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Objective:To construct an evidence-based phased swallowing training program for patients after partial laryngectomy applying the Delphi method.Methods:Evidence was screened systematically applying evidence-basing principles to construct a first draft of a phased swallowing training program for patients after partial laryngectomy. After two rounds of Delphi expert consultation a final draft was formed.Results:The protocol was composed of 27 items covering 5 aspects of the gastrointestinal decompression period, the first- and second-stage continuous tube feeding periods, trial feeding of the intermittent tube feeding period and the oral feeding stage.Conclusion:The phased swallowing training program is scientifically sound and feasible in clinical practice. It can provide references for clinic staff to improve swallowing management.
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@#Objective To explore the effect of family swallowing training program on swallowing function in patients with head and neck cancer after radiotherapy. Methods From September, 2020 to September, 2021, 45 patients with head and neck tumors who received radiotherapy in the oncology department of Beidahuang Industry Group General Hospital were randomly divided into control group (n = 23) and observation group (n = 22). Both groups received routine treatment, and the observation group received swallowing training program for 14 weeks at the beginning of radiotherapy, including six weeks of individualized guidance training in hospital and eight weeks of home training after leaving the hospital. The incisors spacing, body mass, Kubota Water Swallowing Test (WST) and Functional Oral Intake Scale (FOIS) were compared at the beginning of training, six weeks and 14 weeks after training. Results At the beginning of training, there was no significant difference in incisor spacing, body mass and the scores of WST and FOIS between two groups (P > 0.05). Six weeks and 14 weeks after training, the incisors spacing, and the scores of WST and FOIS were better in the observation group than in the control group (|Z| > 2.332, P < 0.05). Conclusion Family-based swallowing training program is helpful to improve the limitation of mouth opening and dysphagia caused by radiotherapy. Family-based swallowing training program is simple, safe, economical and highly operable, which is worthy of clinical promotion.
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OBJECTIVE: To study the efficacy of the neuromuscular electrical stimulation combined with swallowing training on the patients with swallowing dysfunction following acute cerebral infarction.Method Totally 100 patients with swallowing dysfunction following acute cerebral infarction were randomly divided into the experimental group(50 patients)and the control group(50 patients).The patients in the experimental group were treated with neuromuscular electrical stimulation combined with swallowing training,while the patients in the control group were treated with routine care and swallowing training.The improvement in swallowing function,complications,quality of life and prognosis were compared between the two groups after treatment.RESULTS: After treatment,the evaluation of drinking water test,SSA score and GUSS score in the experimental group and the control group were significantly improved compared with those before treatment(P<0.05),and the improvement of the experimental group was significantly better than that of the control group(P<0.05).The white blood cell count,CRP value,mRS score at 90 days,and the incidence of aspiration pneumonia and malnutrition in the experimental group were significantly lower than those in the control group(P<0.05),and the albumin,pre-albumin,total lymphocyte count and SWAL-QOL score at the time of discharge were significantly higher than those in the control group(P<0.05).CONCLUSION: Neuromuscular electrical stimulation combined with swallowing training has better effect than pure swallowing training in the patients with swallowing dysfunction due to acute cerebral infarction;the complication incidence is lower,the quality of life is higher,and the prognosis is better.
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OBJECTIVE: To observe the therapeutic effect of acupuncture therapy in the treatment of dysphagia in apoplexy patients. METHODS: A total of 104 patients with post-stroke dysphagia were randomized into a control (conventional swallowing rehabilitation training) group and an acupuncture group (n＝ 52 cases in each one). In the control group, the conventional swallowing rehabilitation training was conducted, twice daily, 6 times a week for 4 weeks. In the acupuncture group, deep needling of main acupoints Lianquan (CV23) and Yifeng (TE17), and conventional acupuncture of adjuvant acupoints as Fengchi (GB20) and Fengfu (GV16), Wangu (GB12), Lieque (LU7), Jinjin (EX-HN12), Yuye (EX-HN13), etc. as well as electroacupuncture stimulation (15－20 Hz, 5 mA, and duration of 30 min) of ipsilateral CV23-GV16, TE17-GB20, and bilateral Neidaying acupoints were conducted. The acupuncture treatment was given once daily, 6 times a week for consecutive 4 weeks. In addition, patients of the two groups also received routine symptomatic treatment with drugs for anti-platelet aggregation, nourishing cranial nerve, lowering blood pressure, controlling blood glucose, improving cerebral circulation, etc. Before and after the treatment, the standard swallowing assessment (SSA, 18－46 points) and Kubota water swallowing test (WST, 1－5 grades) were conducted to evaluate the patient's swallowing function. The comprehensive therapeutic effect was assessed in accordance with the SSA and Kubota WST, and adverse reactions were recorded. RESULTS: After the treatment, the SSA score was considerably reduced in the two groups relevant to their own pre-treatment (both P<0.05), and was significantly lower in the acupuncture group than in the control group (P<0.05). The Kubota WST grade was evidently increased in the number of patients with grade Ⅰ (P<0.05) and reduced in the numbers of patients with grade Ⅲ－Ⅴ in both groups relevant to their own pre-treatment, and was more patients with grade Ⅰ in the acupuncture group than in the control group (P<0.05). Outcomes of the comprehensive therapeutic effect indicated that of the two 52 cases in the control and acupuncture groups, 8 (15.38%) and 19 (36.53%) were cured, 7 (13.46%) and 15 (28.45%) had marked improvement, 17 (32.69%) and 12 (23.08%) were effective, and 20 (38.46%) and 6 (11.54%) failed in the treatment, with the effective rate being 61.54% and 88.46%, respectively. The total effective rate of the acupuncture group was significantly higher than that of the control group (P<0.05). The adverse reactions such as regional hematoma (in 3 cases) and pain (in 2 cases) in the acupuncture group, and choking-coughing in the control group were seen, being 9.62% and 11.54% in the incidence rate, respectively. CONCLUSION: Deep needling of main acupoints Lianquan (CV23) and Yifeng (TE 17) in combination with conventional acupuncture of other acupoints is effective in improving local glossopharyngeal function in apoplexy patients with dysphagia, which is obviously superior to conventional swallowing rehabilitation training in the therapeutic effect and is applicable in clinical practice.
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OBJECTIVE: To observe the efficacy of Tongdu Tiaoshen (dredging Governor Vessel and regulating mind) needling combined with swallowing training in the treatment of ischemic stroke (IS) with dysphagia, and to investigate its effect on cerebral blood flow and serum levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF). METHODS: A total of 100 IS inpatients with dysphagia were enrolled in the present study, and randomly and equally divided into control group and treatment group by using a random number table. The patients of the control group received routine swallowing training including tongue extending and retracting, cheek-muscle training, breathing exercise, and laryngopharyngeal exercise, beginning from the 2nd day after hospitalization. The patients of the treatment group received manual acupuncture stimulation of Dazhui (GV14), Fengfu (GV16), Shenting (GV24), Shendao (GV11), Baihui (GV20), Shuigou (GV26), etc., on the basic treatment as those mentioned in the control group. The treatment was conducted once daily, 5 times per week and for 4 successive weeks. The swallowing ability was tested by using video fluoroscopic swallowing study (VFSS), Kubota water swallowing test, and the standard swallowing function assessment (SSA) scale, separately, and patients' daily life quality was assessed by using swallowing related quality of life questionnaire (SWAL-QOL). The cerebral hemodynamics including mean blood flow velocity (Vm), maximum peak flow speed (Vs), and vascular resistance index (RI) of the bilateral cerebral arteries was detected by transcranial color Doppler ultrasound tests, and serum BDNF and NGF contents were assayed by enzyme linked immunosorbent assay. The therapeutic effect of swallowing ability was evaluated after the treatment. RESULTS: After 4 weeks' treatment, the scores of Kubata water swallowing test, SSA, and SWAL-QOL and RI were considerably decreased (P<0.01), and the VFSS scores, Vs and Vm levels as well as serum BDNF and NGF contents were significantly increased (P<0.01) in both groups compared with their own pre-treatment. Of the 48 and 49 cases in the control and treatment groups, 4 (8.33%) and 8(16.33%) were cured, 26 (54.17%) and 33 (67.35%) effective, 18 (37.50%) and 8 (16.33%) failed, with the effective rate being 62.50% and 83.67%, respectively. The therapeutic effect of the treatment group was significantly superior to that of the control group in the effective rate (P<0.05), and in lowering the scores of Kubota water swallowing test, SWAL-QOL, SSA, RI, and in up-regulating the scores of VFSS, Vs and Vm, and serum BDNF and NGF levels (P<0.01). CONCLUSION: Tongdu Tiaoshen needling combined with swallowing training is effective in improving swallowing ability, promoting cerebral blood flow and in up-regulating serum neurotrophic factor levels in patients with dysphagia after ischemic stroke.
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Objective To explore the effect of neuromuscular electrical stimulation combined with swallowing training for dysphagia after acute ischemic stroke. Methods A total of 104 patients with dysphagia after acute ischemic stroke receiving treatment in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Sep. 2016 were retrospectively enrolled. According to the treatment method, the patients were divided into treatment group and control group. The 73 patients in the treatment group received neuromuscular electrical stimulation combined with swallowing training, and the 31 patients in the control group received conventional treatment. The change of water swallow test (WST) score, pulmonary infection incidence and gastric tube removal rate were compared between the two groups. Results There were no significant differences in gender, age, baseline WST score or hospital stay between the two groups (all P>0.05). The WST score after intervention was significantly lower in the treatment group than that in the control group ([1.39±0.85] vs [2.71±1.16], F=17.236, P<0.001). The decreased WST score was significantly higher in the treatment group than that in the control group ([2.60±0.89] vs [1.29±0.46], F=19.910, P<0.001). The incidence of pulmonary infection was significantly lower in the treatment group than that in the control group (20.55% [15/73] vs 64.52% [20/31], χ2=18.840, P<0.001). The removal rate of gastric tube was significantly higher in the treatment group than that in the control group (52.05% [38/73] vs 25.81% [8/31], χ2=6.078, P=0.014). Conclusion Neuromuscular electrical stimulation combined with swallowing training can improve swallowing function and reduce the incidence of pulmonary infection in the patients with dysphagia after acute ischemic stroke.
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Objective To evaluate the effectiveness of swallowing training supplemented with neuromuscular electrical stimulation to provide a reference for clinical treatment and further study.Methods Reports of randomized and controlled trials of surface neuromuscular electrical stimulation in treating post-stroke dysphagia were sought in the Cochrane library,the PubMed and Embase databases,the Cumulative Index to Nursing and Allied Health Literature (CINAHL),and also in the ProQuest,PsycARTICLES,CBMdisc,China National Knowledge Infrastructure (CNKI),CQVIP database and Wanfang databases.All of the literature found was evaluated by 2 researchers according to predefined inclusion and exclusion criteria and the data were extracted and combined.Then meta-analysis was performed using version 5.3 of the RevMan software package.Results Eleven randomized and controlled trials involving 576 patients were included in the meta-analysis.Together,the data showed that swallowing training supplemented by neuromuscular electrical stimulation is significantly more effective than swallowing training alone in improving swallowing function.It reduces the risk of aspiration and improves quality of life.It does not,however,generally shorten the pharyngeal transmit time.Conclusions Swallowing training supplemented with neuromuscular electrical stimulation is a promising approach for treatment of post-stroke dysphagia and warrants further study.
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Objective To observe the effect of respiratory training on post-stroke dysphagia.Methods Forty-two stroke survivors with dysphagia were randomly divided into a control group and an observation group,each of 21.Both groups were given routine swallowing training,while the observation group was additionally provided with respiratory training once a day for 4 weeks.Before and after the treatment,the Kubota drinking water test (KDWT) was administered and a videofluoroscopic swallowing study (VFSS) was performed to assess swallowing function.Forced vital capacity (FVC),forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) were also measured to assess the subjects' pulmonary function.Results After the treatment,the average KDWT and VFSS scores were significantly better in the observation group than in the control group.The effectiveness rate of the observation group (85.71％) was significantly higher than that of the control group (61.90％).After the intervention,the average FVC [(3.57-±0.48)L],FEV1[(2.83±0.49) L/s] and PEF [(5.36±1.04) L/s] of the observation group were significantly better than those before the treatment and those of the control group after the treatment.Conclusion Swallowing training supported by respiratory training is superior to swallowing training alone for improving the swallowing (and pulmonary) function of post-stroke dysphagia patients.Such combined treatment is worthy of application in clinical practice.
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Objective To observe the effect of individualized swallowing training in the neonatal intensive care unit on the swallowing function of premature infants with feeding disorders.Methods Sixty-two preterm (28 to 32 weeks) infants with feeding disorders were randomly divided into a treatment group (n=34) and a control group (n =28).Both groups were given routine gastric tube feeding,but the treatment group was additionally provided with individualized swallowing training twice a day for 2 weeks,including oral sensory and motor stimulation,milking,family participation,a better environment and a selection of feeding tools.The subjects' daily milk consumption and weight were recorded,along with the age when the gastric tube was removed and the total length of the hospital stay.Results The treatment group showed significantly greater improvement than the control group in their daily milk consumption and weight gain,though both groups showed significant improvements.The average time to removing the gastric tube and the average hospital stay were both significantly shorter for the treatment group than for the control group.Conclusion Individualized swallowing training can effectively improve sucking and swallowing skills and shorten the period of using a gastric tube and the total hospital stay for premature infants.
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Objective To explore the effect of swallowing training on dysphagia in patients with head and neck neoplasm receiving ra-diotherapy. Methods 60 patients with head and neck neoplasm receiving radiotherapy from March, 2014 to August, 2015 were divided into intervention group (n=30) and control group (n=30) randomly. The control group received routine nursing and relevant health education, while the intervention group received swallowing training from 2 weeks before to 3 months after radiotherapy. They were assessed with Functional Oral Intake Scale and M. D. Anderson Dysphagia Inventory 1 week, 3 months after radiotherapy. Results The scores of Function-al Oral Intake Scale (Z=-3.195, P4.385, P5.361, P<0.01). Conclusion Swallowing training could improve the condition of dysphagia of head and neck neoplasm patients after radiotherapy.
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Objective To study the effect of early ice stimulation therapy combined with swallowing training on swallowing dysfunction after severe traumatic brain injury. Methods Seventy-four patients with severe brain injury complicated with swallowing disorder were randomly divided into experiment group equally: the treatment group was managed with early ice stimulation therapy combined with swallowing training , while the control group was treated with simple swallowing training . The two groups were compared in terms of dysphagia severity by Watian drinking water test . Results There was significant difference between the two groups ( P<0 . 01 ) . The curative effect of the experiment group was better than that of the control group . Conclusion Early ice stimulation combined with swallowing training can improve the swallowing function in patients with severe traumatic brain injury .
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<p><b>OBJECTIVE</b>To assess the therapeutic effect of acupuncture combining standard swallowing training for patients with dysphagia after stroke.</p><p><b>METHODS</b>A total of 105 consecutively admitted patients with post-stroke dysphagia in the Affiliated Hospital of Gansu University of Chinese Medicine were included: 50 patients from the Department of Neurology and Rehabilitation received standard swallowing training and acupuncture treatment (acupuncture group); 55 patients from the Department of Neurology received standard swallowing training only (control group). Participants in both groups received 5-day therapy per week for a 4-week period. The primary outcome measures included the scores of Videofluoroscopic Swallow Study (VFSS) and the Standardized Swallowing Assessment (SSA); the secondary outcome measure was the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), all of which were assessed before and after the 4-week treatment.</p><p><b>RESULTS</b>A total of 98 subjects completed the study (45 in the acupuncture group and 53 in the control group). Significant differences were seen in VFSS, SSA and RBHOMS scores in each group after 4-week treatment as compared with before treatment (P<0.01). Comparison between the groups after 4-week treatment showed that the VFSS P=0.007) and SSA scores (P=0.000) were more significantly improved in the acupuncture group than the control group. However, there was no statistical difference (P=0.710) between the acupuncture and the control groups in RBHOMS scores.</p><p><b>CONCLUSIONS</b>Acupuncture combined with the standard swallowing training was an effective therapy for post-stroke dysphagia, and acupuncture therapy is worth further investigation in the treatment of post-stroke dysphagia.</p>
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Aged , Female , Humans , Male , Middle Aged , Acupuncture Therapy , Deglutition , Physiology , Deglutition Disorders , Therapeutics , Prospective Studies , StrokeABSTRACT
Objective To observe the effects of neuromuscular stimulation (NMES) intensity on post-stroke dysphagia.Methods Thirty patients with dysphagia resulting from a stroke were randomly divided into a control group,an NMES group,and an intensive NMES group,with 10 patients in each.The 3 groups all received conven-tional swallowing training.Patients in the NMES group also received NMES once a day and those in the intensive NMES group received it twice a day.Kubota's water drinking test and videofluoroscopy were used to assess the subjects' swallowing function before treatment and after 2 and 4 weeks of treatment.Results After 2 weeks,the average water drinking test score was significantly better in the intensive NMES group than in the control group.The fluoroscopic results of all three groups had improved significantly,but the results in the NMES group and the intensive NMES group were significantly better than those of the control group.The intensive NMES group also scored significantly higher than the NMES group.Conclusion NMES can improve the swallowing reflex and the contraction of the suprahyoid muscles.It can strengthen the effect of re-learning swallowing.Two NMES sessions a day are better than one.
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Objective To observe the effect of electromyographic biofeedback combined with swallowing training on dysphagia after stroke.Methods Ninety-five patients with difficulty in swallowing after stroke were randomly divided into a treatment group (48 eases) and a control group (47 cases).The patients in the treatment group were provided electromyographic biofeedback and swallowing training; the patients in the control group received swallowing training only.The therapeutic effect was assessed with Kubota's drinking water test before treatment and 30d after treatment.Results Swallowing in both groups improved after treatment.The total recovery rate in the treatment group was 87.5％,and in the control group it was 68.0％,a significant difference.Conclusion Electromyographic biofeedback can improve the effectiveness of swallowing training after stroke.
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@#Objective To observe the effect of acupuncture, neuromuscular electrical stimulation and swallowing training on acute stroke patients with dysphagia and the incidence of post-stroke pneumonia (PSP). Methods Acute stroke patients with dysphagia were divided into 3 groups. Routine group (n=188) received routine swallowing training. Stimulation group (n=196) received routine swallowing training and neuromuscular electrical stimulation. Acupuncture group (n=112) received routine swallowing training, neuromuscular electrical stimulation, and acupuncture. The incidence of improvment of dysphagia and PSP, and the improvement of National Institutes of Health Stroke Scale (NIHSS) within 3 weeks were compared. They were followed up for 3 months for the incidence of PSP. Results The incidence of improvment of dysphagia was the most in the acupuncture group (P<0.05), while the incidence of PSP was the least (P<0.05). The improvement of NIHSS was the most in the acupuncture group (P<0.05). The incidence of PSP was not significantly different (P>0.05) within 3 months followed up. Conclusion The acupuncture, neuromuscular electrical stimulation and swallowing training combination can improve the swallowing function and decrease the incidence of PSP in stroke patients with dysphagia.
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@#Objective To observe the effect of neuromuscular electrical stimulation and swallowing trainging on dysphagia after stroke.Methods 60 stroke patients following dysphagia were randomly divided into neuromuscular electrical stimulation group (n=20), swallowingtraining group (n=20), and combined therapy group (n=20), which received neuromuscular electrical stimulation, swallowing training, orcombined treatment of the above respectively, on the basis of routine treatment. Swallowing function was assessed by Kubota test and videofluoroscopyswallowing study (VFSS). Results The scores improved significantly in three groups after the treatment (P<0.05), and combinedtherapy group improved best (P<0.01). Conclusion Neuromuscular electrical stimulation and swallowing training can improve swallowingfunction after stroke, and combined therapy was more effective.
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@#ObjectiveTo investigate the effects of swallowing training combined with real-time electrical stimulation on dysphagia after stroke. Methods17 patients, older than 80 years old, with dysphagia after stroke, were treated with Vocastim-Master Physiomed Elektromedizin. They were assessed with the Watian drinking water test, swallowing disorder evaluation, swallowing ability evaluation, and α. ResultsAll the assessment significantly improved in the 17 patients (P<0.001). ConclusionSwallowing training combined with real-time electrical stimulation can significantly improve the swallowing capacity of the patients older than 80 after stroke.
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@#Objective To observe the effect of hyperbaric oxygen,rehabilitation training or acupuncture at Fengchi acupoint on pseudobulbar paralysis after stroke.Methods 90 patients were divided into group Ⅰ(A,B,C) or Ⅱ(A,B,C) randomly.Patients in all groups were given conventional therapy,while those in groups ⅠB and ⅡB were given hyperbaric oxygen,ⅠC and ⅡC were given swallowing training and group Ⅱ was given acupuncture at Fengchi acupoint additionally.They were assessed with Modified Kubota-Chiari's swallowing functional classification before and after treatment.Results In all groups except ⅠA,swallowing function scores improved after treatment significantly(P<0.05).The scores were different significantly between group Ⅰ and group Ⅱ after treatment(P<0.05).Except 3 d after treatment,the scores were different significantly between sub-group of group Ⅰ or group Ⅱon other time points(P<0.05).Conclusion The hyperbaric oxygen is more effective than conventional therapy on pseudobulbar paralysis,but less than swallowing training.Acupuncture at Fengchi acupoint can improve their efficacy.
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@#ObjectiveTo evaluated the effect of swallowing training and acupuncture on dysphagia in nasopharyngeal carcinoma after radiotherapy.MethodsThirty-eight post-radiotherapeutic nasopharyngeal carcinoma patients were divided into 2 groups: comprehensive group (n=20) were treated with swallowing training and acupuncture therapy, acupuncture group (n=18) were treated with acupuncture only. The patients were assessed with water-swallow test and videofluoroscopy (VFS) before and after treatment.ResultsBoth groups improved their score of water-swallow test after treatment (P<0.01), but the scores of comprehensive group were better than that of acupuncture group(P<0.05).Under the VFS, the cure rate was 70.0% or 38.9% respectively(P=0.089). ConclusionSwallowing training can improve the swallow ability of bulbar palsy patients.