Document Type : Original Articles
Authors
1 Department of Speech Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
2 Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
3 Speech and Language Pathologist, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: The incidence of stroke escalates with age in both genders, with nearly 50% and 30% of cases reported in individuals over the ages of 75 and 85 years, respectively. This pilot randomized clinical trial was designed to explore the effects of combined thermal and neuromuscular stimulations on dysphagia improvement. It also aimed to identify the most efficient dysphagia management plan for acute stroke patients.
Methods: In this pilot randomized clinical trial study, twelve acute stroke patients were randomly and concurrently allocated into two groups. The control group received routine medical treatment without speech therapy counseling, while the intervention group underwent superficial and deep thermal neuromuscular stimulations. In the intervention group, one patient received treatment for two weeks, three patients for three weeks, and two patients for five weeks (five times a week). Patients in the intervention group were re-evaluated each week after five days of therapy using the Motility Function (MF) and Mann’s Assessment of Swallowing Ability (MASA) tests to monitor consistent improvement. Based on the cutoff point of the MASA test, treatment was either continued or terminated. Accordingly, different follow-up periods were considered for the patients: one received treatment for two weeks, three for three weeks, and two for five weeks.
Results: The results indicated a significant difference between the two groups regarding the mean MASA score after a 21-day intervention. The intervention group scored 166.5±3.53, while the control group scored 163±10.02 after 35 days (P=0.03). Furthermore, the intervention group reached the cutoff MASA score in the sixth MASA assessment after a 35-day intervention.
Conclusion: According to the protocol proposed by speech-language pathologists, it is recommended to perform stimulations for approximately 21-35 days. Given the significant results obtained from this preliminary study, it is suggested that this protocol be implemented in a larger sample size.
Keywords
- Lui SK, Nguyen MH. Elderly stroke rehabilitation: overcoming the complications and its associated challenges. Current gerontology and geriatrics research. 2018 Jun 27;2018.
- Donkor ES. Stroke in the century: a snapshot of the burden, epidemiology, and quality of life. Stroke Res Treat. 2018.
- Béjot Y, Daubail B, Giroud M. Epidemiology of stroke and transient ischemic attacks: Current knowledge and perspectives. Revue neurologique. 2016; 172(1):59-68.
- Horn, J. The Relationship between Post-Stroke Depression and Post-Stroke Dysphagia [Dissertations]. Medical Univ. of South Carolina, 2021.
- Chang MC, Choo YJ, Seo KC, Yang S. The Relationship Between Dysphagia and Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis. Frontiers in neurology. 2022;13:834240-834240.
- Bonilha HS, Simpson AN, Ellis C, Mauldin P, Martin-Harris B, Simpson K. The one-year attributable cost of post-stroke dysphagia. Dysphagia. 2014;29(5):545-52.
- Feng M-C, Lin Y-C, Chang Y-H, Chen C-H, Chiang H-C, Huang L-C, et al. The mortality and the risk of aspiration pneumonia related with dysphagia in stroke patients. J Stroke Cerebrovasc Dis. 2019;28(5):1381-7. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.011
- González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: an overview. Curr Phys Med Rehabil Rep. 2013;1(3):187-96.
- Vose A, Nonnenmacher J, Singer ML, González-Fernández M. Dysphagia management in acute and sub-acute stroke. Curr Phys Med Rehabil Rep. 2014;2(4):197-206.
- Arreola V, Ortega O, Álvarez-Berdugo D, Rofes L, Tomsen N, Cabib C, Muriana D, Palomera E, Clavé P. Effect of transcutaneous electrical stimulation in chronic poststroke patients with oropharyngeal dysphagia: 1-year results of a randomized controlled trial. Neurorehabilitation and Neural Repair. 2021 Sep;35(9):778-89.
- Lund I, Lundeberg T, Kurosawa M, Uvnäs-Moberg K. Sensory stimulation (massage) reduces blood pressure in unanaesthetized rats. Journal of the autonomic nervous system. 1999; 78(1):30-7.
- 12. Hägglund P, Hägg M, Levring Jäghagen E, Larsson B, Wester P. Oral neuromuscular training in patients with dysphagia after stroke: a prospective, randomized, open-label study with blinded evaluators. BMC neurology. 2020 Dec;20(1):1-0.
- Alam ZA, Elsaay O, Weheida SM, Elazazy HM, Ahamed E. Effect of sensory and motor stimulation program on clinical outcomes of patients with moderate head injury. J Nurs Health Sci. 2016;5(5):24-36.
- Hägg M, Tibbling L. Effect of IQoro® training on impaired postural control and oropharyngeal motor function in patients with dysphagia after stroke. Acta Otolaryngol. 2016; 136(7):742-8.
- Byeon H, Koh HW. Comparison of treatment effect of neuromuscular electrical stimulation and thermal-tactile stimulation on patients with sub-acute dysphagia caused by stroke. J Phys Ther Sci. 2016; 28(6):1809-12.
- Seager J, kyle-Brown D. New Foundations in Therapeutic Massage and Bodywork. 2007. 1st Edition. Chapter 4, Therapeutic Massage Techniques. P. 80. 83.
- Sproson L, Pownall S, Enderby P, Freeman J. Combined electrical stimulation and exercise for swallow rehabilitation post‐stroke: a pilot randomized control trial. International journal of language & communication disorders. 2018 Mar;53(2):405-17.
- Hägg M, Larsson B. Effects of motor and sensory stimulation in stroke patients with long-lasting dysphagia. Dysphagia. 2004;19(4):219-30.
- Teismann IK, Steinsträter O, Warnecke T, Suntrup S, Ringelstein EB, Pantev C, Dziewas R. Tactile thermal oral stimulation increases the cortical representation of swallowing. BMC neuroscience. 2009 Dec;10(1):1-0.
- Kwon S, Sim J, Park J, Jung Y, Cho KH, Min K, Kim M, Kim JM, Im SH. Assessment of aspiration risk using the Mann assessment of swallowing ability in brain-injured patients with cognitive impairment. Frontiers in neurology. 2019 Dec 3; 10:1264.
- Malik SN, Khan G, Sikander M, Ehsaan F. Effectiveness of swallow maneuvers, thermal stimulation and combination both in treatment of patients with dysphagia using functional outcome swallowing scale. Biomedical Research (0970-938X). 2017 Aug 1;28(4).
- Alaparthi GK, Raigangar V, Chakravarthy Bairapareddy K, Gatty A, Mohammad S, Alzarooni A, Atef M, Abdulrahman R, Redha S, Rashid A, Tamim M. A national survey in United Arab Emirates on practice of passive range of motion by physiotherapists in intensive care unit. PloS one. 2021 Aug 20; 16(8):e0256453.
- Dhawale AK, Wolff SB, Ko R, Ölveczky BP. The basal ganglia control the detailed kinematics of learned motor skills. Nature neuroscience. 2021 Sep;24(9):1256-69.
- Yokoi A, Diedrichsen J. Neural organization of hierarchical motor sequence representations in the human neocortex. Neuron. 2019 Sep 25;103(6):1178-90.
- Sessle BJ. Can you be too old for oral implants? An update on ageing and plasticity in the oro‐facial sensorimotor system. Journal of Oral Rehabilitation. 2019 Oct;46(10):936-51.
- Regan J, Walshe M, Tobin WO. Immediate Effects of Thermal–Tactile Stimulation on Timing of Swallow in Idiopathic Parkinson’s Disease. Dysphagia. 2010; 25(3):207-15.
- Rolls ET. The affective and cognitive processing of touch, oral texture, and temperature in the brain. Neuroscience & Biobehavioral Reviews. 2010; 34(2):237-45.
- Zhou Z, Yang Y, Liu J, Zeng J, Wang X, Liu H. Electrotactile Perception Properties and Its Applications: A Review. IEEE Transactions on Haptics. 2022 Apr 27.
- Haggard P, de Boer L. Oral somatosensory awareness. Neuroscience & Biobehavioral Reviews. 2014; 47: 469-84. https://doi.org/10.1016/j.neubiorev.2014.09.015
- Wirth R, Dziewas R, Beck AM, Clave P, Hamdy S, Heppner HJ, et al. Oropharyngeal dysphagia in older persons–from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging. 2016; 11:189.
- Sakamoto K, Nakata H, Yumoto M, Kakigi R. Somatosensory processing of the tongue in humans. Front Physiol. 2010; 1:136.