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.