학술논문
Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: A double-blind placebo-controlled trial.
Document Type
Academic Journal
Author
Carnaby GD; Center for Upper Aerodigestive Functions, School of Communication Sciences & Disorders, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA.; LaGorio L; Department of Communication Disorders and Sciences, Rush University, Chicago, IL, USA.; Silliman S; Department of Neurology, University of Florida, Jacksonville, FL, USA.; Crary M; Center for Upper Aerodigestive Functions, School of Communication Sciences & Disorders, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA.
Source
Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 0433604 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2842 (Electronic) Linking ISSN: 0305182X NLM ISO Abbreviation: J Oral Rehabil Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Dysphagia following stroke is prevalent; however, dysphagia treatment is often applied haphazardly and outcomes unclear. Neuromuscular electrical stimulation (NMES) has received increased attention as a treatment for post-stroke dysphagia; but application data remain conflicted.
Objective: This study investigated effectiveness and safety of an exercise-based swallowing therapy (McNeill Dysphagia Therapy: MDTP) +NMES for dysphagia rehabilitation following stroke.
Methods: Stroke patients (n = 53, x̅ age: 66 [13.2], 47.2% male) with dysphagia admitted to sub-acute rehabilitation hospital were randomised to MDTP + NMES [NMES], MDTP + sham NMES [MDTP] or usual care [UC] swallowing therapy groups. Patients were treated for 1 hour per day for 3 weeks and monitored to 3 months by a blinded evaluator. Outcomes included clinical swallowing ability, oral intake, weight, patient perception of swallow and occurrence of dysphagia-related complications.
Results: Post-treatment dysphagia severity and treatment response were significantly different between groups (P ≤ .0001). MDTP demonstrated greater positive change than either NMES or UC arms, including increase in oral intake (χ2 = 5, P ≤ .022) and improved functional outcome by 3 months post-stroke (RR = 1.72, 1.04-2.84). Exploratory Cox regression revealed the MDTP group conferred the greatest benefit in time to "return to pre-stroke diet" of 4.317 [95% CI: 1.08- 17.2, P< .03].
Conclusion: Greater benefit (eg reduction in dysphagia severity, improved oral intake and earlier return to pre-stroke diet) resulted from a programme of MDTP alone vs NMES or UC.
(© 2019 John Wiley & Sons Ltd.)
Objective: This study investigated effectiveness and safety of an exercise-based swallowing therapy (McNeill Dysphagia Therapy: MDTP) +NMES for dysphagia rehabilitation following stroke.
Methods: Stroke patients (n = 53, x̅ age: 66 [13.2], 47.2% male) with dysphagia admitted to sub-acute rehabilitation hospital were randomised to MDTP + NMES [NMES], MDTP + sham NMES [MDTP] or usual care [UC] swallowing therapy groups. Patients were treated for 1 hour per day for 3 weeks and monitored to 3 months by a blinded evaluator. Outcomes included clinical swallowing ability, oral intake, weight, patient perception of swallow and occurrence of dysphagia-related complications.
Results: Post-treatment dysphagia severity and treatment response were significantly different between groups (P ≤ .0001). MDTP demonstrated greater positive change than either NMES or UC arms, including increase in oral intake (χ
Conclusion: Greater benefit (eg reduction in dysphagia severity, improved oral intake and earlier return to pre-stroke diet) resulted from a programme of MDTP alone vs NMES or UC.
(© 2019 John Wiley & Sons Ltd.)