The Use of Biofeedback in the Treatment of Chronic Dysphagia in Stroke Patients

Abstract

Objective: To evaluate the efficacy of the use of surface electromyographic feedback in the treatment of stroke patients with chronic dysphagia. Patients and Methods: Data of 11 consecutive patients with chronic dysphagia after stroke were analyzed. Our patients were treated for dysphagia with surface electromyography as biofeedback as adjunct to normal exercises. All patients suffered from dysphagia after stroke. The average time after onset was 31.1 months. All patients had been previously treated by speech therapists without success. Functional swallowing was estimated using the Functional Oral Intake Scale (FOIS). At the start of the treatment 8 patients were tube dependent (FOIS ≤4). Three patients were on an oral diet, but with restrictions (FOIS ≥5). Results: The patients were treated on average seven 7 times. The time between the first and last treatment session was on average 76.1 days (SD ± 44.0; range = 29–168). Before treatment the average FOIS was 2.6 (SD ±2.3) and after treatment 5.6 (SD ±1.6). The median scores improved from 1 to 6, showing a significant and clinically relevant improvement (z = –2.820: p < 0.01) in swallowing function. In 6 of initially 8 patients with percutaneous enteral gastrostomy tubes, the feeding tube could be removed after treatment. Conclusion: Our data suggest that the use of surface electromyography as biofeedback in the treatment of chronic dysphagia after stroke could be an effective adjunct to standard therapy for swallowing disorders in 11 patients.

Management of Dysphagia Following Traumatic Brain Injury

“…Limited evidence suggests that sEMG can be an effective adjunct to these exercises [81,103]. However, the neuromuscular processes behind why improvement in is observed in these sEMG studies is not well understood [81] and further research is necessary [103,105].…”

“…Surface Electromyography Biofeedback (sEMG) sEMG is an adjunctive therapy tool that can increase motor learning via biofeedback during dysphagia treatment tasks [103,104]. Electrodes are placed in the submental region [104] to record muscle activity during rehabilitative swallowing tasks such as the Mendelsohn maneuver, Masako maneuver, effortful swallow or Shaker Head Lift [81].…”

“…Electrodes are placed in the submental region [104] to record muscle activity during rehabilitative swallowing tasks such as the Mendelsohn maneuver, Masako maneuver, effortful swallow or Shaker Head Lift [81]. While performing these tasks, the patient watches real-time sEMG feedback of their muscle activity [103]. Electrode placement can be difficult as the muscles are small and overlapping [105].…”

“…However, the neuromuscular processes behind why improvement in is observed in these sEMG studies is not well understood [81] and further research is necessary [103,105].…”

Surface electromyography: diagnostic input for atypical swallowing as an aid for choosing therapy

“…The experience of the practitioner and clinical know-how must inform the electromyographic protocol in order to make a more exact diagnosis of deglutition function so as to ensure a successful re-training. 2,3,27 .…”