methods 2014; 233:89-98. [PMID: 24932964 DOI: 10.1016/j.jneumeth.2014.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 06/07/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
Transcranial magnetic stimulation (TMS) has been used extensively as a method of investigating the corticomotor physiology of many motor tasks, including healthy and disordered swallowing. Changes in excitability of cortical projections to various swallowing muscles have been documented in response to treatments with TMS induced motor evoked potentials (MEPs). These studies have provided valuable insight into CNS response to swallowing impairment, and more importantly, the adaptations associated with functional recovery. However, unique obstacles are presented when investigating corticobulbar neurophysiology associated with the complex task of swallowing. Stringent methodological control and supplementary outcome measures are required to ensure robust and clinically applicable findings. This article offers a tutorial for the researcher who may be considering the use of TMS for investigating changes in cortical excitability associated with various swallowing paradigms. Included is a review of the mechanisms of TMS and what can be measured with this technique, a summary of existing research using MEPs to investigate swallowing, a review of methodological factors that may influence outcomes, and proposed directions for new areas of research.
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Affiliation(s)
- Phoebe R Macrae
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
| | - Richard D Jones
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand; Department of Medicine, University of Otago, Private Bag 4710, Christchurch, New Zealand; Department of Medical Physics and Bioengineering, Canterbury District Health Board, Private Bag 4710, Christchurch, New Zealand.
| | - Maggie-Lee Huckabee
- New Zealand Brain Research Institute, 66 Stewart Street, Christchurch, New Zealand; Department of Communication Disorders, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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Somasundaram S, Henke C, Neumann-Haefelin T, Isenmann S, Hattingen E, Lorenz MW, Singer OC. Dysphagia Risk Assessment in Acute Left-Hemispheric Middle Cerebral Artery Stroke. Cerebrovasc Dis 2014; 37:217-22. [DOI: 10.1159/000358118] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
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Buckley RT, Morgan T, Saneto RP, Barber J, Ellenbogen RG, Ojemann JG. Dysphagia after pediatric functional hemispherectomy. J Neurosurg Pediatr 2014; 13:95-100. [PMID: 24206342 DOI: 10.3171/2013.10.peds13182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Functional hemispherectomy is a well-recognized surgical option for the treatment of unihemispheric medically intractable epilepsy. While the resultant motor deficits are a well-known and expected consequence of the procedure, the impact on other cortical functions has been less well defined. As the cortical control of swallowing would appear to be threatened after hemispherectomy, the authors retrospectively studied a pediatric population that underwent functional hemispherectomy for medically intractable epilepsy to characterize the incidence and severity of dysphagia after surgery. METHODS A retrospective cohort (n = 39) of pediatric patients who underwent hemispherectomy at a single institution was identified, and available clinical records were reviewed. Additionally, the authors examined available MR images for integrity of the thalamus and basal ganglia before and after hemispherectomy. Clinical and video fluoroscopic assessments of speech pathology were reviewed, and the presence, type, and duration of pre- and postoperative dysphagia were recorded. RESULTS New-onset, transient dysphagia occurred in 26% of patients after hemispherectomy along with worsening of preexisting dysphagia noted in an additional 15%. Clinical symptoms lasted a median of 19 days. Increased duration of symptoms was seen with late (> 14 days postoperative) pharyngeal swallow dysfunction when compared with oral dysphagia alone. Neonatal stroke as a cause for seizures decreased the likelihood of postoperative dysphagia. There was no association with seizure freedom or postoperative hydrocephalus. CONCLUSIONS New-onset dysphagia is a frequent and clinically significant consequence of hemispherectomy for intractable epilepsy in pediatric patients. This dysphagia was always self-limited except in those patients in whom preexisting dysphagia was noted.
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Altman KW, Richards A, Goldberg L, Frucht S, McCabe DJ. Dysphagia in Stroke, Neurodegenerative Disease, and Advanced Dementia. Otolaryngol Clin North Am 2013; 46:1137-49. [DOI: 10.1016/j.otc.2013.08.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
OBJETIVOS: verificar a presença e evolução da queixa de deglutição em pacientes afásicos pós- AVE e, a partir do relato dos familiares em relação à melhora das manifestações, analisar se a ocorrência da afasia interferiu no prognóstico da disfagia. MÉTODO: 30 pacientes afásicos pós-AVE na fase crônica foram entrevistados e, juntamente com seus familiares, responderam a um questionário sobre a presença e a permanência de queixas de deglutição pós-AVE e aspectos relacionados, bem como melhoras ocorridas em relação aos quadros de disfagia e afasia. Para verificar se a disfagia parece ter interferido no prognóstico da afasia, comparou-se as curvas de Kaplan-Meier dos pacientes que referiram queixas de disfagia com os que não referiram. RESULTADOS: 48% dos pacientes tiveram queixas de dificuldades de deglutição pós-AVE. Destes, 93% apresentaram mudanças positivas (melhora parcial ou total do quadro). O tempo médio para que o paciente apresentasse qualquer tipo de mudança (espontânea ou não) foi de 76 dias. 60% referiu melhora total da disfagia, sendo que 47% foram submetidos à terapia fonoaudiológica. Em relação à afasia, 87% dos pacientes referiram melhora, apesar de nenhum paciente ter referido melhora total. 57% haviam sido expostos à terapia fonoaudiológica para a afasia. O tempo médio referido para que o paciente apresentasse qualquer tipo de mudança positiva nas manifestações foi de 183 dias. Não houve diferença significante na melhora da afasia entre o grupo com e sem queixa de deglutição. CONCLUSÕES: dos pacientes afásicos avaliados neste estudo, 48% apresentou queixa de disfagia. Verificou-se, a partir do relato dos familiares, que a ocorrência da afasia parece não ter interferido no prognóstico da disfagia.
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Flamand-Roze C, Roze E, Denier C. Troubles du langage et de la déglutition à la phase aiguë des accidents vasculaires cérébraux : outils d’évaluation et intérêt d’une prise en charge précoce. Rev Neurol (Paris) 2012; 168:415-24. [DOI: 10.1016/j.neurol.2011.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 10/10/2011] [Accepted: 10/12/2011] [Indexed: 10/28/2022]
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Doeltgen SH, Huckabee ML. Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application. Arch Phys Med Rehabil 2012; 93:207-13. [DOI: 10.1016/j.apmr.2011.08.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/18/2011] [Accepted: 08/25/2011] [Indexed: 10/14/2022]
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Barritt AW, Smithard DG. Targeting fatigue in stroke patients. ISRN NEUROLOGY 2011; 2011:805646. [PMID: 22389829 PMCID: PMC3263555 DOI: 10.5402/2011/805646] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 10/09/2011] [Indexed: 12/22/2022]
Abstract
Symptoms of fatigue are often reported by patients in both the acute and chronic stages of recovery following a stroke. It is commonly associated with low mood and sleep disturbances, but can arise in their absence. However, it has also been associated with poorer long-term outcome and, as such, its aetiology warrants a greater understanding. There is convincing evidence that inflammatory cascades and cytokine signalling precipitated by the infarct promote fatigue, and these pathways may harbour therapeutic targets in its management.
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Affiliation(s)
- Andrew W Barritt
- Division of Medicine, Royal Sussex County Hospital, Brighton, East Sussex BN2 5BE, UK
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