An overview of dysphagia rehabilitation for stroke patients

ABSTRACT

Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.

RESUMO

Antecedentes: A disfagia é caracterizada como uma dificuldade no padrão de deglutição em qualquer fase desse processo neuromuscular. É um sintoma frequente após o Acidente Vascular Cerebral.

Objetivos: O objetivo deste estudo foi investigar as intervenções fonoaudiológicas mais utilizadas como terapia para o tratamento dos distúrbios da deglutição em pacientes com disfagia pós AVC. Métodos: Realizamos uma revisão dos estudos indexados no MEDLINE-PubMed, LILACS, Cochrane e Clinical trials.gov com foco nas intervenções fonoaudiológicas em pacientes adultos e disfágicos após AVC entre janeiro de 2008 e janeiro de 2021. Resultados: Foram selecionados trinta e seis artigos de ensaios clínicos e estudados onze tipos de terapia. Os estudos sobre a eficácia de intervenções terapêuticas para a reabilitação destes pacientes adultos ainda são restritos. A maioria das técnicas é aplicada em combinação com a terapia convencional, tornando inconclusiva a medição da eficácia de outras técnicas isoladamente. Conclusões: As intervenções terapêuticas devem ser escolhidas de acordo com as possibilidades e limitações dos pacientes e, principalmente, com os achados da avaliação clínica e seu objetivo.

Keywords:

Deglutition Disorders - Stroke - Speech Therapy - Rehabilitation

Palavras-chave:

Transtornos de Deglutição - Acidente Vascular Cerebral - Fonoterapia - Reabilitação

Authors’ contributions:

KCM, VFO, PLCO, PBN: study conception and design and data collection; KCM, VFO, PBN: analysis and interpretation of results; KCM, VFO: drafting of the manuscript. All authors reviewed the results and approved the final version of the manuscript.

Publication History

Received: 15 March 2021

Accepted: 28 April 2021

Article published online:
30 January 2023

• REFERENCES

• 1 Feller AG, Alva ME, Richer SP. Nutrition support in the stroke patient. Nestle Nutr Works Se 2011; 159-170
• 2 Ickenstein GW, Höhlig C, Prosiegel M, Koch H, Dziewas R, Bodechtel U. et al. Prediction of outcome in neurogenic oropharyngeal dysphagia within 72 hours of acute stroke. J Stroke Cerebrovasc Dis 2012; 21 (07) P569-P576 https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.01.004
• 3 Jayasekeran V, Singh S, Tyrrell P, Michou E, Jefferson S, Mistry S. et al. Adjunctive functional pharyngeal electrical stimulation reverses swallowing disability after brain lesions. Gastroenterology 2010; 138 (05) P1737-P1746 https://doi.org/10.1053/j.gastro.2010.01.052
• 4 Sukthankar SM, Reddy NP, Canilang EP, Stephenson L, Thomas R. Design and development of portable biofeedback systems for use in oral dysphagia rehabilitation. Med Eng Phys 1994; 16 (05) 430-435 https://doi.org/10.1016/1350-4533(90)90011-V
• 5 Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 1989; 52 (02) 236-241 https://doi.org/10.1136/jnnp.52.2.236
• 6 Bonilha HS, Simpson AN, Ellis C, Mauldin P, Martin-Harris B, Simpson K. The one-year attributable cost of post-stroke dysphagia. Dysphagia 2014; 29 (05) 545-552 https://doi.org/10.1007/s00455-014-9543-8
• 7 Sun S-F, Hsu C-W, Lin H-S, Sun H-P, Chang P-H, Hsieh W-L. et al. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia. Dysphagia 2013; 28 (04) 557-566 https://doi.org/10.1007/s00455-013-9466-9
• 8 Umay EK, Yaylaci A, Saylam G, Gundogdu I, Gurcay E, Akcapinar D. et al. The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: a randomized controlled study. Neurol India 2017; 65 (04) 734-742 https://doi.org/10.4103/neuroindia.NI_377_16
• 9 Terré R, Mearin F. A randomized controlled study of neuromuscular electrical stimulation in oropharyngeal dysphagia secondary to acquired brain injury. Eur J Neurol 2015; 22 (04) 687-e44 https://doi.org/10.1111/ene.12631
• 10 Rofes L, Arreola V, López I, Martin A, Sebastián M, Ciurana A. et al. Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction. Neurogastroenterol Motil 2013; 25 (11) 888-e701 https://doi.org/10.1111/nmo.12211
• 11 Konecny P, Elfmark M. Electrical stimulation of hyoid muscles in post-stroke dysphagia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162 (01) 40-42 https://doi.org/10.5507/bp.2017.043
• 12 Meng P, Zhang S, Wang Q, Wang P, Han C, Gao J. et al. The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia. J Back Musculoskelet Rehabil 2018; 31 (02) 363-370 https://doi.org/10.3233/BMR-170788
• 13 Park J-S, Oh D-H, Hwang N-K, Lee J-H. Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial. J Oral Rehabil 2016; 43 (06) 426-434 https://doi.org/10.1111/joor.12390
• 14 Lim K-B, Lee H-J, Lim S-S, Choi Y-I. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a randomized controlled trial. J Rehabil Med 2009; 41 (03) 174-178 https://doi.org/10.2340/16501977-0317
• 15 Park J-W, Kim Y, Oh J-C, Lee H-J. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia 2012; 27 (04) 521-527 https://doi.org/10.1007/s00455-012-9403-3
• 16 Simonelli M, Ruoppolo G, Iosa M, Morone G, Fusco A, Grasso MG. et al. A stimulus for eating. The use of neuromuscular transcutaneous electrical stimulation in patients affected by severe dysphagia after subacute stroke: a pilot randomized controlled trial. NeuroRehabilitation 2019; 44 (01) 103-110 https://doi.org/10.3233/NRE-182526
• 17 Li L, Li Y, Wu X, Wang G, Yi X, Zhao Y. et al. The value of adding transcutaneous neuromuscular electrical stimulation (VitalStim) to traditional therapy for post-stroke dysphagia: a randomized controlled trial. Top Geriatr Rehabil 2018; 34 (03) 200-206 https://doi.org/10.1097/TGR.20210073202100730195
• 18 Xia W, Zheng C, Lei Q, Tang Z, Hua Q, Zhang Y. et al. Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training. J Huazhong Univ Sci Technol Med Sci 2011; 31 (01) 73-76 https://doi.org/10.1007/s11596-011-0153-5
• 19 Running A, Hildreth L. A pilot study. J Holist Nurs 2017; 35 (01) 25-32 https://doi.org/10.1177/0898010116638739
• 20 Carnaby GD, LaGorio L, Silliman S, Crary M. Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: a double-blind placebo-controlled trial. J Oral Rehabil 2020; 47 (04) 501-510 https://doi.org/10.1111/joor.12928
• 21 Cheng IKY, Chan KMK, Wong C-S, Li LSW, Chiu KMY, Cheung RTF. et al. Neuronavigated high-frequency repetitive transcranial magnetic stimulation for chronic post-stroke dysphagia: a randomized controlled study. J Rehabil Med 2017; 49 (06) 475-481 https://doi.org/10.2340/16501977-2235
• 22 Cheng IKY, Chan KMK, Wong CS, Cheung RTF. Preliminary evidence of the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) on swallowing functions in post-stroke individuals with chronic dysphagia. Int J Lang Commun Disord 2015; 50 (03) 389-396 https://doi.org/10.1111/1460-6984.12144
• 23 Du J, Yang F, Liu L, Hu J, Cai B, Liu W. et al. Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: a randomized, double-blind clinical trial. Clin Neurophysiol 2016; 127 (03) 1970-1913 https://doi.org/10.1016/j.clinph.2015.11.045
• 24 Bath PM, Scutt P, Love J, Clavé P, Cohen D, Dziewas R. et al. Pharyngeal electrical stimulation for treatment of dysphagia in subacute stroke: a randomized controlled trial. Stroke 2016; 47 (06) 1562-1570 https://doi.org/10.1161/STROKEAHA.115.012455
• 25 Vasant DH, Michou E, O’Leary N, Vail A, Mistry S, Hamdy S. Pharyngeal electrical stimulation in dysphagia poststroke: a prospective, randomized single-blinded interventional study. Neurorehabil Neural Repair 2016; 30 (09) 866-875 https://doi.org/10.1177/1545968316639129
• 26 Essa H, Vasant DH, Raginis-Zborowska A, Payton A, Michou E, Hamdy S. The BDNF polymorphism Val66Met may be predictive of swallowing improvement post pharyngeal electrical stimulation in dysphagic stroke patients. Neurogastroenterol Motil 2017; 29 (08) e13062 https://doi.org/10.1111/nmo.13062
• 27 McCullough GH, Kim Y. Effects of the Mendelsohn Maneuver on extent of hyoid movement and UES opening post-stroke. Dysphagia 2013; 28 (04) 511-519 https://doi.org/10.1007/s00455-013-9461-1
• 28 McCullough GH, Kamarunas E, Mann GC, Schmidley JW, Robbins JA, Crary MA. Effects of mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil 2012; 19 (03) 234-243 https://doi.org/10.1310/tsr1903-234
• 29 Ahn YH, Sohn H-J, Park J-S, Ahn TG, Shin YB, Park M. et al. Effect of bihemispheric anodal transcranial direct current stimulation for dysphagia in chronic stroke patients: a randomized clinical trial. J Rehabil Med 2017; 49 (01) 30-35 https://doi.org/10.2340/16501977-2170
• 30 Shigematsu T, Fujishima I, Ohno K. Transcranial direct current stimulation improves swallowing function in stroke patients. Neurorehabil Neural Repair 2013; 27 (04) 363-369 https://doi.org/10.1177/1545968312474116
• 31 Suntrup-Krueger S, Ringmaier C, Muhle P, Wollbrink A, Kemmling A, Hanning U. et al. Randomized trial of transcranial direct current stimulation for poststroke dysphagia. Ann Neurol 2018; 83 (02) 328-340 https://doi.org/10.1002/ana.25151
• 32 Park J-S, An D-H, Oh D-H, Chang M-Y. Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: a randomized pilot study. NeuroRehabilitation 2018; 42 (02) 191-197 https://doi.org/10.3233/NRE-172250
• 33 Gao J, Zhang H-J. Effects of chin tuck against resistance exercise versus Shaker exercise on dysphagia and psychological state after cerebral infarction. Eur J Phys Rehabil Med 2017; 53 (03) 426-432 https://doi.org/10.23736/S1973-9087.16.04346-X
• 34 Park J-S, Lee G, Jung Y-J. Effects of game-based chin tuck against resistance exercise vs head-lift exercise in patients with dysphagia after stroke: an assessor-blind, randomized controlled trial. J Rehabil Med 2019; 51 (10) 749-754 https://doi.org/10.2340/16501977-2603
• 35 Kim H-H, Park J-S. Efficacy of modified chin tuck against resistance exercise using hand-free device for dysphagia in stroke survivors: a randomised controlled trial. J Oral Rehabil 2019; 46 (11) 1042-1046 https://doi.org/10.1111/joor.12837
• 36 Choi JB, Jung YJ, Park J-S. Comparison of 2 types of therapeutic exercise: jaw opening exercise and head lift exercise for dysphagic stroke: a pilot study. Medicine (Baltimore) 2020; 99 (38) e22136 https://doi.org/10.1097/MD.202100730000022136
• 37 Choi J-B, Shim S-H, Yang J-E, Kim H-D, Lee D-H, Park J-S. Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia. NeuroRehabilitation 2017; 41 (04) 753-757 https://doi.org/10.3233/NRE-172145
• 38 Xia W, Zheng C, Zhu S, Tang Z. Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke? a randomized controlled trial. Clin Rehabil 2016; 30 (03) 237-246 https://doi.org/10.1177/0269215515578698
• 39 Mao L-Y, Li L-L, Mao Z-N, Han Y-P, Zhang X-L, Yao J-X. et al. Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: a prospective cohort study. Chin J Integr Med 2016; 22 (07) 525-531 https://doi.org/10.1007/s11655-016-2457-6
• 40 Chen L, Fang J, Ma R, Gu X, Chen L, Li J. et al. Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: A multicenter randomized controlled trial. BMC Complement Altern Med 2016; 16: 226 https://doi.org/10.1186/s12906-016-1193-y
• 41 Moon J-H, Hahm S-C, Won YS, Cho H-Y. The effects of tongue pressure strength and accuracy training on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia: a preliminary randomized clinical trial. Int J Rehabil Res 2018; 41 (03) 204-210 https://doi.org/10.1097/MRR.20210073202100730282
• 42 Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. J Oral Rehabil 2017; 44 (01) 59-64 https://doi.org/10.1111/joor.12461
• 43 Koyama Y, Sugimoto A, Hamano T, Kasahara T, Toyokura M, Masakado Y. Proposal for a modified jaw opening exercise for dysphagia: a randomized, controlled trial. Tokai J Exp Clin Med 2017; 42 (02) 71-78
• 44 Ploumis A, Papadopoulou SL, Theodorou SJ, Exarchakos G, Givissis P, Beris A. Cervical isometric exercises improve dysphagia and cervical spine malalignment following stroke with hemiparesis: a randomized controlled trial. Eur J Phys Rehabil Med 2018; 54 (06) 845-852 https://doi.org/10.23736/S1973-9087.17.04952-8