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.

A research on improving the food intake assessment method in acquired brain injury patients / 中国实用护理杂志

Objective To apply repetitive saliva swallowing test and standardized swallowing assessment combined with the volume-viscosity swallow test on patients with acquired brain injury, we aim to identify the potential risks of oral intake during the patients′recovery stage, and improve the strategy of aspiration prevention. Methods Totally 142 patients with acquired brain injury were selected as the observation group during November 2016 and November 2017, and 153 patients with acquired brain injury were selected as the control group during October 2015 and October 2016. The control group was assessed by water swallow test, while a combination of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and Volume-Viscosity Swallow Test was used to assess the observation group till discharging. The detection rate of aspiration risk and the incidence of aspiration pneumonia was compared between the two groups. ResuLts The detection rate of aspiration risk was 36.6% (52/142) in the observation group and 7.8% (12/153) in the control group, the difference was statistically significant (χ2=35.899, P<0.05). The incidence of aspiration pneumonia was 1.4% (2/142) in the observation group and 12.4% (19/153) in the control group, the difference was statistically significant (χ2=13.502, P<0.05). ConcLusions The combined application of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and the Volume-Viscosity Swallow Test can improve the detection rate of aspiration risk in the acquired- brain- injury patients with suspicious swallowing dysfunction, reduce the incidence of aspiration pneumonia, increase the nursing safety, and improve the health outcomes of neurosurgical patients.

A research on improving the food intake assessment method in acquired brain injury patients / 中国实用护理杂志

Objective@#To apply repetitive saliva swallowing test and standardized swallowing assessment combined with the volume-viscosity swallow test on patients with acquired brain injury, we aim to identify the potential risks of oral intake during the patients′ recovery stage, and improve the strategy of aspiration prevention.@*Methods@#Totally 142 patients with acquired brain injury were selected as the observation group during November 2016 and November 2017, and 153 patients with acquired brain injury were selected as the control group during October 2015 and October 2016. The control group was assessed by water swallow test, while a combination of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and Volume-Viscosity Swallow Test was used to assess the observation group till discharging. The detection rate of aspiration risk and the incidence of aspiration pneumonia was compared between the two groups.@*Results@#The detection rate of aspiration risk was 36.6% (52/142) in the observation group and 7.8% (12/153) in the control group, the difference was statistically significant (χ2=35.899, P < 0.05). The incidence of aspiration pneumonia was 1.4% (2/142) in the observation group and 12.4% (19/153) in the control group, the difference was statistically significant (χ2=13.502, P < 0.05).@*Conclusions@#The combined application of the Repetitive Saliva Swallowing Test, the Standardized Swallowing Assessment and the Volume-Viscosity Swallow Test can improve the detection rate of aspiration risk in the acquired-brain-injury patients with suspicious swallowing dysfunction, reduce the incidence of aspiration pneumonia, increase the nursing safety, and improve the health outcomes of neurosurgical patients.

Randomized Trial of Acupoint Injection plus Nerve Electrical Stimulation for Deglutition Disorders After Cerebral Stroke / 上海针灸杂志

Objective To observe the clinical efficacy of acupoint injection plus nerve electrical stimulation in treating deglutition disorders after cerebral stroke. Method Seventy-seven patients with deglutition disorders after cerebral stroke were randomized into an electrical stimulation group of 24 cases, a hydroacupuncture group of 26 cases, and a comprehensive group of 27 cases, to respectively receive Vitalstim electrical stimulation, acupoint injection of Mecobalamin, and both of the treatments, 5 d as a treatment course, with 2-day interval between two courses, for 4 courses in total. The modified water-drinking test and Standardized Swallowing Assessment (SSA) were adopted to evaluate the therapeutic efficacy before the intervention, after 20-day treatment, and after 60-day treatment, and the therapeutic efficacies were compared. Result The modified water-drinking test and SSA scores were significantly changed in the three groups after 20-day treatment compared with that before the intervention, and the scores in the comprehensive group were superior to that of the electrical stimulation group and hydroacupuncture group. However, on the 60th day, the scores were equivalent among the three groups. Conclusion The Vitalstim electrical stimulation and acupoint injection of Mecobalamin both can produce certain treatment effects for deglutition disorders after cerebral stroke;the two methods can work in a synergistic way and can boost the improvement of swallowing function.

Importância da interdisciplinaridade na avaliação das disfagias: avaliação clínica e videofluoroscópica da deglutição / Interdisciplinary evaluation of dysphagia: clinical swallowing evaluation and videoendoscopy of swallowing

O paciente disfágico apresenta prejuízos em diversos aspectos, sendo a atuação interdisciplinar fundamental para definição do diagnóstico e da conduta. A atuação em conjunto na avaliação clínica e videoendoscópica é de extrema importância. Objetivo: Estudar a correlação entre a avaliação clínica (ACD) e videoendoscópica da deglutição (VED) por meio da classificação do grau de severidade e a análise qualitativo/descritiva dos procedimentos. Forma de estudo: Estudo transversal, descritivo, comparativo. Material e método: Realizado no março a dezembro de 2006 no ambulatório de Otorrinolaringologia/Disfagia de um hospital do interior de São Paulo. Foram avaliados pela ACD e VED 30 pacientes disfágicos com diferentes doenças. Os dados foram classificados por meio de escalas de severidade e análise qualitativa/descritiva. Resultados: A correlação entre as escalas de severidade de ACD e VED apontou concordância baixa (KAPA = 0,4) de modo estatisticamente significante (p=0,006). A correlação entre a análise qualitativa/descritiva apontou concordância excelente (KAPA=0.962) estatisticamente significante (p<0.001) para a amostra total. Conclusão: A concordância baixa entre as escalas de severidade aponta a necessidade da realização de ambos os procedimentos, reforçando a VED como procedimento factível. A análise qualitativa descritiva apontou concordância excelente, dado que reforça a necessidade da compreensão da deglutição como um processo.

Patients with dysphagia have impairments in many aspects, and an interdisciplinary approach is fundamental to define diagnosis and treatment. A joint approach in the clinical and videoendoscopy evaluation is paramount. AIM: To study the correlation between the clinical assessment (ACD) and the videoendoscopic (VED) assessment of swallowing by classifying the degree of severity and the qualitative/descriptive analyses of the procedures. Study design: cross-sectional, descriptive and comparative. Materials and methods: held from March to December of 2006, at the Otolaryngology/Dysphagia ward of a hospital in the country side of São Paulo. 30 dysphagic patients with different disorders were assessed by ACD and VED. The data was classified by means of severity scales and qualitative/ descriptive analysis. Results: the correlation between severity ACD and VED scales pointed to a statistically significant low agreement (KAPA = 0.4) (p=0,006). The correlation between the qualitative/descriptive analysis pointed to an excellent and statistically significant agreement (KAPA=0.962) (p<0.001) concerning the entire sample. Conclusion: the low agreement between the severity scales point to a need to perform both procedures, reinforcing VED as a doable procedure. The descriptive qualitative analysis pointed to an excellent agreement, and such data reinforces our need to understand swallowing as a process.

Value of Standardized Swallowing Assessment in Screening for Aspiration after Stroke / 中国康复理论与实践

@#Objective To investigate the value of Standardized Swallowing Assessment (SSA) in the screening for aspiration after stroke.Methods 81 patients with acute stroke received examinations of both SSA and Fiberoptic Endoscopic Examination of Swallowing (FEES). The SSA was then measured against the FEES study for sensitivity, specificity, positive predictive value and negative predictive value for aspiration in acute stroke patients. The relation between the Results of SSA and pneumonia post-stroke was analyzed.Results Sensitivity, specificity, positive predictive value and negative predictive value of SSA for aspiration were 95.0%, 53.7%, 66.7% and 91.7%, respectively. The patients with positive result on SSA had a higher incidence of pneumonia ( P＜0.05).Conclusion SSA is a valid and valuable screening tool for aspiration in acute stroke patients.