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Chen J, Dai L, Guo M, Huang H, He R, Jin H, Jin X, Li X, Li Y, Liu Y, Wang C, Wang Y, Wu L, Xing Z, Fujitani J, Sugiura Y, Hinohara C, Tang W. A multidisciplinary collaborative diagnosis and rehabilitation program for dysphagia in general hospitals. Biosci Trends 2024; 18:108-115. [PMID: 38599879 DOI: 10.5582/bst.2024.01076] [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] [Indexed: 04/12/2024]
Abstract
Dysphagia is a common complication of various clinical conditions, with an increased incidence as age advances. Complications such as aspiration, malnutrition, and aspiration pneumonia caused by dysphagia significantly affect the overall treatment outcomes of patients. Scholars both domestically and internationally are increasingly focusing on early rehabilitation for dysphagia. This article summarizes common conditions causing dysphagia, clinical manifestations, complications, screening assessment, diagnosis, rehabilitation, and nutritional support related to dysphagia. It emphasizes the arrival at a multidisciplinary collaborative diagnosis and formulation of a rehabilitation management plan for dysphagia in general hospitals in order to provide strategic suggestions for establishing a multidisciplinary collaborative model for swallowing disorder management in general hospitals.
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Affiliation(s)
- Juan Chen
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Lili Dai
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Min Guo
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Hui Huang
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Rongfen He
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Hui Jin
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Xin Jin
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Xiaoxiao Li
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Yumin Li
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Yonggang Liu
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Chao Wang
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Yukai Wang
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Li Wu
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Zhongcheng Xing
- Huaibei People's Hospital Affiliated to Bengbu Medical University, Anhui Province, China
| | - Junko Fujitani
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuo Sugiura
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Wei Tang
- National Center for Global Health and Medicine, Tokyo, Japan
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Liu W, Ge W, Murong Z, Li L, Liu J, Shen Y, Yang S, Wang S, Hao R, Wang H, Ding L, Li S, Zhuang Z, Zhao M, Wang R, Qin M, Zhang L, Fan X. Efficacy and safety of acupuncture for post-stroke dysphagia: protocol for a multicenter, single-blinded, randomized controlled trial. Eur J Integr Med 2023. [DOI: 10.1016/j.eujim.2023.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Shao X, Chen B, Zhu L, Zhu L, Zheng J, Pu X, Chen J, Xia J, Wu X, Zhang J, Wu D. The Effects of Adding Di-Tan Decoction (DTD) and/or Electroacupuncture (EA) to Standard Swallowing Rehabilitation Training (SRT) for Improving Poststroke Dysphagia (PSD): A Pilot, Single-Centred, Randomized Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2011597. [PMID: 36532853 PMCID: PMC9754838 DOI: 10.1155/2022/2011597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 01/06/2024]
Abstract
OBJECTIVES To evaluate the effect of adding Di-tan decoction (DTD) and/or electroacupuncture (EA) to standard swallowing rehabilitation training (SRT) on improving PSD. METHODS In total, 80 PSD patients were enrolled and randomly assigned to the DTD, EA, DTD + EA or control group at a 1 : 1 : 1 : 1 ratio. All patients received basic treatment and standard SRT. The DTD group received DTD orally, the EA group received EA, the DTD + EA group received both DTD and EA simultaneously, and the control group received only basic treatment and standard SRT. The interventions lasted for 4 weeks. The outcome measurements included the Standardized Swallowing Assessment (SSA) and Swallowing-Quality of Life (SWAL-QOL), performed and scored from baseline to 2, 4, and 6 weeks after intervention, and the Videofluoroscopic Dysphagia Scale (VDS), scored at baseline and 4 weeks after intervention. Scores were compared over time by repeated-measures analysis of variance (ANOVA) among all groups. Interactions between interventions were explored using factorial design analysis. RESULTS (1) The effective rates (ERs) for PSD treatment were higher in the DTD, EA and DTD + EA groups than in the control group (all P < 0.05). The ER was higher in the DTD + EA group than in the DTD or EA group (both P < 0.05). (2) There were significant group effects, time effects and interactions for the SSA and SWAL-QOL scores (all P < 0.05). All groups showed decreasing trends in SSA scores and increasing trends in SWAL-QOL scores over time from baseline to 6 weeks after intervention (all P < 0.01). (3) Factorial design analysis for ΔVDS showed that there was a significant main effect for DTD intervention (F = 11.877, P < 0.01) and for EA intervention (F = 29.357, P < 0.01). However, there was no significant interaction effect between DTD and EA (F = 0.133, P = 0.717). Multiple comparisons showed that the DTD, EA and DTD + EA groups all had higher ΔVDS values than the control group (P < 0.05). The DTD + EA group had a higher ΔVDS than the DTD or EA group (both P < 0.05). (4) Most adverse reactions were mild and transient. CONCLUSIONS Adding DTD or EA to SRT can better improve PSD than applying SRT alone. Adding DTD and EA simultaneously can accelerate and amplify the recovery of swallowing function versus DTD or EA alone, and both are effective and safe treatments, alone or jointly, for PSD and are a powerful supplement to routine treatments.
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Affiliation(s)
- Xiangzhi Shao
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Bing Chen
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Lielie Zhu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Lili Zhu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Jinyihui Zheng
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Xinyu Pu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Jiajun Chen
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Jianning Xia
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Xinming Wu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Jiacheng Zhang
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Dengchong Wu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, 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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Matos KC, Oliveira VFD, Oliveira PLCD, Braga Neto P. An overview of dysphagia rehabilitation for stroke patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:84-96. [PMID: 35239804 PMCID: PMC9651500 DOI: 10.1590/0004-282x-anp-2021-0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/28/2021] [Indexed: 04/27/2023]
Abstract
ABSTRACT Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.
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Affiliation(s)
| | | | | | - Pedro Braga Neto
- Universidade Federal do Ceará, Brazil; Universidade Estadual do Ceará, Brazil; Universidade Federal do Ceará, Brazil
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Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava EM, Bath PM, Clavé P, Glahn J, Hamdy S, Pownall S, Schindler A, Walshe M, Wirth R, Wright D, Verin E. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6:LXXXIX-CXV. [PMID: 34746431 DOI: 10.1177/23969873211039721] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece.,Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades, Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Jörg Glahn
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospital Ruhr-University Bochum, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Sue Pownall
- Department of Speech & Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, Sacco Hospital Milano, University of Milano, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-University Bochum, Germany
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, Rouen, France
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Zhang X, Zhang XF, Wang L, Guo DY, Zhang JM, Chen YG, Wang ZC, Pei LS, Chen JX, Shi YJ, Zou JB. Analysis of Clinical Efficacy of Traditional Chinese Medicine in Recovery Stage of Stroke: A Systematic Review and Meta-Analysis. Cardiovasc Ther 2020; 2020:7172052. [PMID: 33042224 PMCID: PMC7528130 DOI: 10.1155/2020/7172052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We provide an updated meta-analysis with detailed information on a combination of TCM and routine treatment. METHODS Retrieve appropriate articles with no language restrictions on keywords until 8 July 2019 in an electronic database. All trajectories are screened according to certain criteria. The quality of certified research was also evaluated. We made a detailed record of the results of the measurement. Meta-analysis was carried out by using the Revman 5.3 software. RESULTS Sixty-seven RCTs were included, and 6594 subjects were analyzed. Compared with routine treatment, the total effective rate (TER) of TCM combined with routine treatment was improved, and the recovery of stroke was also significantly accelerated. Regulation of blood lipids by notably shrinking the contents of TC, TG, and LDL and enhancing the levels of HDL. The levels of serum hs-CRP, WHV, and WLV decreased significantly, indicating that the expression of thrombomodulin was decreased after the comprehensive treatment of traditional Chinese medicines (TCMs). The combination of TCM treatment could enhance the protection of neural function by decreasing the NIHSS scoring while increasing the BI scoring. Paeoniae Radix Rubra, Angeticae Sinensis Radix, etc., can effectively improve the clinical symptoms of stroke convalescent patients and promote the recovery of neurological function. ACU of Baihui, Renzhong, etc., can improve the clinical rehabilitation effect of patients. However, our findings must be handled with care because of the small sample size and low quality of clinic trials cited. Other rigorous and large-scale RCTs are in need to confirm these results. CONCLUSION A combination of TCM and routine treatment in the treatment of stroke could improve TER, and it is beneficial to the rehabilitation of patients in the recovery period of apoplexy. These effects can be mediated by a combination of several mechanisms. Nevertheless, due to the limitations of this study, these results should be handled with caution.
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Affiliation(s)
- Xue Zhang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Xiao-Fei Zhang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Lin Wang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Dong-Yan Guo
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Jia-Min Zhang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Yong-Gang Chen
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Zhi-Chao Wang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Li-Shan Pei
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Jiang-Xue Chen
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Ya-Jun Shi
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Jun-Bo Zou
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
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Cao N, Nguyen B, Li S, Lamba R, Hafner R, Li S. An overview of acupuncture in stroke recovery: A narrative review. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2020. [DOI: 10.4103/jisprm.jisprm_19_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Li XW, Li LY. Efficacy of neuromuscular electrical stimulation on Wilson's disease patients with dysphagia. J Phys Ther Sci 2019; 31:971-974. [PMID: 32038066 PMCID: PMC6893162 DOI: 10.1589/jpts.31.971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Dysphagia is a neurological symptom that is observed in more than half of
patients with Wilson’s disease. It is often associated with aspiration pneumonia,
dehydration, and malnutrition, resulting in drastic reduction of the quality of life.
Neuromuscular electrical stimulation could be an adjunct therapy for dysphagia treatment.
However, there is limited data about the application of NMES for dysphagia in Wilson’s
disease. Thus, we explored the potential application of NMES for dysphagia treatment in
Wilson’s disease. [Participants and Methods] Sixty Wilson’s disease patients who suffered
from dysphagia were randomized into two groups. Swallowing function training was taught to
the control group (n=30) while Neuromuscular electrical stimulation therapy was given to
treatment group (n=30). Eight weeks post treatment, using the water swallow test and the
Standardized Swallowing Assessment, the swallowing function was determined. [Results] None
of the patients experienced discomfort before, during or after the intervention. After 8
weeks of therapy, when compared to the control, an increased improvement in swallowing
function was noted for the treatment group. [Conclusion] Neuromuscular electrical
stimulation treatment can improve swallowing function in Wilson’s disease patients
afflicted with dysphagia. Therefore, it has the potential to be a form of therapy in
clinical practice.
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Affiliation(s)
- Xue-Wei Li
- Department of Neurology, The First Affiliated Hospital of Nanhua University, China
| | - Liang-Yong Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine: Meishan Road 117, Hefei 230031, China
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Abstract
BACKGROUND Dysphagia (swallowing problems), which is common after stroke, is associated with increased risk of death or dependency, occurrence of pneumonia, poor quality of life, and longer hospital stay. Treatments provided to improve dysphagia are aimed at accelerating recovery of swallowing function and reducing these risks. This is an update of the review first published in 1999 and updated in 2012. OBJECTIVES To assess the effects of swallowing therapy on death or dependency among stroke survivors with dysphagia within six months of stroke onset. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (26 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 26 June 2018), MEDLINE (26 June 2018), Embase (26 June 2018), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (26 June 2018), Web of Science Core Collection (26 June 2018), SpeechBITE (28 June 2016), ClinicalTrials.Gov (26 June 2018), and the World Health Organization International Clinical Trials Registry Platform (26 June 2018). We also searched Google Scholar (7 June 2018) and the reference lists of relevant trials and review articles. SELECTION CRITERIA We sought to include randomised controlled trials (RCTs) of interventions for people with dysphagia and recent stroke (within six months). DATA COLLECTION AND ANALYSIS Two review authors independently applied the inclusion criteria, extracted data, assessed risk of bias, used the GRADE approach to assess the quality of evidence, and resolved disagreements through discussion with the third review author (PB). We used random-effects models to calculate odds ratios (ORs), mean differences (MDs), and standardised mean differences (SMDs), and provided 95% confidence intervals (CIs) for each.The primary outcome was functional outcome, defined as death or dependency (or death or disability), at the end of the trial. Secondary outcomes were case fatality at the end of the trial, length of inpatient stay, proportion of participants with dysphagia at the end of the trial, swallowing ability, penetration aspiration score, or pneumonia, pharyngeal transit time, institutionalisation, and nutrition. MAIN RESULTS We added 27 new studies (1777 participants) to this update to include a total of 41 trials (2660 participants).We assessed the efficacy of swallowing therapy overall and in subgroups by type of intervention: acupuncture (11 studies), behavioural interventions (nine studies), drug therapy (three studies), neuromuscular electrical stimulation (NMES; six studies), pharyngeal electrical stimulation (PES; four studies), physical stimulation (three studies), transcranial direct current stimulation (tDCS; two studies), and transcranial magnetic stimulation (TMS; nine studies).Swallowing therapy had no effect on the primary outcome (death or dependency/disability at the end of the trial) based on data from one trial (two data sets) (OR 1.05, 95% CI 0.63 to 1.75; 306 participants; 2 studies; I² = 0%; P = 0.86; moderate-quality evidence). Swallowing therapy had no effect on case fatality at the end of the trial (OR 1.00, 95% CI 0.66 to 1.52; 766 participants; 14 studies; I² = 6%; P = 0.99; moderate-quality evidence). Swallowing therapy probably reduced length of inpatient stay (MD -2.9, 95% CI -5.65 to -0.15; 577 participants; 8 studies; I² = 11%; P = 0.04; moderate-quality evidence). Researchers found no evidence of a subgroup effect based on testing for subgroup differences (P = 0.54). Swallowing therapy may have reduced the proportion of participants with dysphagia at the end of the trial (OR 0.42, 95% CI 0.32 to 0.55; 1487 participants; 23 studies; I² = 0%; P = 0.00001; low-quality evidence). Trial results show no evidence of a subgroup effect based on testing for subgroup differences (P = 0.91). Swallowing therapy may improve swallowing ability (SMD -0.66, 95% CI -1.01 to -0.32; 1173 participants; 26 studies; I² = 86%; P = 0.0002; very low-quality evidence). We found no evidence of a subgroup effect based on testing for subgroup differences (P = 0.09). We noted moderate to substantial heterogeneity between trials for these interventions. Swallowing therapy did not reduce the penetration aspiration score (i.e. it did not reduce radiological aspiration) (SMD -0.37, 95% CI -0.74 to -0.00; 303 participants; 11 studies; I² = 46%; P = 0.05; low-quality evidence). Swallowing therapy may reduce the incidence of chest infection or pneumonia (OR 0.36, 95% CI 0.16 to 0.78; 618 participants; 9 studies; I² = 59%; P = 0.009; very low-quality evidence). AUTHORS' CONCLUSIONS Moderate- and low-quality evidence suggests that swallowing therapy did not have a significant effect on the outcomes of death or dependency/disability, case fatality at the end of the trial, or penetration aspiration score. However, swallowing therapy may have reduced length of hospital stay, dysphagia, and chest infections, and may have improved swallowing ability. However, these results are based on evidence of variable quality, involving a variety of interventions. Further high-quality trials are needed to test whether specific interventions are effective.
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Affiliation(s)
- Philip M Bath
- University of Nottingham, City HospitalStroke Trials Unit, Division of Clinical NeuroscienceNottinghamUKNG5 1PB
| | - Han Sean Lee
- University of Nottingham, City HospitalStroke Trials Unit, Division of Clinical NeuroscienceNottinghamUKNG5 1PB
| | - Lisa F Everton
- University of Nottingham, City HospitalStroke Trials Unit, Division of Clinical NeuroscienceNottinghamUKNG5 1PB
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Li X, Wu L, Guo F, Liang X, Fu H, Li N. Quick needle insertion at pharyngeal acupoints for poststroke dysphagia: A case report. Medicine (Baltimore) 2017; 96:e9299. [PMID: 29390393 PMCID: PMC5815805 DOI: 10.1097/md.0000000000009299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Dysphagia following stroke is a major complaint among patients, and effective treatment of post-stroke dysphagia can be difficult. We present a case report describing a new treatment for dysphagia, namely, quick needle insertion at pharyngeal acupoints. PATIENT CONCERNS A 70-year-old man developed pharyngeal dysphagia after a stroke. Three months after the patient experienced a sudden stroke leading to liquid dysphagia, acupuncture, one of the most important therapies in Traditional Chinese Medicine, was used to treat the patient. DIAGNOSES A diagnosis of cerebral infarction and bulbar paralysis was made. INTERVENTIONS Quick needle insertion was performed at five pharyngeal acupoints, once a day, 6 times a week for 6 weeks. OUTCOMES The patient subsequently showed significant improvement in the pharyngeal phase of swallowing. His performance in the drinking water test reduced to level 1 from level 4. The functional oral intake scale score changed from level 2 to level 7. In the video fluoroscopic swallowing study, no spillage occurred, but aspiration was present. The residue of the contrast agent was reduced. LESSONS Quick needle insertion at pharyngeal acupoints can be an efficient way to treat post-stroke dysphagia.
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Affiliation(s)
- Xiaoning Li
- Acupuncture and Moxibustion Four Ward, Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine
| | - Lei Wu
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Fan Guo
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Xuesong Liang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Hao Fu
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Nuo Li
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
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