1
|
Skott P, Åkesson E, Johansson K, Dalum J, Persson E, Karlsson Å, Seiger Å, McAllister A, Sandborgh-Englund G. Orofacial dysfunction after stroke-A multidisciplinary approach. Gerodontology 2024; 41:376-384. [PMID: 37694276 DOI: 10.1111/ger.12713] [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] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE This paper describes the study protocol in an ongoing clinical trial evaluating oral screen training as part of a post-stroke rehabilitation programme. Baseline data were related to four domains: dysphagia, lip function, masticatory performance and patient-related outcome measures (PROM). BACKGROUND Stroke is one of the most common causes of disability-adjusted life years, and dysphagia is a common remaining problem after stroke. Rehabilitation using oral screen training has been suggested to improve swallowing, but evidence is still insufficient. MATERIALS AND METHODS Patients diagnosed with stroke with persisting objective and/or subjective swallowing dysfunction after primary rehabilitation were assessed for eligibility. In total, 25 patients were included. Objective function was assessed by swallowing capacity test (SCT), lip force and masticatory performance, subjective function by EAT-10 and NOT-S and PROM by LiSat-11 and ESAS. RESULTS Baseline data presented a heterogeneous pattern with no significant association between objective and subjective dysfunction. Most of the participants (20/25) showed impaired swallowing capacity in SCT, and 23/24 revealed orofacial dysfunction according to NOT-S. The most common subjective item reported was chewing and swallowing problems (19/24). CONCLUSION The heterogenous findings in the included tests and the lack of correlations emphasise the importance of multidisciplinary approaches to identify objective and subjective orofacial post-stroke dysfunction in clinical practice to be able to offer evidence-based individualised care. The included participants were representative of stroke patients with dysphagia, which supports proceeding with the planned intervention.
Collapse
Affiliation(s)
- Pia Skott
- Folktandvården Stockholm AB, Public Dental Services, Stockholm, Sweden
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Åkesson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholms Sjukhem, Stockholm, Sweden
| | - Kerstin Johansson
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Dalum
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Åke Seiger
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
- Aleris Rehab Station, Stockholm, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anita McAllister
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Sandborgh-Englund
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Zhang Y, Chen S, Ruan Y, Lin J, Li C, Li C, Xu S, Yan Z, Liu X, Miao P, Jia J. The Facial Skin Blood Flow Change of Stroke Patients with Facial Paralysis after Peripheral Magnetic Stimulation: A Pilot Study. Brain Sci 2022; 12:brainsci12101271. [PMID: 36291205 PMCID: PMC9599644 DOI: 10.3390/brainsci12101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/31/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Facial paralysis (FP) is a common symptom after stroke, which influences the quality of life and prognosis of patients. Recently, peripheral magnetic stimulation (PMS) shows potential effects on peripheral and central nervous system damage. However, the effect of PMS on FP after stroke is still unclear. Methods: In this study, we applied PMS on the facial nerve of nine stroke patients with FP. At the same time, laser speckle contrast imaging (LSCI) was used to explore the facial skin blood flow (SkBF) in 19 healthy subjects and nine stroke patients with FP before and after the PMS intervention. The whole face was divided into 14 regions to compare the SkBF in different sub-areas. Results: In baseline SkBF, we found that there were no significant differences in the SkBF between the left and right faces in the healthy subjects. However, there was a significant difference in the SkBF between the affected and unaffected faces in Region 7 (Chin area, p = 0.046). In the following five minutes after the PMS intervention (Pre_0–5 min), the SkBF increased in Region 5 (p = 0.014) and Region 7 (p = 0.046) and there was an increasing trend in Region 3 (p = 0.088) and Region 6 (p = 0.069). In the five to ten minutes after the intervention (Post_6–10 min), the SkBF increased in Region 5 (p = 0.009), Region 6 (p = 0.021) and Region 7 (p = 0.023) and there was an increasing trend in Region 3 (p = 0.080) and left and right whole face (p = 0.051). Conclusions: These pilot results indicate that PMS intervention could increase facial skin blood flow in stroke patients with FP. A further randomized controlled trial can be performed to explore its possible clinical efficacy.
Collapse
Affiliation(s)
- Yongli Zhang
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yinglu Ruan
- Department of Rehabilitation Medicine, Shanghai Jing’an District Central Hospital, Shanghai 200040, China
| | - Jiaying Lin
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chengdong Li
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai 200030, China
| | - Chong Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Shuo Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhijie Yan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiangyun Liu
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Peng Miao
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai 200030, China
| | - Jie Jia
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Rehabilitation Medicine, Shanghai Jing’an District Central Hospital, Shanghai 200040, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- National Regional Medical Center, Fuzhou 350200, China
- Correspondence:
| |
Collapse
|
3
|
Fabricius J, Kothari SF, Kothari M. Assessment and rehabilitation interventions for central facial palsy in patients with acquired brain injury: a systematic review. Brain Inj 2021; 35:511-519. [PMID: 33645363 DOI: 10.1080/02699052.2021.1890218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: To do a systematic review covering assessments and interventions for central facial palsy (CFP) in patients with acquired brain injury.Methods: PubMed, Embase, Cinahl, PsycInfo, and Web of Science were screened until April 2019. Assessments were defined as clinical- and instrumental tools and rating scales. Interventions were defined as rehabilitation interventions alleviating CFP.Results: 690 articles were screened based on the title and abstract. Interrater agreement was 98.12%. Sixteen articles were included: six clinical trials and 10 observational studies. Assessment: Commonest scale for assessing CFP was the House-Brackmann facial nerve Grading System. Strain gauges for measuring lip and cheek strength were applied in five studies and neurophysiological methods of assessing motor neuron pathways were applied in three studies. Interventions: An oral screen for improving lip strength was reported in three studies. Other interventions reported were neuromuscular electrical stimulation, Castillo Morales therapy, mirror therapy, exercises with electromyography feedback, and acupuncture.Conclusions: Scales for assessing peripheral facial palsy were applied for assessing CFP. Based on neurophysiological differences in the manifestation of peripheral facial palsy and CFP, these scales should be validated in patients with CFP. More studies on interventions for CFP are required before conclusions may be drawn about their effectiveness.
Collapse
Affiliation(s)
- Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Simple F Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark.,Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Mohit Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark.,JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
| |
Collapse
|
5
|
Onder H, Albayrak L, Polat H. Frontal lobe ischemic stroke presenting with peripheral type facial palsy: A crucial diagnostic challenge in emergency practice. Turk J Emerg Med 2017; 17:112-114. [PMID: 28971160 PMCID: PMC5608613 DOI: 10.1016/j.tjem.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 11/24/2022] Open
Abstract
Here, we illustrate a 69-year old female admitting with weakness on left side of the face who firstly considered peripheral facial palsy in the forefront. However, detailed neurological examination and cranial MRI findings finally yielded the proper diagnosis of right hemisphere ischemic stroke. Via this remarkable presentation, we point out the clinical challenges in evaluation processes of patients with facial palsy in emergency practice and emphasize the importance of detailed examination for the proper diagnosis as well as initiation of appropriate treatment agents without delay.
Collapse
Affiliation(s)
- Halil Onder
- Yozgat State Hospital, Department of Neurology, Yozgat, Turkey
- Corresponding author. Yozgat State Hospital, Department of Neurology, Yozgat, 66700, Turkey.Yozgat State HospitalDepartment of NeurologyYozgat66700Turkey
| | - Levent Albayrak
- Yozgat State Hospital, Department of Emergency Medicine, Yozgat, Turkey
| | - Halil Polat
- Yozgat State Hospital, Department of Otorhinolaryngology, Yozgat, Turkey
| |
Collapse
|
7
|
Hägg M, Tibbling L. Effect of oral IQoro R and palatal plate training in post-stroke, four-quadrant facial dysfunction and dysphagia: A comparison study. Acta Otolaryngol 2015; 135:962-8. [PMID: 25947252 DOI: 10.3109/00016489.2015.1042043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Training with either a palatal plate (PP) or an oral IQoro(R) screen (IQS) in patients with longstanding facial dysfunction and dysphagia after stroke can significantly improve facial activity (FA) in all four facial quadrants as well as swallowing capacity (SC). Improvements remained at late follow-up. The training modalities did not significantly differ in ameliorating facial dysfunction and dysphagia in these patients. However, IQS training has practical and economic advantages over PP training. OBJECTIVES This study compared PP and oral IQS training in terms of (i) effect on four-quadrant facial dysfunction and dysphagia after a first-ever stroke, and (ii) whether the training effect persisted at late follow-up. METHODS Patients were included during two periods; 13 patients in 2005-2008 trained with a PP, while 18 patients in 2009-2012 trained with an IQS. Four-quadrant facial dysfunction was assessed with an FA test and swallowing dysfunction with a SC test: before and after a 3-month training period and at late follow-up. FA and SC significantly improved (p < 0.001) in both groups. FA test scores after training and at late follow-up did not differ significantly between the groups, irrespective of whether the interval between stroke incidence and the start of training was long or short.
Collapse
Affiliation(s)
- Mary Hägg
- Departmen of Otorhinolaryngology, Speech & Swallowing Centre Hudiksvall Hospital , Hudiksvall , Sweden
| | | |
Collapse
|