Evaluating Oral Stimulation as a Treatment for Dysphagia after Stroke

Abstract

Deglutitive aspiration is common after stroke and can have devastating consequences. While the application of oral sensory stimulation as a treatment for dysphagia remains controversial, data from our laboratory have suggested that it may increase corticobulbar excitability, which in previous work was correlated with swallowing recovery after stroke. Our study assessed the effects of oral stimulation at the faucial pillar on measures of swallowing and aspiration in patients with dysphagic stroke. Swallowing was assessed before and 60 min after 0.2-Hz electrical or sham stimulation in 16 stroke patients (12 male, mean age = 73 +/- 12 years). Swallowing measures included laryngeal closure (initiation and duration) and pharyngeal transit time, taken from digitally acquired videofluoroscopy. Aspiration severity was assessed using a validated penetration-aspiration scale. Preintervention, the initiation of laryngeal closure, was delayed in both groups, occurring 0.66 +/- 0.17 s after the bolus arrived at the hypopharynx. The larynx was closed for 0.79 +/- 0.07 s and pharyngeal transit time was 0.94 +/- 0.06 s. Baseline swallowing measures and aspiration severity were similar between groups (stimulation: 24.9 +/- 3.01; sham: 24.9 +/- 3.3, p = 0.2). Compared with baseline, no change was observed in the speed of laryngeal elevation, pharyngeal transit time, or aspiration severity within subjects or between groups for either active or sham stimulation. Our study found no evidence for functional change in swallow physiology after faucial pillar stimulation in dysphagic stroke. Therefore, with the parameters used in this study, oral stimulation does not offer an effective treatment for poststroke patients.

Electrical stimulation of hyoid muscles in post-stroke dysphagia

“…In contrast Power et al found no benefit of ES. In this study ES applied to pharyngeal muscles in post-stroke patients with dysphagia for one hour daily for one month rehabilitation course had no significant functional or neurophysiological benefit in comparison with a control group that received conventional rehabilitation treatment of dysphagia 16 . In our study we used ES of the suprahyoid muscles.…”

Efeito do sabor azedo e da temperatura fria na fase oral da deglutição no acidente vascular encefálico

“…O tempo preparatório oral refere-se à duração em que o bolo é manipulado, mastigado, organizado e mantido na boca, antes de iniciar a propulsão do alimento para a hipofaringe. Os líquidos apresentam um curto tempo de preparo oral e tipicamente são mantidos na boca aproximadamente entre 1 e 2 segundos antes da deglutição ser iniciada (Palmer et al, 1992 (Logemann et al, 1995), ponto este, considerado por diversos autores na literatura, como o marco da divisão entre as cavidades oral e faríngea (Robins et al, 1992(Robins et al, , 1993Logemann et al, 1995;Power et al 2006;2009). As exatas marcações para o início e final desta fase variam de acordo com diferentes investigadores.…”

“…Enquanto estudos mais antigos referem ser quando o bolo alimentar atravessa a região da base da língua (região do pilar das fauces) (Logemann, 1983), estudos mais recentes consideram o ponto entre a base da língua e o ângulo inferior da mandíbula (Logemann et al, 1995;Power et al, 2006;2009).…”

“…O ponto onde o ramo da mandíbula atravessa a superfície faríngea da língua é comumente utilizado como a marca para esta medida (Robins et al, 1992;Logemann et al, 1995;Power et al, 2006;2009). Estudos prévios acreditavam que a deglutição faríngea era desencadeada quando o bolo alimentar passava o pilar das fauces (Logemann, 1983), e, se o bolo passasse por esta região, por mais de um segundo antes de iniciar a deglutição, esta deglutição era considerada atrasada (atraso ou latência para iniciar a deglutição).…”

“…Baseando-se na literatura, nosso estudo utilizou o ponto onde o ramo da mandíbula atravessa a superfície faríngea da língua como a marca de divisão entre a cavidade oral e faríngea (Robins et al, 1992;Logemann et al, 1995;Power et al, 2006;2009).…”