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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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Ku PKM, Vlantis AC, Wong RWM, Hui TSC, Law T, Ng LKY, Wong EWY, Chang WT, Johnson DR, Mok FST, Wong KH, Abdullah V, van Hasselt A, Lee KYS, Tong MCF. Quality of life and swallowing outcomes after early proactive swallowing rehabilitation by either transcutaneous neuromuscular electrical stimulation or exercise-based swallowing training in patients with nasopharyngeal carcinoma after radiotherapy. Laryngoscope Investig Otolaryngol 2023; 8:1532-1546. [PMID: 38130249 PMCID: PMC10731556 DOI: 10.1002/lio2.1162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 12/23/2023] Open
Abstract
Background Exercise-based swallowing training (EBST) and transcutaneous neuromuscular electrical stimulation (TNMES) are common modalities used to treat late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC). We aimed to investigate and compare the efficacies of EBST and TNMES as proactive treatments administered early after radiotherapy. Methods Patients with early post-radiotherapy NPC (n = 120) underwent either TNMES or EBST. Flexible endoscopic evaluation of swallowing (FEES), quality of life (QOL), and swallowing function questionnaires were completed before the intervention as well as immediately, 6, and 12 months after the intervention. Outcome measures included the scores for the swallowing function score (SFS), penetration and aspiration scale (PAS), dynamic imaging grade of swallowing toxicity (DIGEST), functional oral intake scale (FOIS), swallowing performance status scale (SPSS), pharyngeal motor impairment (PMI), pharyngeal function impairment (PFI), and functional assessment after cancer therapy-nasopharyngeal (FACT-NP) questionnaire. Results Three months after radiotherapy, 31 and 34 patients underwent TNMES and EBST, respectively, and completed swallowing assessments at all four assessment timepoints. All patients showed post-radiotherapy impairments in the SFS, PAS, DIGEST, PMI, and PFI. Compared with the EBST group, the TNMES group showed significant improvements in the PFI and PMI scores, with small-to-medium effect sizes. Additionally, compared with the EBST group, the TNMES group demonstrated a trend toward slightly better improvements in the PAS, DIGEST, FOIS, and SPSS scores immediately and 6 months after the intervention. The SFS scores improved from baseline in both groups; however, the TNMES group showed an earlier improvement. Finally, the TNMES group showed better QOL according to the FACT-NP than the EBST group. Conclusion Proactive TMNES and EBST are safe and feasible modalities for improving swallowing in patients with NPC when administered early after radiotherapy. Although TNMES showed better results than EBST, these results should be interpreted with caution given the study limitations. Level of evidence 1B.
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Affiliation(s)
- Peter K. M. Ku
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUnited Christian Hospital and Tseung Kwan O HospitalTseung Kwan OHong Kong
| | - Alexander C. Vlantis
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Rita W. M. Wong
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
- The Institute of Human Communicative ResearchThe Chinese University of Hong KongHong Kong
| | - Thomas S. C. Hui
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUnited Christian Hospital and Tseung Kwan O HospitalTseung Kwan OHong Kong
| | - Thomas Law
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
- The Institute of Human Communicative ResearchThe Chinese University of Hong KongHong Kong
| | - Louisa K. Y. Ng
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
- The Institute of Human Communicative ResearchThe Chinese University of Hong KongHong Kong
| | - Eddy W. Y. Wong
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
| | - W. T. Chang
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
| | - David R. Johnson
- Department of Clinical OncologyPrince of Wales HospitalShatinNew TerritoriesHong Kong
| | - Florence S. T. Mok
- Department of Clinical OncologyPrince of Wales HospitalShatinNew TerritoriesHong Kong
| | - K. H. Wong
- Department of Clinical OncologyQueen Elizabeth HospitalKowloonHong Kong
| | - Victor Abdullah
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryUnited Christian Hospital and Tseung Kwan O HospitalTseung Kwan OHong Kong
| | - Andrew van Hasselt
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
- The Institute of Human Communicative ResearchThe Chinese University of Hong KongHong Kong
| | - Kathy Y. S. Lee
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
- The Institute of Human Communicative ResearchThe Chinese University of Hong KongHong Kong
| | - Michael C. F. Tong
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryThe Chinese University of Hong Kong, Prince of Wales HospitalShatinNew TerritoriesHong Kong
- The Institute of Human Communicative ResearchThe Chinese University of Hong KongHong Kong
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Leydon C, Mital K, DoCarmo J, Gaffney A, Ullucci P. The Impact of Vocal Task on Voice Acoustics, Effort and Discomfort Following Submandibular Neuromuscular Electrical Stimulation in Healthy Adults. J Voice 2023; 37:700-706. [PMID: 34116890 DOI: 10.1016/j.jvoice.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) offers a potential adjuvant to traditional voice therapy for individuals with dysphonia. The type of vocal task to implement in conjunction with electrical stimulation to achieve maximal therapeutic benefit is unknown. The purpose of this study was to elucidate the impact of tasks on voice outcomes. METHODS Nineteen vocally-healthy adult females, between 23 and 27 years of age (Ave: 23.8, SD: 1.13), participated in the study. 15 participants completed all three 30-minute sessions, and four completed at least one session. NMES was paired with three different voice conditions: high-pitched hum, low-pitched hum, and comfortable-pitched hum. Acoustic (average fundamental frequency and loudness; perturbation (jitter, shimmer, noise to harmonic ratio); Cepstral Spectral Index of Dysphonia; pitch range), perceived phonatory effort, and discomfort (delayed onset muscle soreness) measures were compared across conditions. RESULTS Eight participants experienced discomfort following NMES. Three participants withdrew from the study due to discomfort, and one withdrew due to an unrelated oral surgery. NMES paired with high-pitch humming resulted in increased average fundamental frequency during sustained phonation and reading tasks, and increased Cepstral Spectral Index of Dysphonia during sustained phonation. Low-pitch humming resulted in a decreased noise to harmonic ratio. No statistically significant changes in perceived phonatory effort were noted. CONCLUSION Almost half of the participants reported temporary discomfort. Task-specific differences in some outcomes were noted indicating that the nature of voice task performed with NMES must be considered when examining the impact of NMES on voice. Vocal tasks can impact discomfort and acoustic vocal outcomes of NMES.
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Affiliation(s)
- Ciara Leydon
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut.
| | - Kaitlyn Mital
- Department of Physical Therapy and Human Movement, Sacred Heart University, Fairfield, Connecticut; The Spine and Health Center of Closter, Cloister, NJ
| | - Julie DoCarmo
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut; Yale New Haven Hospital, Milford, CT
| | - Annelise Gaffney
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut; AMN Healthcare/ClubStaffing, Kauai, HI
| | - Paul Ullucci
- Department of Physical Therapy and Human Movement, Sacred Heart University, Fairfield, Connecticut; College of Health & Wellness, Johnson & Wales University, Providence, RI
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Lim J, Lee JC, Jang EG, Choi SY, Seo KH, Lee SY, Park D, Oh BM, Seo HG, Ryu JS. Kinematic mechanism of the rehabilitative effect of 4-channel NMES: post-hoc analysis of a prospective randomized controlled study. Sci Rep 2023; 13:13445. [PMID: 37596323 PMCID: PMC10439227 DOI: 10.1038/s41598-023-40359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
The sequential 4-channel neuromuscular electrical stimulation (NMES), based on the normal contractile sequences of swallowing-related muscles, is a new rehabilitative treatment. The objective of this study was to explore the mechanism of the rehabilitative effect of the 4-channel NMES using kinematic analysis of videofluoroscopic swallowing study (VFSS) data. For this post-hoc analysis, we included a subset of participants from the prospective randomized controlled study on the clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES. Seventeen subjects (11 and six in the 4- and 2-channel NMES groups, respectively) were eligible for the kinematic analysis of VFSS data. The hyoid bone movement was analyzed by evaluating the distance and time parameters with four peak points (A, B, C, D). The 4-channel NMES group showed significant improvement in vertical distances (A-C), horizontal distance (A-B, A-C), time interval (A-B-C) and total time, compared with their pretreatment data. The 2-channel NMES group showed significant improvements in time interval (A-B); however, the Euclidean distance (A-D) and mean velocity of the Euclidean distance (A-C) were significantly decreased. When the two groups were directly compared, the 4-channel group showed significantly greater improvement in horizontal distance (A-B), Euclidean distance (A-D), time interval (A-B-C), and mean velocity the Euclidean distance (A-D). The results in this study suggest that the sequential 4-channel NMES might lead to the physiologic circular movement of the hyoid bone during swallowing, and therefore be an effective treatment for dysphagia.Trial registration: Clinicaltrials.gov, registration number: NCT03670498.
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Affiliation(s)
- Jiwoon Lim
- Department of Rehabilitation Medicine, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Jun Chang Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Eun Gyeong Jang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sun Young Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Kyoung-Ho Seo
- Department of Rehabilitation Medicine, Seongnam Citizen's Medical Center, Seongnam-si, South Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, South Korea
| | - Donghwi Park
- Department of Rehabilitation Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, South Korea.
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Zhang YW, Dou ZL, Zhao F, Xie CQ, Shi J, Yang C, Wan GF, Wen HM, Chen PR, Tang ZM. Neuromuscular electrical stimulation improves swallowing initiation in patients with post-stroke dysphagia. Front Neurosci 2022; 16:1011824. [DOI: 10.3389/fnins.2022.1011824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022] Open
Abstract
ObjectiveMore than half of post-stroke patients develop dysphagia, which manifests as delayed swallowing and is associated with a high risk of aspiration. In this study, we aimed to investigate the immediate effect of neuromuscular electrical stimulation (NMES) on swallowing initiation in post-stroke patients using videofluoroscopic swallowing study (VFSS) data.Materials and methodsThis randomized, self-controlled crossover study included 35 patients with post-stroke dysphagia. All selected patients received real and sham NMES while swallowing 5 ml of thin liquid. Participants completed the conditions in random order, with a 10-min interval between conditions. The primary evaluation indicators included the Modified Barium Swallow Impairment Profile-6 (MBSImp-6) and Penetration-Aspiration Scale (PAS). Secondary indicators included oral transit time (OTT), pharyngeal transit time (PTT), and laryngeal closure duration (LCD).ResultsModified Barium Swallow Impairment Profile-6 (P = 0.008) and PAS (P < 0.001) scores were significantly lower in the Real-NMES condition than in the Sham-NMES condition. OTT (P < 0.001) was also significantly shorter during Real-NMES than during Sham-NMES. However, LCD (P = 0.225) and PTT (P = 0.161) did not significantly differ between the two conditions.ConclusionNeuromuscular electrical stimulation may represent a supplementary approach for promoting early feeding training in patients with post-stroke dysphagia.Clinical trial registration[https://clinicaltrials.gov/], identifier [ChiCTR2100052464].
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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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Electrical, taste, and temperature stimulation in patients with chronic dysphagia after stroke: a randomized controlled pilot trial. Acta Neurol Belg 2021; 121:1157-1164. [PMID: 33586087 DOI: 10.1007/s13760-021-01624-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
The objective of present study was compare a traditional swallowing therapy program with a new combined swallowing therapy program including neuromuscular electrical stimulation in patients with oropharyngeal dysphagia after stroke. This pilot study included eight patients with chronic oropharyngeal dysphagia after stroke. These patients underwent traditional therapy with gustative-thermic-tactile stimulation (group A), or a new combined program adding neuromuscular electrical stimulation (group B). Study participants were evaluated before and after the intervention using fiberoptic endoscopic evaluation of swallowing with temporal measures of posterior oral spillage and whiteout time, functional oral intake scale and a visual analog scale classifies an individual's swallowing ability. The two groups did not differ in terms of posterior oral spillage time, whiteout time and functional oral intake scale. Subjects in group B exhibited significant increases in visual analog scale scores. However, both groups demonstrated improvement with decreases in posterior oral spillage time, increased whiteout time, and increased functional oral intake scale and visual analog scale scores. There was no difference in the parameters studied in both therapeutic programs in individuals with chronic oropharyngeal dysphagia after stroke.
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Bai AV, Agostini F, Bernetti A, Mangone M, Fidenzi G, D'Urzo R, Ruggiero M, Murgia M, Santilli V, Paoloni M, Ruoppolo G, Masiero S. State of the evidence about rehabilitation interventions in patients with dysphagia. Eur J Phys Rehabil Med 2021; 57:900-911. [PMID: 33541045 DOI: 10.23736/s1973-9087.21.06716-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Rather than a separate nosological entity, dysphagia must be considered as a symptom of other pathological conditions, which afflicts patients admitted to numerous medical departments (rehabilitation, neurology, geriatrics, internal medicine, etc.) These disorders share the need for timely access to quality care and multidisciplinary treatment, including rehabilitation. The purpose of this study was to conduct a review of the current guidelines' recommendations in the literature and provide recommendations on the rehabilitative management of the patient with dysphagia. EVIDENCE ACQUISITION The search was carried out through the main databases (Medline, PEDro, Cochrane Database and Google Scholar). All the articles concerning rehabilitation management of dysphagia, published in the last 10 years, have been included. EVIDENCE SYNTHESIS Bibliographic research has provided thirteen guidelines. The literature analysed focuses mainly on the screening, the evaluation and the planning of multidisciplinary treatment. The literature agrees in recommending as cornerstones in the treatment of the dysphagic patient dietary changes, rehabilitation training (particularly muscle strengthening exercises and coordination) and early use of alternative nutrition in patients severely compromised. CONCLUSIONS The dysphagic patient requires the deployment of a range of skills by a multiprofessional and multi-disciplinary team. Speech and language pathologists in cooperation with specialists of rehabilitation have the task of managing the various stages, ranging from the early identification of the symptom to the setting of the treatment plan. Due to the lack of standardized protocols, it is necessary to implement the research path, especially regarding rehabilitation intervention.
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Affiliation(s)
- Arianna V Bai
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy -
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Gabriele Fidenzi
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Rossella D'Urzo
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Ruggiero
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Murgia
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Giovanni Ruoppolo
- Department of Sensorial Organs, Sapienza University of Rome, Rome, Italy
| | - Stefano Masiero
- Department of Neuroscience, University of Padua, Padua, Italy
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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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Cui F, Yin Q, Wu C, Shen M, Zhang Y, Ma C, Zhang H, Shen F. Capsaicin combined with ice stimulation improves swallowing function in patients with dysphagia after stroke: A randomised controlled trial. J Oral Rehabil 2020; 47:1297-1303. [PMID: 32757479 DOI: 10.1111/joor.13068] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Feifei Cui
- ICU The First Affiliated Hospital of Soochow University Suzhou China
| | - Qingmei Yin
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Chao Wu
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Meifen Shen
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Yijie Zhang
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Chen Ma
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Haiying Zhang
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
| | - Fang Shen
- Department of Neurosurgery The First Affiliated Hospital of Soochow University Suzhou China
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Jiang YE, Lyu QQ, Lin F, You XT, Jiang ZL. Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports. World J Clin Cases 2020; 8:1142-1149. [PMID: 32258085 PMCID: PMC7103971 DOI: 10.12998/wjcc.v8.i6.1142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/24/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A swallowing disorder may occur following a brainstem stroke, especially one that occurs in the swallowing centers. Lateral medullary syndrome (referred to as LMS), a rare condition in which a vascular event occurs in the territory of the posterior inferior cerebellar artery or the vertebral artery, has been reported to lead to more severe and longer lasting dysphagia.
CASE SUMMARY We report two patients with dysphagia due to LMS and propose a novel technique named hyoid-complex elevation and stimulation technique (known as HEST). The two patients had no other functional incapacity back into life, but nasogastric feeding was the only possible way for nutrition because of severe aspirations. Swallowing function was evaluated by functional oral intake scale, modified water swallow test, surface electromyographic signal associated with video fluorography swallowing study to assess the situation of aspiration, pharyngeal residue, pharyngeal peristalsis, upper esophageal opening and the ability of deglutition. Both patients were treated with the HEST method for dysphagia and recovered quickly.
CONCLUSION HEST is effective for shortening the in-hospital time and improving the quality of life for patients with dysphagia who suffer from LMS and likely other strokes.
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Affiliation(s)
- Yu-Er Jiang
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Qian-Qian Lyu
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Feng Lin
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Xue-Ting You
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhong-Li Jiang
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211100, Jiangsu Province, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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12
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Wirth M, Unterhuber D, von Meyer F, Hofauer B, Ott A, Edenharter G, Eckert DJ, Heiser C. Hypoglossal nerve stimulation therapy does not alter tongue protrusion strength and fatigability in obstructive sleep apnea. J Clin Sleep Med 2020; 16:285-292. [PMID: 31992396 DOI: 10.5664/jcsm.8184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
STUDY OBJECTIVES Hypoglossal nerve stimulation (HNS) is an effective surgical alternative for patients with obstructive sleep apnea (OSA). HNS therapy relies on the stimulation of the hypoglossal nerve to open the upper airways. This stimulation could lead to alterations in tongue strength and fatigability, which could alter treatment outcome over time. The aim of the study was to investigate whether HNS alters tongue strength and fatigability. METHODS Tongue protrusion strength (peak pressure in kPa) and fatigability (time to task failure during 50% of peak pressure contraction) were measured with a pressure transducer at least 2 months after HNS implantation (n = 30). These results were compared to a group of patients with OSA (n = 38) and a non-OSA control group (n = 35). RESULTS Median tongue protrusion strength was lower (54.7 [43.8, 63.0] versus 60.7 [53.7, 66.0] kPa, P = .013) and fatigue occurred more quickly (21.3 [17.4, 26.3] versus 26.0 [19.3, 31.3] seconds, P = .017) in the patients with OSA compared to the non-OSA control group. In multiple regression analysis, age was a significant factor for tongue strength and diagnosis of OSA for tongue fatigability. Tongue strength and fatigability did not differ between patients with OSA with conservative therapy or observation versus after HNS implantation (51.8 [41.3, 63.4] versus 56.3 [45.0, 62.3] kPa, P = .502; 20.8 [16.3, 26.2] versus 21.8 [18.3, 26.8] seconds, P = .418). CONCLUSIONS Tongue strength decreases with age. Tongue fatigability is more pronounced in people with OSA. However, approximately 1.5 years of HNS therapy on average does not alter tongue strength or fatigability compared to an OSA control group. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Change in Tongue Strength and Fatigue After Upper Airway Stimulation Therapy; Identifier: NCT03980158.
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Affiliation(s)
- Markus Wirth
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Daniel Unterhuber
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Franziska von Meyer
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Benedikt Hofauer
- Department of Otolaryngology - Head and Neck Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Armin Ott
- Institute of Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | | | - Danny J Eckert
- Adelaide Institute for Sleep Health, A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Clemens Heiser
- Department of Otolaryngology - Head and Neck Surgery, Technical University of Munich, Munich, Germany
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