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Biofeedback as an Adjunctive Treatment for Post-stroke Dysphagia: A Pilot-Randomized Controlled Trial

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Abstract

Background and Purpose

Post-stroke dysphagia affects almost half of the survivors and severely influences quality of life, thus becoming swallowing rehabilitation of paramount importance. However, there is little adequate evidence on which the best rehabilitative strategy can be. Surface electromyography (sEMG) allows for recording swallowing muscles’ activity and provides real time visual feedback, as a biofeedback adjunctive technique to improve treatment outcome. This study aimed to analyze the effectiveness of biofeedback rehabilitation of swallowing through sEMG compared to standard techniques, in post-stroke dysphagia.

Methods

A pilot-randomized controlled trial included 17 patients diagnosed with post-stroke dysphagia. Nine underwent sEMG-biofeedback rehabilitation; seven controls were submitted to control treatment, one dropout. The primary outcome was the functional oral intake scale (FOIS), secondary outcomes was pharyngeal clearance and safe swallowing, assessed through fiberoptic endoscopic evaluation of swallowing (FEES).

Results

FOIS improved in all patients, regardless of treatment. sEMG-biofeedback rehabilitation led to improvements of the pharyngeal clearance and swallowing safety. The rehabilitative effects appeared stable at 2-months follow-up.

Conclusions

The application of biofeedback based on sEMG in post-stroke dysphagia patients resulted in an effective rehabilitative technique, in particular for pharyngeal clearance improvements and safe swallowing, thus reducing the risk of aspiration and malnutrition.

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Funding

No funding was received for conducting this study.

Author information

Author notes

  1. Daniela D’Imperio and Irene Battel contributed equally to the work and should be considered as joint last authors

Authors and Affiliations

  1. IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy

    Sara Nordio, Giorgio Arcara, Giulia Berta, Angela Dellai, Camilla Brisotto, Isabella Koch, Andrea Turolla & Daniela D’Imperio

  2. Otorhinolaryngology Unit, Department of Neurosciences, University of Padua, Via Giustiniani 5, 35128, Padua, Italy

    Diego Cazzador

  3. Section of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy

    Diego Cazzador

  4. Department of Statistical Sciences, University of Padua, Via Cesare Battisti 241, 35121, Padua, Italy

    Marta Aspidistria & Laura Ventura

  5. Unità Operativa Medicina Fisica e Riabilitativa, Ulss 3 Serenissima, Ospedale Civile di Venezia, Castello, 6667, Venice, Italy

    Irene Battel

  6. Department of Clinical Speech & Language Studies, Trinity College, University of Dublin, College Green, Dublin 2, Ireland

    Irene Battel

Authors
  1. Sara Nordio
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  2. Giorgio Arcara
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  3. Giulia Berta
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  4. Angela Dellai
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  5. Camilla Brisotto
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  7. Diego Cazzador
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  8. Marta Aspidistria
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  9. Laura Ventura
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  10. Andrea Turolla
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  11. Daniela D’Imperio
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  12. Irene Battel
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Corresponding author

Correspondence to Sara Nordio.

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Conflicts of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical Approval

The study was approved by the Ethics Committee of the hospital (Prot.2017.12–Bio_Dys) and carried out in accordance with the Declaration of Helsinki. All participants signed an informed consent for their inclusion.

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Nordio, S., Arcara, G., Berta, G. et al. Biofeedback as an Adjunctive Treatment for Post-stroke Dysphagia: A Pilot-Randomized Controlled Trial. Dysphagia 37, 1207–1216 (2022). https://doi.org/10.1007/s00455-021-10385-2

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  • DOI: https://doi.org/10.1007/s00455-021-10385-2

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