The Effect of Functional Electrical Stimulation on Swallowing Function in Stroke Patients with Dysphagia

OBJECTIVE: This study was designed to evaluate the effect of functional electrical stimulation on swallowing function in stroke patients with dysphagia. METHOD: The subjects were 22 stroke patients with dysphagia. Functional electrical stimulation was applied to skin over anterior neck for thirty minutes and then, the patients were trained to swallow at the time of maximal stimulation. Swallowing function was evaluated by functional dysphagia scale using videofluoroscopic swallowing study with semisolid material before and 2 weeks after electrical stimulation. RESULTS: There were no significant differences in oral phase scores, the scores of triggering of pharyngeal swallow, residue in piriform sinuses, and coating of pharyngeal wall after swallow of pharyngeal phase. However, the scores of laryngeal elevation and epiglottic closure, residue in valleculae and pharyngeal transit time were significantly decreased (p<0.05). The score of pharyngeal phase was negatively correlated with the pulse intensity. The score of oral phase was negatively correlated with the cognitive function. CONCLUSION: The results of this study showed that the functional electrical stimulation can be used as an additional treatment method for stroke patients with dysphagia.

The Effect of Modified Triangular Bobath Slings on Shoulder Subluxation in Stroke Patients

OBJECTIVE: To introduce a Modified triangular Bobath sling (MTBS) and a MTBS with distal support (MTBSDS) as a new slings and to compare with previous slings in the therapeutic effects of shoulder subluxation in stroke patient. METHOD: Using a simple X-ray with and without slings, the vertical and horizontal distances were measured for 17 stroke patients. MTBS and MTBSDS were compared with 3 conventional slings, which were hemisling, Bobath sling and Extension-type sling, in the effects of correction. The questionaire was used to evaluate preference of patients. RESULTS: In two developed slings, inferior subluxation showed significant correction and lateral displace was less increased than a Bobath sling although it was not statistically significant (p<0.05). MTBS had the preference during non-walking because of comfort and easiness for donning and doffing, whereas MTBSDS had the preference during walking because of reciprocal arm swing and protecting the hemiplegic upper extremity from trauma. CONCLUSION: The results indicated MTBS and MTBSDS were more effective on shoulder subluxation in stroke patients. Further study on the development of slings for decrement of lateral displacement is recommended.

Assessment of Shoulder Subluxation Using the Lateral Scapular Slide Test in Hemiplegic Patients

OBJECTIVE: This study was designed to investigate the correlation between the lateral scapular slide test (LSST) and shoulder subluxation, scapular position, pain on movement, Brunnstrom stage in hemiplegic patients. METHOD: 20 hemiplegic patients (right: 10, left: 10) were evaluated LSST in resting position at three different points (T2-Superior Angle, T3-Scapular Spine, T7-Inferior Angle) in three times of the both shoulder. Muscle power of shoulder, Brunnstrom stages, spasticity, subluxation degrees using X-ray studies and ROM pain degrees using Visual Analog Scale (VAS) were also evaluated to examine the clinical correlation RESULTS: This study showed the evidence of positive correlation with LSST and shoulder subluxation, ROM pain degrees using VAS at T7-inferior angle (p<0.05), and negative correlations with LSST with shoulder abduction muscle power and Brunnstrom stage. But, there were no correlations with shoulder spasticity and hemiplegic side. CONCLUSION: This study provided LSST can be a useful predictor of shoulder subluxation and it supposed that the glenoid fossa on the affected side was upward rotated compared to the unaffected side.