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.

Therapeutic Observation of Acupuncture plus Rehabilitation Training for Post-stroke Dysphagia / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture plus rehabilitation training in improving post-stroke dysphagia. Method A total of 60 patients with post-stroke dysphagia were randomized into a treatment group and a control group, 30 cases in each group. The two groups were intervened by basic treatment of internal medicine and swallowing rehabilitation training, and the treatment group was additionally given acupuncture treatment. The Standardized Swallowing Assessment (SSA), water swallowing test and Swallowing Quality of Life Questionnaire (SWAL-QOL) were evaluated in the two groups before and after the treatment. Result After the treatment, the SSA scores in the two groups were significantly decreased compared to those before the treatment (P<0.01), and the SWAL-QOL scores were significantly increased compared to those before the treatment (P<0.01); the SSA score in the treatment group was significantly lower than that in the control group (P<0.01), and the SWAL-QOL score was significantly higher than that in the control group (P<0.05). The water swallowing test classification after the treatment was significantly superior to that before the treatment in the treatment group (P<0.01), and there was a significant difference compared to that in the control group (P<0.05). Conclusion Acupuncture plus rehabilitation training can obviously improve the swallowing function of patients with post-stroke dysphagia, and the clinical efficacy was superior to single rehabilitation training.

Aspiration risk assessment of water-swallowing test in the occurrence of aspiration pneumonia in patients with cerebral infarction / 中国综合临床

Objective To investigate the effect of swallowing water test in the occurrence of aspiration pneumonia in patients with cerebral infarction. Methods One hundred and twenty?seven cases patients with cerebrovascular disease were randomly divided into two groups:swallow water group and control group,who were guided food program according to the result of swallow water test or experience. The number of two groups to use nasal feeding and the number of cases of the two groups occurred aspiration pneumonia in 3, 6 months were observed. Results The nasal feeding rate of swallow water group was higher than that of control group( 27. 6%( 21/76) vs. 11. 8%( 6/51) ,χ2=4. 590,P=0. 032) . After 3,6 months,the incidence of aspiration pneumonia of control group were higher than that of swallow water group(17. 6%(9/51) vs. 1. 3%(1/76),19. 6%(10/51) vs. 3. 9%(3/76),χ2=9. 080,6. 530,P<0. 05). Conclusion Water?swallowing test is a simple and practical method for assessment risk of aspiration pneumonia of patients with cerebral infarction,which is more effectively to reduce the risk of aspiration pneumonia than the empiric selection method of nasal feeding.

Eating and Swallowing Problems in Patients with Acute Cerebral Hemorrhage / The Japanese Journal of Rehabilitation Medicine

There are many stroke patients who have eating and swallowing problems after stroke, especially in the acute phase. However, little is known about the relationship between lesion, hematoma volume and pattern of dysphagia in hemorrhagic stroke. Accordingly, we evaluated the clinical features of swallowing function in acute cerebral hemorrhage. Four hundred and forty-seven newly diagnosed acute cerebral hemorrhage patients including 183 putamen, 119 thalamus, 30 cerebellum, 25 brainstem, and 90 subcortical hemorrhages were studied. Patients were referred for bedside swallowing assessment (BSA) using the Repetitive Saliva Swallowing Test and the Modified Water Swallowing Test at initial evaluation. Additionally, videofluoroscopy was performed in 129 patients to determine their oral intake status. The type of diet and outcomes were assessed on discharge. As results, most patients with normal BSA were consuming a regular diet on discharge. However, the number of patients who consumed a regular meal amongst the 289 patients with abnormal BSA was very few. Two hundred ten patients were nutritionally managed using enteral feeding. Lesion site and hematoma volume were related to the BSA result and oral intake outcome at discharge. Eating and swallowing dysfunction is not rare in patients with acute cerebral hemorrhage. We therefore recommend that all patients with cerebral hemorrhage should undergo a swallowing assessment and management in the acute stage.

Food and Liquid Swallowing Difficulty in Stroke Patients : A Study based on the Findings of Food Tests, a Modified Water Swallowing Test and Videofluoroscopic Examination of Swallowing / The Japanese Journal of Rehabilitation Medicine

We compared food and water swallowing tests to investigate the reliability of the tests to exclude aspiration following acute stroke. Subjects were 155 patients with cerebral strokes aged between 20.98 years (66.6±12.9 years) and for whom videofluoroscopic examination of swallowing (VF) was performed for swallowing difficulty or suspected swallowing difficulty. Food tests (FTs) using jelly and rice porridge, and a modified water swallowing test (MWST) were evaluated during VF. The results showed fewer occurrences of choking, cough, wet voice and aspiration during the FTs than in the MWST. The sensitivity and specificity of the FTs for aspiration ranged from 80.0% to 83.3% and 25.5% to 41.3%, respectively. The MWST gave a sensitivity of 58.0% and a specificity of 72.4% for aspiration. There were more incidences of silent aspiration in the MWST than in the FTs. However, the validity of the FTs and their positive predictive value were lower than for the MWST. Choking and cough had a significant relation to aspiration in both tests. We recommend that we need to use each of these tests with an understanding of their characteristics and limitations in order to obtain correct findings in stroke patient swallowing assessments.