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Li K, Fu C, Xie Z, Zhang J, Zhang C, Li R, Gao C, Wang J, Xue C, Zhang Y, Deng W. The impact of physical therapy on dysphagia in neurological diseases: a review. Front Hum Neurosci 2024; 18:1404398. [PMID: 38903410 PMCID: PMC11187312 DOI: 10.3389/fnhum.2024.1404398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia.
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Affiliation(s)
- Kun Li
- Shandong Daizhuang Hospital, Jining, China
| | - Cuiyuan Fu
- Shandong Daizhuang Hospital, Jining, China
| | - Zhen Xie
- Shandong Daizhuang Hospital, Jining, China
| | - Jiajia Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | | | - Rui Li
- Shandong Daizhuang Hospital, Jining, China
| | | | | | - Chuang Xue
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Wei Deng
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
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Depolli GT, de Oliveira GB, de Oliveira TJ, Santos MHDS, Rocha RM, Guimarães MF, Azevedo EHM. Quality of life in dysphagia and anxiety and depression symptoms pre and post-thyroidectomy. Codas 2023; 35:e20220099. [PMID: 37556687 PMCID: PMC10449093 DOI: 10.1590/2317-1782/20232022099pt] [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: 03/24/2022] [Accepted: 09/23/2022] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To correlate the dysphagia quality of life and symptoms of anxiety and depression before and after thyroidectomy. METHODS Observational, longitudinal, prospective, and experimental study. Twenty patients participated, with a mean age of 54 years, prevalence of females (n=17; 85%) and partial thyroidectomy (n=14; 70%). All subjects underwent laryngeal visual examination and answered the MD Anderson Dysphagia Questionnaire (MDADI) and the Hospital Anxiety and Depression Scale (HADS) in three different moments: preoperatively, immediately postoperatively (maximum one week) and three months after surgery. RESULTS There was a significant difference in dysphagia quality of life for the physical and total domains in the three different moments. Regarding anxiety and depression, a statistically significant difference was observed between the scores in all domains, with a greater difference observed between the preoperative period and after 1 week. Higher values were observed in the preoperative period for mild anxiety traits, being more frequent in relation to depression, with a reduction after 1 week and an increase after three months of surgery. There was no significant correlation between the MDADI and HADS protocols. CONCLUSION Patients undergoing thyroidectomy self-report better quality of life in dysphagia and reduced anxiety/depression scores after three months of surgery. There was no correlation between anxiety, depression and quality of life in dysphagia at the moments evaluated.
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Affiliation(s)
- Gabriel Trevizani Depolli
- Departamento de Fonoaudiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES), Brasil.
| | | | - Thais Jejesky de Oliveira
- Departamento de Fonoaudiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES), Brasil.
| | | | - Ricardo Mai Rocha
- Hospital Universitário Cassiano Antônio Moraes - EBSERH - Vitória (ES), Brasil.
- Departamento de Cirurgia de Cabeça e Pescoço, Universidade Federal do Espírito Santo - UFES - Vitória (ES), Brasil.
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Zhuang Y, Wang X, Yin X, Li X, Liu W. Exploration of treatment methods for patients with post-stroke dysphagia: a network meta-analysis. Biotechnol Genet Eng Rev 2023:1-18. [PMID: 36966378 DOI: 10.1080/02648725.2023.2184044] [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: 03/27/2023]
Abstract
To compare the effects of various therapies in patients with post-stroke dysphagia. DATA SOURCES We searched databases between January 1980 and 2022. STUDY ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) on therapy for dysphagia after stroke. STUDY APPRAISAL AND SYNTHESIS METHODS The outcomes were improvement in dysphagia, case fatality, and chest infection or pneumonia, reported as OR (odd ratio), 95% CrI (confidence interval), and SUCRA (the surface under the cumulative ranking curve analysis) score. Forty-two randomized controlled trials (2,993 patients, seven therapies, and one control) were included. In the improvement of dysphagia analysis, the following therapies were superior to the control: Acupuncture, behavioral interventions, drug therapy, neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES). In the case fatality analysis, OR and 95% CrI indicated none of the therapies were superior to the control. In the chest infection or pneumonia analysis, OR values showed that no therapy was superior to the control. Our Network Meta-analysis suggests that commonly used therapies for dysphagia after stroke have equal efficacies.
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Affiliation(s)
- Yueyang Zhuang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xiaohua Wang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xinbo Yin
- Intensive Care Unit, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Xiaoling Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Weilin Liu
- Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, 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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Tarihci Cakmak E, Sen EI, Doruk C, Sen C, Sezikli S, Yaliman A. The Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Post-stroke Dysphagia: A Randomized Controlled Trial. Dysphagia 2022; 38:874-885. [PMID: 35986170 DOI: 10.1007/s00455-022-10512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
The study aimed to evaluate the effects of traditional dysphagia therapy (TDT) and neuromuscular electrical stimulation (NMES) combined with TDT on functionality of oral intake, dysphagia symptom severity, swallowing- and voice-related quality of life, leakage, penetration-aspiration, and residue levels in patients with post-stroke dysphagia (PSD). Thirty-four patients with PSD were included in our prospective, randomized, controlled, and single-blind study. The patients were divided into two groups: (1) TDT only (control group, n = 17) and (2) TDT with NMES (experimental group, n = 17). TDT was applied to both groups for three consecutive weeks, 5 days a week, 45 min a day. Sensory NMES was applied to the experimental group for 45 min per session. Patients were evaluated by the functional oral intake scale (FOIS), the eating assessment tool (EAT-10), the swallowing quality of life questionnaire (SWAL-QOL), and the voice-related quality of life questionnaire (VRQOL) at baseline, immediately post-intervention, and at the 3rd month post-intervention. Fiberoptic endoscopic evaluation of swallowing (FEES) with liquid and semi-solid food was performed pre- and post-intervention. A significant post-intervention improvement was observed on all scales in both groups, and these improvements were maintained 3 months post-intervention. Leakage and penetration-aspiration levels with semi-solid food declined only in the experimental group. In conclusion, TDT is a non-invasive and inexpensive method that leads to improvement in many swallowing-related features in stroke patients; however, NMES as an adjunct therapy is costly but can provide additional benefits for improving features, such as penetration-aspiration and residue levels.
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Miller S, Peters K, Ptok M. Review of the effectiveness of neuromuscular electrical stimulation in the treatment of dysphagia - an update. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc08. [PMID: 35875244 PMCID: PMC9284430 DOI: 10.3205/000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/20/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) has been used as a treatment option in the therapy of dysphagia for several years. In a previous review of the literature, it was concluded that NMES might be a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. However, due to different stimulation protocols, electrode positioning and various underlying pathological conditions, it was difficult to compare the studies which were identified and it was concluded that more empirical data is needed to fully understand the benefits provided by NMES. The purpose of this systematic review is, therefore, to evaluate recent studies regarding a potential effectiveness of transcutaneous NMES applied to the anterior neck as a treatment for dysphagia considering these different aspects. METHOD For this systematic review, a selective literature research in PubMed has been carried out on 5th May 2021 using the terms electrical stimulation AND dysphagia and screened for inclusion criteria by two reviewers in Rayyan. The search resulted in 62 hits. RESULTS Studies were excluded due to their publication language; because they did not meet inclusion criteria; because the topical focus was a different one; or because they did not qualify as level 2 studies. Eighteen studies were identified with varying patient groups, stimulation protocols, electrode placement and therapy settings. However, 16 studies have reported of beneficial outcomes in relation with NMES. DISCUSSION The purpose of this systematic review was to evaluate the most recent studies regarding a potential effectiveness of NMES as a treatment for oropharyngeal dysphagia considering different aspects. It could generally be concluded that there is a considerable amount of level 2 studies which suggest that NMES is an effective treatment option, especially when combined with TDT for patients with dysphagia after stroke and patients with Parkinson's disease, or with different kinds of brain injuries. Further research is still necessary in order to clarify which stimulation protocols, parameters and therapy settings are most beneficial for certain patient groups and degrees of impairment.
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Affiliation(s)
- Simone Miller
- Klinik für Phoniatrie und Pädaudiologie, Hannover, Germany,*To whom correspondence should be addressed: Simone Miller, Klinik für Phoniatrie und Pädaudiologie, MHH OE 6510, 30623 Hannover, Germany, Phone: +49 511 532-5778, Fax: +49 511 532-4609, E-mail:
| | | | - Martin Ptok
- Klinik für Phoniatrie und Pädaudiologie, Hannover, Germany
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Doan TN, Ho WC, Wang LH, Chang FC, Tran TTQ, Chou LW. Therapeutic Effect and Optimal Electrode Placement of Transcutaneous Neuromuscular Electrical Stimulation in Patients with Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Life (Basel) 2022; 12:life12060875. [PMID: 35743906 PMCID: PMC9225155 DOI: 10.3390/life12060875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background: To date, there is no conclusive evidence that transcutaneous neuromuscular electrical stimulation (TNMES) benefits patients with post-stroke dysphagia (PSD). In addition, the optimal TNMES electrode placement has not been well-established. This systematic review and meta-analysis were conducted to investigate these two research gaps. Methods: Five major databases were systematically searched for randomized controlled trials (RCTs) through January 2022. Effect sizes were computed using Hedges’ g statistic, which were then entered into the random-effects model to obtain pooled effect estimates. Results: Twenty-four RCTs met the eligibility criteria. On the improvement of swallowing function, TNMES alone was not superior to conventional swallowing therapies (CSTs); combined therapy of TNMES and CSTs significantly surpassed CSTs alone (standardized mean difference (SMD) = 0.91, 95% confidence interval (95% CI): 0.68 to 1.14, p < 0.0001; I2 = 63%). Moreover, significant pooled effect sizes were observed in subgroups with horizontal electrode placement above the hyoid bone (SMD = 0.94, 95% CI: 0.72 to 1.16; I2 = 0%) and horizontal electrode placement just above and below the hyoid bone (SMD = 0.87, 95% CI: 0.59 to 1.14; I2 = 0%). The largest pooled effect size was observed in the subgroup that individualized electrode placement according to dysphagia evaluation (SMD = 1.65, 95% CI: 0.38 to 2.91; I2 = 90%). Conclusion: TNMES should be used in combination with CSTs for PSD. Horizontal electrode placement should target suprahyoid muscles or both suprahyoid and thyrohyoid muscles.
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Affiliation(s)
- Thanh-Nhan Doan
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (T.-N.D.); (W.-C.H.)
- Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Quang Nam 560000, Vietnam
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (T.-N.D.); (W.-C.H.)
| | - Liang-Hui Wang
- Department of Speech Language Pathology and Auditory, HungKuang University, Taichung 433304, Taiwan;
- Ph.D. Program for Aging, China Medical University, Taichung 404332, Taiwan;
| | - Fei-Chun Chang
- Ph.D. Program for Aging, China Medical University, Taichung 404332, Taiwan;
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
| | - Trang Thi Quynh Tran
- Faculty of Rehabilitation, University of Medicine and Pharmacy, Hue University, Thành phố Huế 530000, Vietnam;
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413505, Taiwan
- Correspondence: or
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Speyer R, Sutt AL, Bergström L, Hamdy S, Heijnen BJ, Remijn L, Wilkes-Gillan S, Cordier R. Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials-Part I: Pharyngeal and Neuromuscular Electrical Stimulation. J Clin Med 2022; 11:jcm11030776. [PMID: 35160228 PMCID: PMC8836998 DOI: 10.3390/jcm11030776] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 12/22/2022] Open
Abstract
Objective. To assess the effects of neurostimulation (i.e., neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES)) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted to retrieve randomised controlled trials in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of included studies was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Results. In total, 42 studies reporting on peripheral neurostimulation were included: 30 studies on NMES, eight studies on PES, and four studies on combined neurostimulation interventions. When conducting meta analyses, significant, large and significant, moderate pre-post treatment effects were found for NMES (11 studies) and PES (five studies), respectively. Between-group analyses showed small effect sizes in favour of NMES, but no significant effects for PES. Conclusions. NMES may have more promising effects compared to PES. However, NMES studies showed high heterogeneity in protocols and experimental variables, the presence of potential moderators, and inconsistent reporting of methodology. Therefore, only conservative generalisations and interpretation of meta-analyses could be made. To facilitate comparisons of studies and determine intervention effects, there is a need for more randomised controlled trials with larger population sizes, and greater standardisation of protocols and guidelines for reporting.
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Affiliation(s)
- Renée Speyer
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 ZA Leiden, The Netherlands;
- Correspondence:
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD 4032, Australia;
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Liza Bergström
- Remeo Stockholm, 128 64 Stockholm, Sweden;
- Speech Therapy Clinic, Danderyd University Hospital, 182 88 Stockholm, Sweden
| | - Shaheen Hamdy
- GI Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Bas Joris Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 ZA Leiden, The Netherlands;
| | - Lianne Remijn
- School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands;
| | - Sarah Wilkes-Gillan
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK;
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Ebihara S, Naito T. A Systematic Review of Reported Methods of Stimulating Swallowing Function and their Classification. TOHOKU J EXP MED 2022; 256:1-17. [DOI: 10.1620/tjem.256.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College
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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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Liang Y, Lin J, Wang H, Li S, Chen F, Chen L, Li L. Evaluating the Efficacy of VitalStim Electrical Stimulation Combined with Swallowing Function Training for Treating Dysphagia following an Acute Stroke. Clinics (Sao Paulo) 2021; 76:e3069. [PMID: 34755758 PMCID: PMC8552953 DOI: 10.6061/clinics/2021/e3069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study explored the clinical efficacy of VitalStim electrical stimulation combined with swallowing function training for patients with dysphagia following an acute stroke. METHODS Seventy-two patients with dysphagia following an acute stroke were admitted to our hospital and were further divided into two groups using prospective research methods. There were 36 cases in each group according to the random number table method. The control group received conventional medical treatment and swallowing function training while the experimental group received conventional medical treatment and VitalStim electrical stimulation combined with swallowing function training. RESULTS The overall response rate of the experimental group (94.44%) was higher than that of the control group (77.78%), and the difference was statistically significant (p<0.05). Compared with before treatment, the upward and forward movement speeds of the hyoid bone, anterior movement speed, the grading score of the Kubota drinking water test, Caiteng's grading score, serum superoxide dismutase, 5-hydroxytryptamine, and norepinephrine levels, Fugl-Meyer Assessment score, and multiple quality of life scores of the two groups showed improvement after treatment. While the standard swallowing assessment score, serum malondialdehyde level, and National Institutes of Health Stroke Scale score decreased, the aforementioned indices showed a significant improvement in the experimental group (p<0.05). CONCLUSION The results of this study indicate that VitalStim electrical stimulation combined with swallowing function is effective for treating dysphagia following an acute stroke. It can effectively improve swallowing, neurological, and limb motor functions, reduce complications, promote physical recovery, and improve overall quality of life of patients.
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Affiliation(s)
- Yu Liang
- Department of Geriatric Rehabilitation, Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH), Haikou, Hainan 571100, China
| | - Jing Lin
- Eldercare Services and Medical Care Area, Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH), Haikou, Hainan 571100, China
| | - Hui Wang
- Department of Cardiovascular Medicine, Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH), Haikou, Hainan 571100, China
| | - Shufen Li
- Department of Geriatric Rehabilitation, Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH), Haikou, Hainan 571100, China
| | - Fang Chen
- Department of Neurology, Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH), Haikou, Hainan 571100, China
| | - Lili Chen
- Department of Geriatric Rehabilitation, Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH), Haikou, Hainan 571100, China
| | - Ling Li
- Pediatric Area II, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, China
- Corresponding author. E-mail:
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Alamer A, Melese H, Nigussie F. Effectiveness of Neuromuscular Electrical Stimulation on Post-Stroke Dysphagia: A Systematic Review of Randomized Controlled Trials. Clin Interv Aging 2020; 15:1521-1531. [PMID: 32943855 PMCID: PMC7481288 DOI: 10.2147/cia.s262596] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/31/2020] [Indexed: 11/27/2022] Open
Abstract
The purpose of this review was to summarize the latest best scientific evidence on the efficacy of neuromuscular electrical stimulation on swallowing function in dysphagic stroke patients. A comprehensive systematic search of literature published between November 2014 and May 2020 was performed using the following electronic databases: PubMed/Medline, CINAHL, PEDro, Science Direct, Google Scholar, EMBASE, and Scopus. Only randomized controlled trials (RCT) evaluating the effect of neuromuscular electrical stimulation on swallowing function in dysphagic stroke patients were included. Physiotherapy Evidence Database (PEDro) has been used to evaluate the risk of bias of included trials. This review was reported in accordance with PRISMA statement guideline. The methodological quality of the studies was determined using PEDro scale and GRADE approach. Evidence of overall quality was graded from moderate to high. Eleven RCTs involving 784 patients were analyzed. The primary outcome measures of this review were functional dysphagia scale (FDS) and standard swallowing assessment. This review found neuromuscular electrical stimulation (NMES) coupled with traditional swallowing therapy could be an optional intervention to improve swallowing function after stroke in rehabilitation department.
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Affiliation(s)
- Abayneh Alamer
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Haimanot Melese
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Fetene Nigussie
- Department Of Nursing Institute of Medicine, College of Health Sciences, DebreBerhan University, Debre Berhan, Ethiopia
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Effectiveness of Different Application Parameters of Neuromuscular Electrical Stimulation for the Treatment of Dysphagia after a Stroke: A Systematic Review. J Clin Med 2020; 9:jcm9082618. [PMID: 32806675 PMCID: PMC7463982 DOI: 10.3390/jcm9082618] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Dysphagia causes severe complications among people with a stroke. Physiotherapy allows the cure of this pathology, and among the tools it offers is neuromuscular electrical stimulation. However, this is a technique that has not been protocolized. Therefore, it was considered necessary to carry out a systematic review on the efficacy of the various parameters of application of the neuromuscular electrical stimulation in dysphagia generated after a stroke. Methods: A systematic search for publications was conducted in March 2020 in the Pubmed, Cinahl, Medline, Web of Science and Scopus databases, using as search terms: Electric stimulation therapy, Deglutition disorders and Stroke. Results: 21 articles were obtained in which the application of neuromuscular electrical stimulation was applied in isolation (n = 7) or in combination with other techniques such as strengthening exercises and manual therapy techniques (n = 14), with this second modality of treatment having greater benefits for patients. Conclusion: The greatest efficacy of this technique is reached when applied at 60-80 Hz, 700 μs of pulse duration, at the motor intensity threshold and in sessions of 20–30 min.
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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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