Treating dysphagia with surface neuromuscular electrical stimulation of the neck / 中华物理医学与康复杂志

Objective To explore the effect of applying surface neuromuscular electrical stimulation (NMES) on the functioning of the upper esophageal sphincter (UES) using the high-resolution solid-state manometry.Methods Seventeen healthy volunteers were selected and given sham stimulation (SS),superior and inferior hyoid stimulation (SIHS),superior hyoid stimulation (SHS) or inferior hyoid stimulation (IHS) at a frequency of 80 Hz and the maximum tolerated level before swallowing.Any changes in the kinematics or biomechanics during swallowing and at rest were recorded using high-resolution solid-state manometry.One-factor repeated analysis of the measurement variance was used.Results A significant decrease in the duration of UES relaxation was observed in response to the electrical stimulation (compared with the sham stimulation).The UES's residual pressure showed a rising trend during electrical stimulation,especially in response to IHS,but the difference compared with SS was not significant.The UES's resting pressure during SIHS increased significantly compared with SS,but there was no significant difference between SHS and IHS in this respect.Conclusions Surface neuromuscular electrical stimulation applied to the neck can immediately change the functioning of the UES.NMES at the maximum tolerated intensity can reduce the duration of UES relaxation,which is important for dysphagia therapy and research.

The effect of transcranial direct current stimulation of the motor cortex when swallowing / 中华物理医学与康复杂志

Objective To assess the neurophysiological effects of transcranial direct current stimulation (tDCS) of the motor cortex when swallowing.Methods Twenty healthy volunteers had anodal tDCS (a-tDCS), cathodal tDCS (c-tDCS) or sham tDCS applied over the hemisphere with stronger suprahyoid projections, effortful swallowing was performed simultaneously.Suprahyoid motor-evoked potentials (MEPs) on both the stimulated and non-stimulated contra-lateral hemisphere were examined immediately before stimulation and 5,30, 60 and 90 minutes later.The MEPs were normalized and analyzed using two-way repeated measures analysis of variance.Results The tDCS had long-lasting effects on the suprahyoid MEPs bilaterally.There were significant changes in the effect over time.Sham tDCS showed no significant effect.Compared with sham tDCS, a-tDCS significantly increased the excitability of the stimulated hemisphere, but not the non-stimulated projection.Compared with sham tDCS, c-tDCS induced decreased cortical excitability in the stimulated hemisphere but an increase in the non-stimulated projection.Conclusions tDCS during swallowing can alter bilateral swallowing activity in the motor cortex in a polarity-dependent and site-dependent way.A-tDCS enhances the excitability of the stimulated hemisphere while c-tDCS inhibits it ipsilaterally but increases it contralaterally.

Balloon dilatation therapy for treating dysphagia after brainstem stroke: A fMRI study / 中华物理医学与康复杂志

Objective To explore the effects of modified balloon dilatation therapy for treating upper esophageal sphincter dysfunction after a brainstem stroke.Methods Ten healthy adult volunteers and 20 dysphagic patients with upper esophageal sphincter dysfunction after a brainstem stroke were recruited.The 20 patients were divided into a balloon dilatation therapy group of ten who were treated with catheter balloon dilatation therapy, and a control group of ten who received conventional therapy.All were given block-designed task fMRI scans guided by a matched visual presentation system before and after the treatment.Results Widespread activation was observed in both hemispheres, including the bilateral cerebral cortex, the brainstem and the cerebellum, but the activated areas were significantly smaller in the stroke patients before treatment.After the treatment, seven patients in the balloon dilatation group were totally orally fed, while only three patients in the control group recovered totally oral intake.After dilatation, significantly more regions were activated, including the anterior cingulate, insula, supplementary motor area, precuneus and the frontal lobe.They were activated with relatively low voxels in the treatment group, while in the control group significant activation was observed only in the precuneus after treatment.Conclusion Modified balloon dilatation therapy can increase activation of the cortex and subcortical structures related to swallowing, promoting better swallowing function.

Cough Reflex Induced with Citric Acid in Post-stroke Dysphagia Patients and Healthy Adults / 中国康复理论与实践

@#Objective To evaluate the application of cough reflex testing with various concentrations of citric acid for dysphagia post stroke. Methods 20 normal controls (NC), 20 stroke patients with dysphagia (SD) and 20 stroke patients without dysphagia (SND) were tested with cough reflex inhalated 4 kinds of dosage of citric acid: 0.2 mol/L, 0.4 mol/L, 0.6 mol/L and 0.8 mol/L. Results The incidence of pass (coughed twice or more) decreased in the SD compared with those in the NC as inhalated citric acid of 0.2 mol/L and 0.4 mol/L (P< 0.05), and decreased under 0.4 mol/L compared with the SND (P<0.05). There was no significant difference between the SND and the NC (P>0.05). 90% of the NC passed as inhalated citric acid of 0.4 mol/L; however, it was 45% in the SD, and increased when they inhalated more dosage of citric acid (P<0.05). The incidence of pass decreased under 0.2 mol/L citric acid in the SND compared with other concentration (P<0.05). The result of the test was reliable interrater (κ=0.97). The incidence of cough was consistent of 96.8% with the same concentration. No asthma and asphyxia was observed. Conclusion Cough reflex testing with citric acid inhalation can be used to assess the defensive function of airway in lower concentration for dysphagia after stroke.

Cough Reflex Induced with Citric Acid in Post-stroke Dysphagia Patients and Healthy Adults / 中国康复理论与实践

Objective To evaluate the application of cough reflex testing with various concentrations of citric acid for dysphagia post stroke. Methods 20 normal controls (NC), 20 stroke patients with dysphagia (SD) and 20 stroke patients without dysphagia (SND) were test-ed with cough reflex inhalated 4 kinds of dosage of citric acid:0.2 mol/L, 0.4 mol/L, 0.6 mol/L and 0.8 mol/L. Results The incidence of pass (coughed twice or more) decreased in the SD compared with those in the NC as inhalated citric acid of 0.2 mol/L and 0.4 mol/L (P0.05). 90%of the NC passed as inhalated citric acid of 0.4 mol/L;however, it was 45%in the SD, and increased when they inhalated more dosage of citric acid (P<0.05). The incidence of pass decreased under 0.2 mol/L citric acid in the SND compared with other concentra-tion (P<0.05). The result of the test was reliable interrater (κ=0.97). The incidence of cough was consistent of 96.8%with the same concen-tration. No asthma and asphyxia was observed. Conclusion Cough reflex testing with citric acid inhalation can be used to assess the defen-sive function of airway in lower concentration for dysphagia after stroke.

The effect of sEMG biofeedback combined with swallowing training in treatment of dysphagic patients with cerebral infarction at recovery stage / 中华物理医学与康复杂志

Objective To observe the effect of surface electromyographic biofeedback (sEMG-BFB) combined with routine swallow training on dysphagic patients with cerebral infarction at recovery stage.Methods Fiftyone dysphagic patients with cerebral infarction were randomly divided into two groups:control group (26 cases) and biofeedback training group (25 cases).The control group was given routine training including orofacial function training,balloon dilatation and behavioral swallowing training,while the biofeedback training group was given behavioral swallowing training was conducted with the guidance of sEMG-BFB in addition to the routine training.Before and after the treatment,videofluoroscopy swallowing study (VFSS) was performed to observe the opening of upper esophageal sphincter (UES).Functional oral intake scale (FOIS) was used to evaluate swallow function.Results Before treatment,there were no significant difference between the two groups in terms of FOIS score and UES opening (P ＞0.05).The FOIS score increased in both groups after treatment (P ＜ 0.05),and the FOIS score was higher in the biofeedback training group than that of the control group (P ＜ 0.05).After treatment,the number of UES complete opening and incomplete opening was 18 and 8,respectively,in the control group,versus 20 and 5,respectively,in the biofeedback training group.UES opening improved in both groups after treatment (P ＜ 0.05).Conclusion Routine swallowing training combined with sEMG-BFB can benefit the dysphagic patients with cerebral infarction for their UES opening and swallowing ability at recovery stage.