Dysphagia is common after stroke. Neuromuscular electrical stimulation (NMES) and fiberoptic endoscopic evaluation of swallowing (FEES) for the treatment of dysphagia have gained in popularity, but the combined application of these promising modalities has rarely been studied. We aimed to evaluate whether combined NMES, FEES, and traditional swallowing rehabilitation can improve swallowing functions in stroke patients with moderate to severe dysphagia. Thirty-two patients with moderate to severe dysphagia poststroke (≥3 weeks) were recruited. Patients received 12 sessions of NMES for 1 h/day, 5 days/week within a period of 2-3 weeks. FEES was done before and after NMES for evaluation and to guide dysphagic therapy. All patients subsequently received 12 sessions of traditional swallowing rehabilitation (50 min/day, 3 days/week) for 4 weeks. Primary outcome measure was the Functional Oral Intake Scale (FOIS). Secondary outcome measures included clinical degree of dysphagia, the patient's self-perception of swallowing ability, and the patient's global satisfaction with therapy. Patients were assessed at baseline, after NMES, at 6-month follow-up, and at 2-year follow-up. Twenty-nine patients completed the study. FOIS, degree of dysphagia, and patient's self-perception of swallowing improved significantly after NMES, at the 6-month follow-up, and at the 2-year follow-up (p < 0.001, each compared with baseline). Most patients reported considerable satisfaction with no serious adverse events. Twenty-three of the 29 (79.3 %) patients maintained oral diet with no pulmonary complications at 2-year follow-up. This preliminary case series demonstrated that combined NMES, FEES, and traditional swallowing rehabilitation showed promise for improving swallowing functions in stroke patients with moderate-to-severe dysphagia. The benefits were maintained for up to 2 years. The results are promising enough to justify further studies.
BACKGROUND Naming problem is often seen in patients with aphasia (PWA). For whom, the practice is an important issue during therapy. It is well known that intensive as well as errorless practice can benefit the patients with naming problem. However, it is not usually possible to meet the prescribed face-to-face treatments in clinics due to the shortage of speech therapist. OBJECTIVE The purpose of this study is firstly to develop a client-server model based self-practice strategy for the treatment of naming problem, and then to assess the learning effectiveness during treatment. METHODS A total of 13 aphasic patients with naming problem (aged 32–73 years) were recruited in this study with written informed consent. This study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital. All the participants were diagnosed as having the Broca’s aphasia without impaired auditory comprehension or progressive brain disease. A client server model was implemented in a mobile device based system to provide the picture/video-naming practice using a semantic cueing hierarchy for Mandarin Chinese. Learning performance were evaluated at the baseline test, one-week post-intervention (immediate results), and 12 weeks later (follow-up). The participants were asked to perform this self-practice system for three months, and to receive the routine face-to-face therapy once a week as well. RESULTS The naming abilities presented as novel naming score of these aphasia participants assessed in baseline test, immediate test, and follow up test were 37.96±22.58, 62.55±22.66, and 53.69±23.34, respectively. The results of Wilcoxon signed ranks test found that the scores in immediate test and baseline test, as well as the follow up test (p=0.001) and the baseline test (p=0.008) were significantly different. The participants' satisfaction with the system was almost over 90%. CONCLUSIONS The proposed system is demonstrated to effectively enhance the naming ability and long-term retention for PWA with additional self-practice. A client server model based naming therapy is easy to access and adaptable for personalized treatment protocol. Besides, the cost and time spent for outpatients during face-to-face therapy may be reduced. Self-assessment and naming library update can also be remotely provided. It is suggested that a mobile device-based self-practice combined with regular hospital-based therapy once a week will significantly improve the naming ability of PWA.
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