Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: a randomized controlled study.

BACKGROUND: Dysphagia after stroke is associated with increased mortality, higher dependence, and longer hospitalization. Different therapeutic strategies have been introduced to improve swallowing impairment. There are no current studies that compare rehabilitation swallowing therapy (RST) and neuromuscular electrical stimulation therapy (NMES). OBJECTIVE: To compare treatment outcomes between RST and NMES intervention in stroke patients with pharyngeal dysphagia. STUDY DESIGN: A randomized controlled study. MATERIAL AND METHOD: Twenty-three stroke patients with persistent pharyngeal dysphagia (RST 11, NMES 12) were enrolled in the present study. The subjects received 60 minutes of either RST or NMES treatment for five consecutive days, had two days off and then five more consecutive days of treatment for a four-week period or until they reached functional oral intake scale (FOIS) level 7. The outcome measures assessed were change in FOIS, complications related to the treatment and number of therapy sessions. RESULTS: There were no significant differences in the stroke characteristics and the VFSS results between the two groups. At the end of treatment, the average numbers of therapy sessions per subject in the RST and NMES groups were 18.36 +/- 3.23 and 17.25 +/- 5.64, respectively, a non-significant difference. Average changes in FOIS scores were 2.46 +/- 1.04 for the RST group and 3.17 +/- 1.27 for the NMES group, statistically significant at p < 0.001. No complications were observed in either group. CONCLUSION: While both RST and NMES therapy showed a positive effect in the treatment of persistent dysphagia in stroke patients, NMES was significantly superior.

Factors influencing home modification of stroke patients.

BACKGROUND: Home modification for stroke victims is often necessary to prevent falls and enable them to have a better quality of life. Up-to-date relationship between personal factors and home modifications in post-stroke patients has not been investigated. OBJECTIVE: To identify significant personal factors influencing the requirement for home modification in post-stroke patients. STUDY DESIGN: Prospective, analytical study. MATERIAL AND METHOD: Two hundred eighty one post-stroke patients were recruited from nine tertiary rehabilitation centers in Thailand. All patients received inpatient rehabilitation programs until either they reached the rehabilitation goals or registered two consecutive stable weeks as measured by their Barthel index score. Personal factors related to home modification were assessed at study entry, during hospital stay and at discharge. The correlation between personal factors and necessities of home modification in post-stroke patients were reported through univariate and multivariate modeling. RESULTS: The results of univariate analysis showed that a low Barthel index score (< or = 14/20) (at baseline and discharge), low Brunnstrom stage of arm or leg (< or = IV/VI) at baseline, and intolerance to intensive rehabilitation programs (< 3 hr/day) indicated a necessity for modifications in the patient's home (p < 0.05). The results of multivariate modeling showed that a low Barthel index score (at baseline and discharge), and intolerance to intensive rehabilitation were significant predictors of a requirement for home modification (p < 0.05). CONCLUSION: A low level of physical functioning and intolerance to intensive rehabilitation are significant predictors for the necessity of home modifications in stroke victims.

Quality of life after stroke rehabilitation among urban vs. rural patients in Thailand.

BACKGROUND: Stroke patients who live in different areas might have different adjustments for their impairment and disability after stroke attack. These factors should be evaluated in Thai patients. OBJECTIVE: To compare functional outcome, psychological outcome and quality of life of stroke patients who live in urban vs. rural areas, before and after an in-patient rehabilitation program. STUDY DESIGN: A multi-center, prospective, analytical study. MATERIAL AND METHOD: Urban and rural stroke patients admitted to the rehabilitation ward received a rehabilitation program. Pre- and post-rehabilitation, patients were measured using the Barthel index, the Hospital Anxiety and Depression scale (HADS) and the WHO BREF QOL questionnaire. The data were collected from nine rehabilitation centers in Thailand. RESULTS: Significant improvement in functional outcome, psychological condition and quality of life score was achieved via the rehabilitation program in both groups. There was no statistically significant difference between urban vs. rural patients. CONCLUSION: Previous living areas (urban vs. rural) before admission had no effect on functional outcome, psychological outcome and quality of life among stroke patients after an in-patient rehabilitation program conducted in Northeast Thailand.

An epidemiologic study of the Thai Stroke Rehabilitation Registry (TSRR): a multi-center study.

OBJECTIVE: To perform the registry of stroke patients receiving the in-patient comprehensive rehabilitation program at main tertiary hospitals from March to December 2006. MATERIAL AND METHOD: Demographic data including medical history and pathology of stroke were recorded. All subjects received a comprehensive rehabilitation program until they reached their rehabilitation goals or discharge criteria. RESULTS: Three hundred twenty seven patients met the inclusion criteria. The mean age was 62 +/- 12 years, and 59% were males. Most of the patients were married (73.1%), lived in an urban area (62.1%), and had an education level of primary school or lower (58.7%). The median duration from onset to admission for rehabilitation was 24 days. The major medical history was hypertension (74.9%), followed by dyslipidemia (54.4%), diabetes mellitus (26.6%), and ischemic heart disease (18.0%). Fifty-one (15.6%) patients had a history of previous stroke. Cerebral infarction was found in 71.9%, including thrombosis (45.3%), lacuna infarction (15.3%), and emboli (8.0%) and 28.1% had hemorrhagic stroke. On admission, more than half (51.8%) had cognitive impairment and one-third (31.5%) had bowel-bladder problems. Almost all of the patients (99.4%) had family support. Either their spouse or siblings had undertaken the main caregiver role (46.5% and 40.4% respectively). However, more than 80% of the patients were discharged to their own homes or immediate family's house. CONCLUSION: This was the first multi-center registry of inpatient stroke rehabilitation in Thailand. It presented the epidemiologic aspects in order to become national data of stroke patients receiving medical rehabilitation services.

Long stick exercise to improve muscular strength and flexibility in sedentary individuals.

The objective of this study was to investigate the effects of long stick exercise training on the strength and flexibility of sedentary individuals. An observational prospective study was conducted at the Prince of Songkla University. Eighty-five subjects who did not engage in any regular physical activity for at least three months before the study. A long stick exercise program was taught by a master for 45 minutes, at least three times weekly, for three months. Handgrip strength, back-leg strength, and flexibility were measured at the beginning of the program as a baseline, and at one, two, and three months of training. The subjects had increased back-leg strength and flexibility. Median back-leg strength increased from the baseline by 0.07 kg/weight, 0.19 kg/weight, and 0.21 kg/weight, at one, two, and three months, respectively (p< 0.05). Median flexibility (sit-and-reach test) improved from the baseline by 4.34 cm, 4.71 cm, and 5.56 cm, at one, two, and three months, respectively (p = 0.001). There were no statistically significant changes in handgrip strength.