Lateral needling at Lianquan (CV 23) for post-stroke dysphagia: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of lateral needling at Lianquan (CV 23) for post-stroke dysphagia, and explore its mechanism.@*METHODS@#A total of 64 patients with post-stroke dysphagia were randomly divided into an observation group and a control group, 32 cases in each group. Both groups were treated with conventional basic treatment. The observation group was treated with lateral needling at CV 23, without needle retaining, once a day. The control group was treated with swallowing rehabilitation training, once a day. Both groups were treated for 5 days a week, with 2 days interval, 1 week as one course and 4 courses were required. Before and after treatment, the Kubota water swallowing test grade and standardized swallowing assessment (SSA) score were compared in the two groups. Before and after treatment, the video fluoroscopic swallowing study (VFSS) was used to measure the hyoid bone movement displacement and pharyngeal delivery time in the observation group.@*RESULTS@#Compared before treatment, the Kubota water swallowing test grade after treatment was improved in the two groups (P<0.05), and the observation group was superior to the control group (P<0.05); the SSA scores after treatment were decreased in the two groups (P<0.05), and the observation group was lower than the control group (P<0.05). Compared before treatment, the hyoid bone movement displacement was increased and pharyngeal delivery time was shortened after treatment in the observation group (P<0.05).@*CONCLUSION@#Lateral needling at CV 23 could improve dysphagia symptoms in patients with post-stroke dysphagia, its mechanism may be related to the increasing of hyoid bone movement displacement and shortening of pharyngeal delivery time.

Acupoint injection combined with Vitalstim electrical stimulation for post-stroke dysphagia:a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of acupoint injection combined with Vitalstim electrical stimulation for post-stroke dysphagia.@*METHODS@#A total of 98 patients with dysphagia after first stroke were randomized into an acupoint injection group (35 cases, 2 cases dropped off), an electrical stimulation group (31 cases, 3 cases dropped off) and a combination group (32 cases, 3 cases dropped off). Injection of mecobalamin into Tunyan point, Vitalstim electrical stimulation and the combination of injection of mecobalamin into Tunyan point and Vitalstim electrical stimulation were applied respectively in the 3 groups, once a day, 10 times as one course, 2 courses were required. Before and after treatment, the tongue muscle thickness and video fluoroscopic swallowing study (VFSS) score were observed in the 3 groups.@*RESULTS@#After treatment, the tongue muscle thickness was decreased (P<0.05), the VFSS scores were increased (P<0.05) compared with before treatment in the 3 groups, and the variation of tongue muscle thickness and VFSS score in the combination group was greater than the acupoint injection group and the electrical stimulation group (P<0.05).@*CONCLUSION@#Both acupoint injection of mecobalamin and Vitalstim electrical stimulation have therapeutic effect on dysphagia after stroke, and the two have synergistic effect.

Anatomical Location of Cricopharyngeus in Patients with Swallowing Disorder / 中国康复理论与实践

Objective:To further clarify the location of cricopharyngeus in human body. Methods:From September, 2018 to December, 2019, 19 inpatients with swallowing disorders received video fluoroscopic swallowing study (VFSS).The videoes were used to measure the position of cricopharyngeus with Uniweb 4.0 software. Water model simulating the structure of an adult's neck was established to restore the real measurement scene, and obtain the scale ratio between the actual measurement and the computer measurement, then obtain the accurate actual position of the cricopharyngeus. Six adult specimens were dissected. The intersection point of the intended treatment plane and the long axis of cricopharyngeus was taken as the origin, the horizontal axis as X axis, and the sagittal axis as Y axis, to locate the position of cricopharyngeus precisely. Results:Cricopharyngeus was closest to the sixth cervical vertebra. The scaling ratio of the actual measurement obtained from the water model to the computer measurement was about 1∶1.340. The intended treatment plane was closest to the upper edge of the sixth cervical vertebra; on lateral edge of thyroid, cricopharyngeus was (33.47±2.21) mm deep to epidermis, with the angle of (43.37±1.34)° to sagittal axis; and it was (34.59±1.29) mm and (46.32±0.93)° on medial edge of internal jugular vein. Conclusion:The the accurate location of cricopharyngeus in human body has been measured, which can help for the rehabilitation for cricopharyngeal dysfunction.

Therapeutic effect of nape cluster acupuncture combined with swallowing function training on post-stroke dysphagia / 中国针灸

OBJECTIVE@#To observe the effect on swallowing function in patients with post-stroke dysphagia treated with nape cluster acupuncture and the immediate effect of acupuncture at Fengchi (GB 20).@*METHODS@#A total of 60 patients with post-stroke dysphagia were randomized into an observation group and a control group, 30 cases in each one.On the basis of conventional western medication treatment, swallowing function training was applied in the control group, once a day.On the base of the treatment as the control group, nape cluster acupuncture was applied at Fengchi (GB 20), Tianzhu (BL 10), Wangu (GB 12), Lianquan (CV 23), Panglianquan (Extra), Jinjin (EX-HN 12) and Yuye (EX-HN 13) in the observation group, once a day. Additionally, pricking blood was applied at Jinjin (EX-HN 12) and Yuye (EX-HN 13), 2 times a week. The treatment was given 30 min each time, a week as one course and 4 courses were required. Before and after treatment, the standardized swallowing assessment (SSA) score and video fluoroscopic swallowing study (VFSS) score were compared in the two groups. The ultrasonic diagnostic device of swallowing and surface electromyography were used to observe the immediate effect on swallowing related muscles of acupuncture at Fengchi (GB 20).@*RESULTS@#Compared before treatment, the SSA scores were reduced after treatment in the two groups (<0.05), and the change of the observation group was larger than the control group (<0.05). Compared before treatment, the VFSS scores were increased after treatment in the two groups (<0.05), and the change of the observation group was larger than the control group (<0.05). Acupuncture at Fengchi (GB 20) immediately increased the amplitude of submental muscles and infrahyoid muscles in the observation group (<0.05), the geniohyoid muscle movement time was reduced and geniohyoid muscle displacement was increased (<0.05).@*CONCLUSION@#On the base of the routine treatment, nape cluster acupuncture could improve swallowing function in patients with post-stroke dysphagia. Acupuncture at Fengchi (GB 20) could immediately affect swallowing related muscles, improve muscle amplitude and reduce swallowing time.

Video Fluoroscopic Swallowing Study of Radiation Induced Dysphagia in Head and Neck Cancer / 대한연하장애학회지

Dysphagia is a symptom of head and neck cancer itself and a significant complication of its treatments. Radiation therapy also causes dysphagia due to radiation toxicity. Therefore, it is necessary to evaluate patients who complain of dysphagia after radiation therapy. A video fluoroscopic swallowing study (VFSS) is an imaging tool that can diagnose dysphagia objectively from the oral to the esophagus phase. This tool is also used to evaluate to radiation-induced dysphagia. The abnormal findings in each swallowing phase are diverse. Interpreting each abnormal finding in relation to periodic complications caused by radiation toxicity is very important. A delayed pharyngeal transit time is the most characteristic abnormal finding of VFSS due to fibrosis, which is a chronic complication. To accurately assess the radiation-induced dysphagia, an evaluation of dysphagia prior to radiation therapy in head and neck cancer patients should be preceded. A multidisciplinary approach for evaluating dysphagia is needed throughout the entire period of head and neck cancer treatment.

Effect of neuromuscular electrical stimulation on hyolaryngeal structural movement in post-stroke dysphagia / 中华物理医学与康复杂志

Objective To explore the effect of neuromuscular electrical stimulation(NMES) on hyolaryngeal structural movement in post-stroke dysphagia.Methods Thirty patients with post-stroke dysphagia were randomly divided into 3 groups (n =10) namely group A,group B and group C.On the basis of routine swallowing training,medication and rehabiliation given to group C,group A was provided with VitalStim therapy on both suprahyoid and infrahyoid muscles,while group B was only on suprahyoid muscles lasting 2 weeks.Before and after treatment,the Video Fluoroscopy Swallowing Study (VFSS) was carried out and the upward and forward displacement distances of the hyoid and thyroid cartilage when swallowing pap were measured.Moreover,water swallow test,dysphagia severity scale and DOSS scores were used to assess the swallowing function.Results After 2 weeks' treatment,the water drinking test score,dysphagia severity scale and DOSS scores increased significantly in all groups than before treatment.The water drinking test score of group A (2.40 ± 1.26) and group B (2.10 ± 0.99),dysphagia severity scale of group A (5.30 ± 1.89) and group B(5.20 ± 1.69),as well as the DOSS level of group A (5.20 ± 1.40) and group B (5.10 ± 1.45) were significantly better than the control group.However,no significant difference was observed in all measurements between group A and group B.The group B revealed a significantly increase in anterior hyoid excursion distance of (12.15 ± 7.59) mm,much bigger than that before treatment and that of group A and B after treatment.Conclusion NMES on the basis of traditional swallowing training can improve the swallowing function of post-stroke dysphagia patients,and NMES on suprahyoid muscles can further induce an increase in anterior hyoid excursion.

Correlation of video fluoroscopic swallowing study and clinical swallowing function of patients with post-stroke dysphagia / 中国脑血管病杂志

Objective To investigate the correlation between clinical presentations and the findings of video fluoroscopic swallowing study (VFSS)in patients with post-stroke dysphagia. Methods A total of 56 consecutive patients with post-stroke dysphagia admitted to Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from June 2012 to May 2014 were enrolled. Four different kinds of food were selectively used to complete clinical assessment of swallowing function and VFSS respectively. The SPSS 20. 0 statistical software was used to perform univariate and multivariate Logistic regression analyses for all observed indexes of the 2 methods. Results there were significant correlations in the point correspondence relation among the clinical manifestations and VFSS in food residue in the mouth and abnormal closure of lips in the oral phase (95%CI 1. 430-101. 468;P=0. 022);poor soft palate elevation and food residue in the mouth (95%CI 1. 476-102. 033;P=0. 020);graded swallowing and piecemeal deglutition with delayed oral transit (95% CI 2. 616 -182. 897;P = 0. 004);tongue movement disorders,poor soft palate elevation and tongue dyskinesia with poor bolus formation (95%CI 1. 468-50. 795,1. 220-13. 825;P=0. 017,0. 023);food leak from the corner of mouth,dysphagia,bolus falling to the epiglottis from the base of tongue or trachea (95%CI 1. 146-125. 459,1. 657-174. 400;P=0.038,0. 017). The weakened pharyngeal reflex with weak laryngeal elevation in the pharyngeal phase (95%CI 1. 150-92. 815;P =0. 037);dysphagia and delayed swallowing with prolonged triggering of swallowing reflex (95%CI 2. 123-37. 770,1. 233-114. 176;P=0. 003,0. 032);graded swallowing,hard swallowing, choking sensation,and poor laryngeal elevation with prolonged pharyngeal transit (95%CI 1. 619-223. 316,1. 061-31. 445,2. 834 -132. 707;P =0. 019,0. 042,and 0. 003);dysphagia and the opening of cricopharyngeal muscle insufficiency (95%CI 1. 037 -24. 115;P =0. 045);weak laryngeal elevation,foreign body sensation in the throat,and choking after swallowing with food retention or residual in vallecula or pyriform sinus (95%CI 1. 046 -13. 685,1. 116 -87. 741;P =0. 043, 0.040);and coughing during swallowing and eating choking or aspiration (95%CI 0. 010-0. 921,0. 037-0. 826;P=0. 042,0. 028). Conclusion Some clinical manifestations are closely correlated with the swallowing dysfunction revealed by VFSS. With the help of this law,it may more simply and safely determine the degree and type of dysphagia in patients,and provide guidance for patients with dysphagia after stroke who can not accept VFSS in the rehabilitation treatment.

Long Term Improvement of Dysphagia in Lateral Medullary Infarction: A Case Report / 이화의대지

This report concerns a male patient suffered from refractory dysphagia after subarachnoid hemorrhage. A 49-year-old man admitted with severe headache followed by mental change. Imaging studies revealed that subarachnoid hemorrhage was located in basal cistern, and demonstrated ruptured vertebral dissecting aneurysm. After operation, the patient recovered well except severe dysphagia. Initial VFSS showed aspiration in fluid trial, penetration in semisolid bolus, and large amount of pharyngeal residue with poor relaxation of upper esophageal sphincter. For about 5 months, his symptom and several follow-up VFSS findings did not show marked improvement by various treatments. On magnetic resonance imaging for further evaluation of his brain lesion, an old infarction in right lateral side of medulla was found. He kept dysphagia rehabilitation more than one year, and his symptom improved to the level of oral feeding at last.

Diet Modification Based on Video Fluoroscopic Swallowing Study/Modified Barium Swallow in Dysphagia (review) / 中国康复理论与实践

@#Diet modification is a common and important approach for dysphagia rehabilitation. Categories of foods/liquids, suitable volumes per swallow, and effective methods of posture adjustment can be selected through Video Fluoroscopic Swallowing Study (VFSS)/Modified Barium Swallow (MBS), to determine a safe and valid strategy of diet modification. Diet modification based on VFSS/MBS will ensure eating ability and promote swallowing function in dysphagia patients to the greatest extent.

Diet Modification Based on Video Fluoroscopic Swallowing Study/Modified Barium Swallow in Dysphagia (review) / 中国康复理论与实践

@#Diet modification is a common and important approach for dysphagia rehabilitation. Categories of foods/liquids, suitable volumes per swallow, and effective methods of posture adjustment can be selected through Video Fluoroscopic Swallowing Study (VFSS)/Modified Barium Swallow (MBS), to determine a safe and valid strategy of diet modification. Diet modification based on VFSS/MBS will ensure eating ability and promote swallowing function in dysphagia patients to the greatest extent.

Swallowing Difficulties in Polio Survivors

OBJECTIVE: In patients with a history of acute paralytic poliomyelitis, late progressive muscle weakness, fatigue, pain may arise, a symptom complex of known as post-poliomyelitis syndrome (PPS). Dysphagia may also develop in some PPS patients. The purpose of this study was to assess the presence of is swallowing difficulty in polio survivors and to describe the nature of the swallowing difficulty. METHOD: Polio survivors answered the questionnaire pertaining to swallowing function and received a videofluroscopic evaluation of the oral and pharyngeal phases using 3 consistencies of material: liquid barium; semisolid barium paste; boiled yolk of an egg coated with barium. RESULTS: Of the 16 subjects, 8 had subjective symptoms of swallowing difficulties. All of the 6 PPS patients, regardless of whether they had symptoms of swallowing difficulties, had some abnormal oropharyngeal function through video fluoroscopic swallowing study. CONCLUSION: In patients with post-polio syndrome, there is progressive deterioration of swallowing functions similar to that in the muscles of the limbs. This swallowing dysfunction is not related with their subjective symptoms.