Effect of swallowing therapy to avoid aspiration in patients with post-stroke dysphagia at the stroke unit of Harjono hospital, Indonesia

Background: Aspiration is common complication of dysphagia stroke due to cranial nerve damage, especially cranial nerves V, VII, IX, X and XII. Existing therapies to prevent aspiration is the compensation strategy therapy and semisolid nutritional therapy, but each of these therapies is still have a weakness, so it needs a new therapeutic method namely swallowing therapy which combine the advantages and reduce the weaknesses of each of the therapy. Aim of the study is to determine the effect of swallowing therapy on aspiration prevention in patients with dysphagia stroke.Methods: This research was a quasi-experimental research involving 16 respondents in the intervention group and 16 respondents in the control group who obtained through consecutive sampling techniques. Data was collected from February-March 2016 at the Stroke Unit RSUD Dr. Harjono Ponorogo through observations using Gugging Swallowing Screen (GUSS) instruments. Data analysis used in this research was wilcoxon test to determine the difference of swallowing therapy effect before and after intervention. Mann-Whitney test was also used to determine the difference of swallowing therapy effect between intervention group and control group after intervention.Results: There was a differences of swallowing therapy effect between pre-test and post-test in the intervention group (p = 0.002). In addition, there was no differences between pre-test and post-test in the control group (p = 0.157).Conclusions: Swallowing therapy have a positive effect against aspiration prevention in patients with dysphagia stroke, so it can be recommended as an acute care intervention in stroke patients at stroke unit.

Experiencia en la evaluación diagnóstica y terapéutica de la disfagia orofaríngea y esofágica en niños / Experience in diagnostic and therapeutic evaluation of oropharyngeal and esophageal dysphagia in children

Introducción: La disfagia puede ser a nivel orofaríngeo o esofágico debido a trastornos estructurales o funcionales. Su abordaje diagnóstico y tratamiento evita la desnutrición y el riesgo de aspiración. Objetivo: reportar la experiencia en la evaluación diagnóstica y tratamiento en niños con disfagia orofaríngea y esofágica. Pacientes y método: estudio descriptivo y transversal, de 49 niños con disfagia, durante dos años. Protocolo de estudio: historia clínica, patologías asociadas, estudio radiológico, endoscopia, nasolaringoscopia-videodeglutoscopia, terapia deglutoria, videofluoroscopia, manometría y ph-metría esofágica y tratamiento indicado. Resultados: 20(40,82%) hembras y 29(59,18%) varones. Edad promedio 2,56 años (rango: 1m-16 años). El 46,93% presentó trastornos neurológicos como patología asociada. El 65,31% con disfagia a sólidos y 34,69% a líquidos, otros síntomas: vómitos, regurgitaciones y reflujo faringo-nasal. Posterior a la evaluación y estudios se encontró: disfagia orofaríngea 25/49(51,02%), de origen funcional en 22/25(88%) y mecánica 3(12%); disfagia esofágica 13/49(26,53%), mecánica en 1/13(7,69%) y funcional en 12/13(92,30%) de los cuales 6 con dismotilidad inespecífica y 4 asociada a esofagitis; disfagia mixta 11(22,44%). Evaluación nutricional fue requerida en 65,30%, se indicó nutrición por sonda de alimentación en 21 niños, por gastrostomía endoscópica en 4 y cambio en la consistencia de los alimentos en 7. Dilatación esofágica por estenosis congénita en un caso y por acalasia esofágica en 2. Terapia deglutoria en 71,42%. Conclusiones: la evaluación integral del niño con disfagia orofaríngea y esofágica es fundamental para identificar la causa e indicar el tratamiento específico con apoyo nutricional, procedimientos endoscópicos y terapia deglutoria.

Introduction: Dysphagia can be oropharyngeal or esophageal level due to structural or functional disorders. Its diagnosis and treatment approach prevents malnutrition and the risk of aspiration. Objective: To report our experience in the diagnostic evaluation and treatment for children with oropharyngeal and esophageal dysphagia. Patients and methods: Descriptive, cross-sectional, 49 children with dysphagia, for two years. Study protocol: clinical history, associated diseases, radiographs, endoscopy, Nasolaryngoscopy-videodeglutoscopia therapy, swallowing, videofl uoroscopy, manometry and esophageal pHmetry and appropriate treatment. Results: 20 (40.82%) females and 29 (59.18%) males. Average age 2.56 years (range: 1m-16 years). The 46.93% had neurological disorders and associated diseases. The 65.31% with dysphagia to solids and 34.69% for liquids, other symptoms: vomiting, regurgitation and nasal pharyngeal reflux. After the evaluation and studies found: Oropharyngeal Dysphagia 25/49 (51.02%) of functional origin in 22/25 (88%) and mechanical 3 (12%) Esophageal Dysphagia 13/49 (26.53% ) mechanical 1/13 (7.69%) and functional in 12/13 (92.30%) of which 6 and 4 with dysmotility associated nonspecifi c oesophagitis Mixed Dysphagia 11 (22.44%). Nutritional assessment was required to 65.30%, is indicated feeding tube 21 feeding children endoscopic gastrostomy 4 and change in the consistency of food at 7. Dilatation Congenital esophageal stenosis in one case and two esophageal achalasia. Swallowing therapy in 71.42%. Conclusions: The evaluation of the child with oropharyngeal and esophageal dysphagia is essential to identify the cause and indicate the specifi c treatment with nutritional support and therapeutic endoscopic procedures swallowing.

Treatment of Post-stroke Dysphagia by VitalStim Therapy Coupled with Conventional Swallowing Training / 华中科技大学学报（医学）（英德文版）

To investigate the effects of VitalStim therapy coupled with conventional swallowing training on recovery of post-stroke dysphagia,a total of 120 patients with post-stroke dysphagia were randomly and evenly divided into three groups:conventional swallowing therapy group,VitalStim therapy group,and VitalStim therapy plus conventional swallowing therapy group.Prior to and after the treatment,signals of surface electromyography (sEMG) of swallowing muscles were detected,swallowing function was evaluated by using the Standardized Swallowing Assessment (SSA) and Videofluoroscopic Swallowing Study (VFSS) tests,and swallowing-related quality of life (SWAL-QOL) was evaluated using the SWAL-QOL questionnaire.There were significant differences in sEMG value,SSA,VFSS,and SWAL-QOL scores in each group between prior to and after treatment.After 4-week treatment,sEMG value,SSA,VFSS and SWAL-QOL scores were significantly greater in the VitalStim therapy plus conventional swallowing training group than in the conventional swallowing training group and VitalStim therapy group,but no significant difference existed between conventional swallowing therapy group and VitalStim therapy group.It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of post-stroke dysphagia.

Preemptive Swallowing Stimulation in Long-term Intubated Patients

OBJECTIVE: To evaluate the effect of preemptive swallowing stimulation on the recovery of swallowing function in long-term intubated patients. METHOD: Patients in the intensive care unit intubated for at least 48 hours due to respiratory distress from March to August 2003 were randomly assigned to two groups. Fifteen patients were stimulated (experimental group), and 18 patients were not stimulated (control group). The duration of intubation was 15.5+/-6.7 days in the experimental group and 15.7+/-6.5 days in the control group. Duration of stimulation in the experimental group was 7.3+/-3.6 days. After extubation, we compared the severity of dysphagia via video-fluoroscopic swallowing study. RESULTS: There was no difference in percentage of aspiration and swallowed volume between two groups. Oral transit time of the experimental group (0.37+/-0.07 sec) was significantly shorter than that of the control group (0.83+/-0.10 sec), and the oropharyngeal swallowing efficiency of the experimental group (73.3+/-17.4%/sec) was significantly higher than that of the control group (50.1+/-13.0%/sec). CONCLUSION: Preemptive swallowing stimulation in long term intubated patients may facilitate recovery of dysphagia.