Associating Factors Regarding Nasogastric Tube Removal in Patients With Dysphagia After Stroke

OBJECTIVE: To demonstrate associating factors regarding nasogastric tube (NGT) removal in patients with dysphagia after stroke. METHODS: This study is a retrospective medical chart review. Patients were divided into non-brain stem (NBS) and brain stem (BS) groups. A videofluoroscopic swallowing study was conducted until swallowing functions were recovered. Initial disease status was measured using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Risk factors related to stroke were evaluated. The penetration-aspiration scale (PAS) was used as the swallowing test. Functional status was measured by Mini-Mental Status Examination (MMSE) and Modified Barthel Index (MBI). Within each group, initial evaluations and their subsequent changes were compared according to the NGT removal status. Correlation between the NGT removal time and other initial factors were evaluated. RESULTS: Ninety-nine patients were allocated to the NBS group and 39 to the BS group. In NBS, age, PAS, MMSE, and MBI were significantly different according to the NGT removal status. In BS, smoking and PAS were significantly different. In NBS, changes in PAS, MMSE, and MBI were significantly different according to the NGT removal status. In BS, only PAS change was significantly different. In NBS, initial NIHSS, mRS, MMSE, and MBI were correlated with removal time. CONCLUSION: In stroke patients with NTG, younger age, better initial disease and functional status seems to remove NGT in NBS stroke. Therefore, when deciding to remove NGT, those three factors should be considered discreetly.

Functional Outcomes of Patients with Severe MCA Infarction after Decompressive Craniectomy

OBJECTIVE: To compare the functional outcomes between surgical treatment and conservative medical treatment for severe middle cerebral artery (MCA) infarction. METHOD: This is comparative analysis of prospectively documented data with 25 patients have malignant MCA infarction. Ten patients in Group A (male 7, female 3) received surgical treatment such as decompressive craniectomy, and fifteen patients in Group B (male 10, female 5) received conservative medical treatment. We defined MCA infarction as "severe" when it concerned both the deep and superficial areas of the MCA or when the Functional Independence Measure (FIM) was lower to 75 on admission to our department. Functional status was measured using modified Rankin Scale (mRS), FIM, Motricity Index (MI) and Trunk Control Test (TCT). All evaluations were measured at baseline and 90 days after stroke. RESULTS: Mean age were 55.0 +/- 8.6 and 58.7 +/- 12.3 in Group A and B. Rt. MCA infarction were 4 in Group A and 5 in Group B. Lt. MCA infarction were 5 in Group A and 10 in Group B. Baseline functional status between two groups was not significantly different. Each group showed functional improvement according to the time. When compared changes between two groups, arm Motricity Index, K-MMSE, mRS and FIM were no significant difference between two groups. Leg segments of MI and TCT was significantly improved in Group A more than B at 90 days after baseline evaluation (p<0.05). CONCLUSION: Decompressive craniectomy improved motor function of affected leg and trunk in patients with severe MCA infarction more than conservative medical treatment alone.

The Effect of Early Neuromuscular Electrical Stimulation Therapy in Acute/Subacute Ischemic Stroke Patients With Dysphagia

OBJECTIVE: To compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS). METHODS: Fifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one patients received NMES combined with TDT (NMES/TDT group) and 26 patients received TDT only (TDT group). Electrical stimulation with a maximal tolerable intensity was applied on both suprahyoid muscles for 30 minutes, 5 days per week during 3 weeks. The swallowing function was evaluated at baseline and 3, 6, and 12 weeks after baseline. Outcomes of the VFSS were assessed using the Functional Oral Intake Scale (FOIS). RESULTS: The mean ages were 63.5+/-11.4 years in the NMES/TDT group and 66.7+/-9.5 years in the TDT group. Both groups showed a significant improvement on the FOIS after treatment. The FOIS score was significantly more improved at 3 and 6 weeks after baseline in the NMES/TDT group than in the TDT group (p<0.05). CONCLUSION: An early application of NMES combined with TDT showed a positive effect in acute/subacute ischemic stroke patients with dysphagia. These results indicated that the early application of NMES could be used as a supplementary treatment of TDT to help rehabilitate acute/subacute dysphagic stroke patients by improving their swallowing coordination.

The Effect of Early Neuromuscular Electrical Stimulation Therapy in Acute/Subacute Ischemic Stroke Patients With Dysphagia

OBJECTIVE: To compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS). METHODS: Fifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one patients received NMES combined with TDT (NMES/TDT group) and 26 patients received TDT only (TDT group). Electrical stimulation with a maximal tolerable intensity was applied on both suprahyoid muscles for 30 minutes, 5 days per week during 3 weeks. The swallowing function was evaluated at baseline and 3, 6, and 12 weeks after baseline. Outcomes of the VFSS were assessed using the Functional Oral Intake Scale (FOIS). RESULTS: The mean ages were 63.5+/-11.4 years in the NMES/TDT group and 66.7+/-9.5 years in the TDT group. Both groups showed a significant improvement on the FOIS after treatment. The FOIS score was significantly more improved at 3 and 6 weeks after baseline in the NMES/TDT group than in the TDT group (p<0.05). CONCLUSION: An early application of NMES combined with TDT showed a positive effect in acute/subacute ischemic stroke patients with dysphagia. These results indicated that the early application of NMES could be used as a supplementary treatment of TDT to help rehabilitate acute/subacute dysphagic stroke patients by improving their swallowing coordination.