Evaluating Oral Stimulation as a Treatment for Dysphagia after Stroke
- 2.3k Downloads
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.
KeywordsAspiration Deglutition disorders Stroke Treatment Deglutition
The authors thank Ms. L. Renaut (radiography department) and Dr. A. Vail (statistician) for their invaluable assistance. Maxine Power was an MRC (UK) Clinical Training Fellow and Shaheen Hamdy is an MRC (UK) Clinician Scientist. Salil Singh is a Research Fellow funded by the Health Foundation.
- 1.Doty RW: Neural organisation of deglutition. Handb Physiol 4:1861–1902, 1968Google Scholar
- 2.Mann G: Review of reports on relative prevalence of swallowing disorders after acute stroke (Dysphagia 16:141–142, 2001). Dysphagia 17(1):81–82, 2002Google Scholar
- 6.Logemann JA: Evaluation and treatment of swallowing disorders. San Diego, CA: C.H. Press, 1983Google Scholar
- 10.Power M, Fraser C, Hobson A, Rothwell J, Mistry S, Nicholson DA, et al.: Changes in pharyngeal corticobulbar excitability and swallowing behaviour after oral stimulation. Am J Physiol 286(1):G45–G50, 2004Google Scholar
- 11.Medical Research Council: Aids to the examination of the peripheral nervous system. London: Pendragon House, 1976, pp 6–7Google Scholar
- 13.Logemann JA: Manual for the videofluorographic study of swallowing, 2nd ed. Austin, TX: Pro-Ed, 1993Google Scholar
- 19.Pommerenke WT: A study of the sensory areas eliciting the swallowing reflex. Am J Physiol 84(1):36–41, 1927Google Scholar