Neuromuscular electrical stimulation improves swallowing initiation in patients with post-stroke dysphagia.

Objective: More than half of post-stroke patients develop dysphagia, which manifests as delayed swallowing and is associated with a high risk of aspiration. In this study, we aimed to investigate the immediate effect of neuromuscular electrical stimulation (NMES) on swallowing initiation in post-stroke patients using videofluoroscopic swallowing study (VFSS) data. Materials and methods: This randomized, self-controlled crossover study included 35 patients with post-stroke dysphagia. All selected patients received real and sham NMES while swallowing 5 ml of thin liquid. Participants completed the conditions in random order, with a 10-min interval between conditions. The primary evaluation indicators included the Modified Barium Swallow Impairment Profile-6 (MBSImp-6) and Penetration-Aspiration Scale (PAS). Secondary indicators included oral transit time (OTT), pharyngeal transit time (PTT), and laryngeal closure duration (LCD). Results: Modified Barium Swallow Impairment Profile-6 (P = 0.008) and PAS (P < 0.001) scores were significantly lower in the Real-NMES condition than in the Sham-NMES condition. OTT (P < 0.001) was also significantly shorter during Real-NMES than during Sham-NMES. However, LCD (P = 0.225) and PTT (P = 0.161) did not significantly differ between the two conditions. Conclusion: Neuromuscular electrical stimulation may represent a supplementary approach for promoting early feeding training in patients with post-stroke dysphagia. Clinical trial registration: [https://clinicaltrials.gov/], identifier [ChiCTR2100052464].

Effect of Intensive Oropharyngeal Training on Radiotherapy-Related Dysphagia in Nasopharyngeal Carcinoma Patients.

OBJECTIVE: To evaluate the effect of intensive oropharyngeal functional training on swallowing in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma. METHODS: Fourteen patients with nasopharyngeal carcinomas and dysphagia after radiotherapy received intensive oropharyngeal training for two weeks. The Functional Oral Intake Scale (FOIS) and videofluoroscopic swallowing studies (VFSS) were used to evaluate swallowing function before and after intensive oropharyngeal training. Spatiotemporal parameters of the VFSS were analyzed using a digital image analysis system. RESULTS: After training, the FOIS, Rosenbek penetration-aspiration score, DIGEST, normalized residue ratio scale, and spatiotemporal parameters of VFSS were significantly improved (P < 0.05). CONCLUSIONS: This study indicated that intensive oropharyngeal training improves swallowing function after radiotherapy in patients with nasopharyngeal carcinoma.

Evidence of cortical reorganization of language networks after stroke with subacute Broca's aphasia: a blood oxygenation level dependent-functional magnetic resonance imaging study.

Aphasia is an acquired language disorder that is a common consequence of stroke. The pathogenesis of the disease is not fully understood, and as a result, current treatment options are not satisfactory. Here, we used blood oxygenation level-dependent functional magnetic resonance imaging to evaluate the activation of bilateral cortices in patients with Broca's aphasia 1 to 3 months after stroke. Our results showed that language expression was associated with multiple brain regions in which the right hemisphere participated in the generation of language. The activation areas in the left hemisphere of aphasia patients were significantly smaller compared with those in healthy adults. The activation frequency, volumes, and intensity in the regions related to language, such as the left inferior frontal gyrus (Broca's area), the left superior temporal gyrus, and the right inferior frontal gyrus (the mirror region of Broca's area), were lower in patients compared with healthy adults. In contrast, activation in the right superior temporal gyrus, the bilateral superior parietal lobule, and the left inferior temporal gyrus was stronger in patients compared with healthy controls. These results suggest that the right inferior frontal gyrus plays a role in the recovery of language function in the subacute stage of stroke-related aphasia by increasing the engagement of related brain areas.

[Effect of balloon dilatation on upper esophageal sphincter in brainstem stroke patients with dysphagia: an investigation using high-resolution solid-state manometry].

OBJECTIVE: To explore the effects of balloon dilation intervention on function of upper esophageal sphincter ( UES) in brainstem stroke patients with dysphagia before and after treatment by high resolution solid-state manometry. METHODS: Thirty brainstem stroke patients with pharyngeal dysphagia were recruited. The dilatation treatment group ( n = 15) completed a 3-week regimen of modified balloon dilatation and traditional swallowing including E-stim, Mendelsohn Maneuver and supraglottic swallowing. And the control group ( n = 15) only completed 3 weeks of traditional swallowing therapy. Before, and after dilatation, the nadir of UES and its duration were measured during swallowing of thin liquid, thick liquid and pasty material in 3-ml volumes. The results of both groups were compared for identical parameters. RESULTS: In the experimental group, post-treatment UES residual pressure (for water, P = 0. 008; for thick liquid,P = 0. 004 ; for paste, P = 0. 001 ) and relaxation duration ( for water, P = 0. 006 ; for thick liquid, P =0. 002; for paste, P < 0. 001 ) both significantly improved for all three materials. UES resting pressure approximated normal (Pre-treatment 30 ± 3 mm Hg; post-treatment 59 ± 6 mm Hg, P < 0. 001 ) . In the control group, there was no improvement in post-treatment UES residual pressure and relaxation duration for all three materials ( P > 0. 05). In the experimental group, feeding tube was removed in 12 /15 versus 2/15 patients in the control group. The experimental group had 3. 5 points improvement (P =0. 001) while the control group improved by a mere 0. 63 point ( P = 0. 026) in FOIS scores. CONCLUSION: Failed UES is a major cause of dysphagia in brainstem stroke patients. Dysphagia therapy with dilatation improves relaxation of UES. Moreover, it is helpful for restoring UES resting pressure. Traditional swallowing therapy has no positive effect on UES.