Fire-needle therapy for deglutition disorders in post-stroke pseudobulbar palsy:a randomized controlled trial

Objective:To observe the clinical efficacy of fire-needle therapy in treating deglutition disorders due to pseudobulbar palsy in the remission stage of stroke.Methods:Sixty-two eligible subjects were divided into a fire-needle group and a rehabilitation group by a simple randomization method at a ratio of 1:1.The two groups received same basic intervention;in addition,the fire-needle group received fire-needle treatment,while the rehabilitation group received rehabilitation training.The two groups of subjects all received a 3-week treatment and were evaluated by the dysphagia severity rating scale (DSRS),modified Mann assessment of swallow ability (MMASA) and Kubota Toshio swallow test (KTST) before and after the intervention.The complications and adverse events occurred during the trial were recorded.The data were statistically analyzed.Results:At the third week,the DSRS,MMASA and KTST scores changed significantly compared with the baseline in both groups (P<0.05),and the changes in the fire-needle group were more significant than those in the rehabilitation group (P<0.05).The between-group comparison at the third week showed that the therapeutic efficacy in the fire-needle group was superior to that in the rehabilitation group (P<0.05).Conclusion:Fire-needle therapy can obviously change the DSRS,MMASA and KTST scores in pseudobulbar palsy in the remission stage of stroke,and significantly enhance the therapeutic efficacy of the treatment of deglutition disorders in this stage.

Efficacy evaluation of acupuncture plus rehabilitation training for post-stroke deglutition disorders of qi-deficiency blood stasis pattern

Objective:To observe the clinical efficacy of acupuncture plus rehabilitation training in treating post-stroke deglutition disorders of qi-deficiency blood stasis pattern.Methods:Sixty-six patients with post-stroke deglutition disorders of qi-deficiency blood stasis patter were divided into an observation group and a rehabilitation group using the random number table method.The two groups both received conventional medications and supportive treatment for stroke.In addition,the observation group received acupuncture plus rehabilitation training while the rehabilitation group only received the same rehabilitation training.The interventions were conducted 3 times a week for a total of 4 weeks in both groups.They were evaluated using Kubota water swallowing test(KWST),Fujishima Ichiro food intake level scale(FILS)and symptoms score of traditional Chinese medicine(TCM)before and after treatment,and at the 1-month follow-up.The therapeutic efficacy was assessed at the 1-month follow-up.Results:The KWST grading and FILS result after treatment and at the follow-up were significantly different from those before treatment in both groups(all P<0.001);the results of these two items at the follow-up were not significantly different from those after treatment in the two groups(all P>0.05).There were significant differences in the KWST grading and FILS result between the two groups after treatment and at the follow-up(all P<0.05).The TCM symptoms score changed significantly after treatment and at the follow-up compared with that before treatment in both groups(all P<0.001).The TCM symptoms grading efficacy at the follow-up was significantly different from that after treatment in the observation group(P<0.05),while the difference was statistically insignificant in the rehabilitation group(P>0.05).The TCM symptoms grading efficacy in the observation group was significantly different from that in the rehabilitation group after treatment and at the follow-up(both P<0.05).Conclusion:Based on the conventional treatment for stroke,acupuncture plus rehabilitation training or use of rehabilitation training alone both can improve the clinical symptoms in post-stroke deglutition disorders of qi-deficiency blood stasis pattern,but acupuncture plus rehabilitation training can produce more significant efficacy and better long-term efficacy in improving TCM symptoms.

Effectiveness of antidepressant repetitive transcranial magnetic stimulation in a patient with refractory psychogenic dysphagia:A case report and review of literature

BACKGROUND Dysphagia is a common condition in older as well as young patients,and a variety of treatments have been reported depending on the cause.However,clinicians are challenged when the cause is unclear.This is the case with psychogenic dysphagia,which has typically been treated with supportive psychotherapy,medi-cation,swallowing exercise,and dysphagia rehabilitation therapy.Here,we aimed to relieve the symptoms of a patient with refractory psychogenic dysphagia,who was unresponsive to conventional swallowing therapy,with repetitive transcranial magnetic stimulation(rTMS).CASE SUMMARY A relatively calm-looking 35-year-old female patient presented with a 2-year history of dysphagia.She showed little improvement with conventional swallowing treatments over the past 2 years.She was relatively compliant with inhospital dysphagia therapy,but uncooperative with home exercise and medication.In particular,since she was resistant to drug treatment,we had to take a different approach than the treatment she had been receiving for the past 2 years.After much deliberation,we decided to initiate antidepressant rTMS treatment with her consent(IRB No.2023-05-021).Antidepressant rTMS treatment was performed twice weekly for a total of 20 sessions over 10 wk.The results showed improvement in subjective symptoms and video fluoroscopic swallowing study findings.To the best of our knowledge,this is the first report of symptomatic improvement using antidepressant rTMS protocol for refractory psychogenic dysphagia.CONCLUSION This case demonstrates that rTMS with antidepressant protocol can be used to improve swallowing in patients with refractory psychogenic dysphagia.

Association of swallowing problems with frailty in Chinese hospitalized older patients

Objective:To estimate the prevalence of dysphagia and frailty among hospitalized older patients and to analyze the relationship between dysphagia and frailty in these people.Methods:Data were collected on 386 participants aged 65 and older in a general hospital from April to December 2017.Patients were asked to complete a self-designed demographic questionnaire.Frailty and swallowing function assessments were performed using the Fried frailty phenotype and the 30-ml water swallowing test,respectively.Multiple stepwise logistic regression analyses were used to identify the association between frailty and dysphagia.Results:Dysphagia developed in 31.1%of older people,and 24.4%developed frailty.Frailty was statistically significantly related with dysphagia.Dysphagia was more prevalent in frail and pre-frail patients(48.9%and 32.4%,respectively)than those who were non-frail(13.6%).In multivariate analyses,frail(OR,5.420;95%CI,2.684±10.944;P<0.001)and history of choking/coughing while drinking(OR,2.954;95%CI,1.844±4.733;P<0.001)were associated with dysphagia.result.Conclusions:Frailty is associated with dysphagia.More attention should be paid to frailty and dysphagia of the elderly and further studies are needed to evaluate the correlated mechanism and develop targeted nursing interventions.

Postmyotomy dysphagia after laparoscopic surgery for achalasia

AIM: To determine predictive factors for postoperative dysphagia after laparoscopic myotomy for achalasia.METHODS: Logistic regression was used to investigate the possible association between the response (postoperative dysphagia, with two levels: none/mild and moderate/severe)and several plausible predictive factors.RESULTS: Eight patients experienced severe or moderate postoperative dysphagia. The logistic regression revealed that only the severity of preoperative dysphagia (with four levels; mild, moderate, severe, and liquid) was a marginally significant (P=0.0575) predictive factor for postoperative dysphagia.CONCLUSION: The severity of postoperative dysphagia is strongly associated with preoperative dysphagia. Preoperative symptomatology can significantly impact patient outcome.

Can patients determine the level of their dysphagia?

To determine if patients can localise dysphagia level determined endoscopically or radiologically and association of gender, age, level and pathology.METHODSRetrospective review of consecutive patients presenting to dysphagia hotline between March 2004 and March 2015 was carried out. Demographics, clinical history and investigation findings were recorded including patient perception of obstruction level (pharyngeal, mid sternal or low sternal) was documented and the actual level of obstruction found on endoscopic or radiological examination (if any) was noted. All patients with evidence of obstruction including oesophageal carcinoma, peptic stricture, Schatzki ring, oesophageal pouch and cricopharyngeal hypertrophy were included in the study who had given a perceived level of dysphagia. The upper GI endoscopy reports (barium study where upper GI endoscopy was not performed) were reviewed to confirm the distance of obstructing lesion from central incisors. A previously described anatomical classification of oesophagus was used to define the level of obstruction to be upper, middle or lower oesophagus and this was compared with patient perceived level.RESULTSThree thousand six hundred and sixty-eight patients were included, 42.0% of who were female, mean age 70.7 ± 12.8 years old. Of those with obstructing lesions, 726 gave a perceived level of dysphagia: 37.2% had oesophageal cancer, 36.0% peptic stricture, 13.1% pharyngeal pouches, 10.3% Schatzki rings and 3.3% achalasia. Twenty-seven point five percent of patients reported pharyngeal level (upper) dysphagia, 36.9% mid sternal dysphagia and 25.9% lower sternal dysphagia (9.5% reported multiple levels). The level of obstructing lesion seen on diagnostic testing was upper (17.2%), mid (19.4%) or lower (62.9%) or combined (0.3%). When patients localised their level of dysphagia to a single level, the kappa statistic was 0.245 (P < 0.001), indicating fair agreement. 48% of patients reporting a single level of dysphagia were accurate in localising the obstructing pathology. With respect to pathology, patients with pharyngeal pouches were most accurate localising their level of dysphagia (P < 0.001). With respect to level of dysphagia, those with pharyngeal level lesions were best able to identify the level of dysphagia accurately (P < 0.001). No association (P > 0.05) was found between gender, patient age or clinical symptoms with their ability to detect the level of dysphagia.CONCLUSIONPatient perceived level of dysphagia is unreliable in determining actual level of obstructing pathology and should not be used to tailor investigations.

Implementation strategies to improve evidence-based practice for post-stroke dysphagia identification and management:A before-andafter study

Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to determine the effect of using tailored,multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community hospital.Methods Guided by the Knowledge to Action framework,the tailored,multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study design.These strategies consisted of training intervention,policy intervention,and audit and feedback intervention.Nurses’level of knowledge and adherence,were collected in March 2019 and again in January 2020.Patients’quality of life and satisfaction were evaluated during the pre-intervention period(between February 2019 and April 2019)and the post-intervention period(between November 2019 and January 2020).Results A total of 55 patients with post-stroke dysphagia(28 in the pre-intervention period and 27 in the post-intervention period)and 17 registered nurses were recruited.Following implementation,there were statistically significant improvements in patients’outcomes(quality of life and satisfaction)and nurses’outcomes(level of knowledge and adherence).Conclusions This study assists in closing the research-practice gap by using tailored,multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.

Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial

BACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter(LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy(POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy,has emerged as a promising minimally invasive technique for the management of this condition.AIM To compare POEM and laparoscopic myotomy and partial fundoplication(LM-PF) regarding their efficacy and outcomes for the treatment of achalasia.METHODS Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria(dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis(as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min(on a barium esophagogram), pressure at the LES, the occurrence of adverse events(AEs), length of stay(LOS), and quality of life(QoL).RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up(P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group(P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group(185.00 ± 56.89 and 95.70 ± 30.47 min vs 296.75 ± 56.13 and 218.75 ± 50.88 min,respectively;P = 0.001 for both). In the POEM group, there were improvements in all domains of the QoL questionnaire, whereas there were improvements in only three domains in the LM-PF group.CONCLUSION POEM and LM-PF appear to be equally effective in controlling the symptoms of achalasia,shortening LOS, and minimizing AEs. Nevertheless, POEM has the advantage of improving all domains of QoL, and shortening anesthesia and procedure times but with a significantly higher rate of gastroesophageal reflux.

Dysphagia lusorium in elderly:A case report

AIM: Late unset of dysphagia due to vascular abnormalities is a rare condition. We aimed to present a case of right subclavian artery abnormalities caused dysphagia in the elderly.METHODS: A 68-year-old female was admitted with dysphagia seven months ago. Upper endoscopic procedures and routine examinations could not demonstrate any etiology. Multislice computed thorax tomography was performed for probable extra- esophagial lesions.RESULTS: Multislice computed thorax tomography showed right subclavian artery abnormality and esophagial compression with this aberrant artery.CONCLUSION: Causes of dysphagia in the elderly are commonly malignancies, strictures and/or motility disorders. If routine examinations and endoscopic procedures fail to show any etiology, rare vascular abnormalities can be considered in such patients. Multislice computed tomography is a usefull choice in such conditions.

Clinical Application of the Jiuwei Point

Jiuwei (CV 15) is a point mainly used to treat epigastric pain, regurgitation, dysphagia, epilepsy, palpitation, vexation, cough and dyspnea.

Dysphagia,reflux and related sequelae due to altered physiology in scleroderma

Systemic sclerosis is a connective tissue disease that presents with significant gastrointestinal involvement,commonly in the esophagus.Dysphagia is a common clinical manifestation of systemic sclerosis and is strongly related to esophageal dysmotility.However,there are multiple other contributing factors in each step in the physiology of swallowing that may contribute to development of severe dysphagia.The oral phase of swallowing may be disrupted by poor mastication due to microstomia and poor dentition,as well as by xerostomia.In the pharyngeal phase of swallowing,pharyngeal muscle weakness due to concurrent myositis or cricopharyngeal muscle tightening due to acid reflux can cause disturbance.The esophageal phase of swallowing is most commonly disturbed by decreased peristalsis and esophageal dysmotility.However,it can also be affected by obstruction from chronic reflux changes,pill-induced esophagitis,or Candida esophagitis.Other contributing factors to dysphagia include difficulties in food preparation and gastroparesis.Understanding the anatomy and physiology of swallowing and evaluating systemic sclerosis patients presenting with dysphagia for disturbances in each step can allow for development of better treatment plans to improve dysphagia and overall quality of life.

Predictive value of symptoms and demographics in diagnosing malignancy or peptic stricture

AIM:To determine which features of history and demographics predict a diagnosis of malignancy or peptic stricture in patients presenting with dysphagia.METHODS:A prospective case-control study of 2000 consecutive referrals(1031 female,age range:17-103 years) to a rapid access service for dysphagia,based in a teaching hospital within the United Kingdom,over 7 years.The service consists of a nurse-led telephone triage followed by investigation(barium swallow or gastroscopy),if appropriate,within 2 wk.Logistic regression analysis of demographic and clinical variables was performed.This includes age,sex,duration of dysphagia,whether to liquids or solids,and whether there are associated features(reflux,odynophagia,weight loss,regurgitation).We determined odds ratio(OR) for these variables for the diagnoses of malignancy and peptic stricture.We determined the value of the Edinburgh Dysphagia Score(EDS) in predicting cancer in our cohort.Multivariate logistic regression was performed and P < 0.05 considered significant.The local ethics committee confirmed ethics approval was not required(audit).RESULTS:The commonest diagnosis is gastro-esophageal reflux disease(41.3%).Malignancy(11.0%) and peptic stricture(10.0%) were also relatively common.Malignancies were diagnosed by histology(97%) or on radiological criteria,either sequential barium swallows showing progression of disease or unequivocal evidence of malignancy on computed tomography.The majority of malignancies were esophago-gastric in origin but ear,nose and throat tumors,pancreatic cancer and extrinsic compression from lung or mediastinal metastatic cancer were also found.Malignancy was statistically more frequent in older patients(aged >73 years,OR 1.1-3.3,age < 60 years 6.5%,60-73 years 11.2%,> 73 years 11.8%,P < 0.05),males(OR 2.2-4.8,males 14.5%,females 5.6%,P < 0.0005),short duration of dysphagia(≤ 8 wk,OR 4.5-20.7,16.6%,8-26 wk 14.5%,> 26 wk 2.5%,P < 0.0005),progressive symptoms(OR 1.3-2.6:progressive 14.8%,intermittent 9.3%,P < 0.001),with weight loss of ≥ 2 kg(OR 2.5-5.1,weight loss 22.1%,without weight loss 6.4%,P < 0.0005) and without reflux(OR 1.2-2.5,reflux 7.2%,no reflux 15.5%,P < 0.0005).The likelihood of malignancy was greater in those who described true dysphagia(food or drink sticking within 5 s of swallowing than those who did not(15.1%vs 5.2% respectively,P < 0.001).The sensitivity,specificity,positive predictive value and negative predictive value of the EDS were 98.4%,9.3%,11.8% and 98.0% respectively.Three patients with an EDS of 3(high risk EDS ≥ 3.5) had malignancy.Unlike the original validation cohort,there was no difference in likelihood of malignancy based on level of dysphagia(pharyngeal level dysphagia 11.9% vs mid sternal or lower sternal dysphagia 12.4%).Peptic stricture was statistically more frequent in those with longer duration of symptoms(> 6 mo,OR 1.2-2.9,≤ 8 wk 9.8%,8-26 wk 10.6%,> 26 wk 15.7%,P < 0.05) and over 60 s(OR 1.2-3.0,age < 60 years 6.2%,60-73 years 10.2%,> 73 years 10.6%,P < 0.05).CONCLUSION:Malignancy and peptic stricture are frequent findings in those referred with dysphagia.The predictive value for associated features could help determine need for fast track investigation whilst reducing service pressures.

Therapeutic observation of Gao's nape acupuncture plus swallowing training for pharyngeal deglutition disorder after stroke

Objective: To observe the clinical efficacy of Gao's nape acupuncture plus swallowing training in treating pharyngeal deglutition disorder after stroke. Methods: One hundred patients with post-stroke pharyngeal deglutition disorder were randomized into a treatment group and a control group, with 50 cases in each group. The two groups both received routine neurological intervention. In addition, the treatment group was given Gao's nape acupuncture plus swallowing training, while the control group was intervened by swallowing training alone. After eight-week treatment, the two groups were observed in terms of the changes in repetitive saliva swallowing test (RSST), modified water swallowing test (MWST), standardized swallowing assessment (SSA) and swallowing-related quality of life (SWAL-QOL). The clinical efficacies of the two groups were also compared. Results: After treatment, the RSST grading, and scores of MWST, SSA and SWAL-QOL changed significantly in both groups (P<0.05 or P<0.01). The RSST grading, and scores of MWSX SSA and SWAL-QOL in the treatment group were significantly different from those in the control group after treatment (P<0.05 or P<0.01). The total effective rate and markedly effective rate were respectively 100.0% and 72.3% in the treatment group, versus 97.9% and 34.0% in the control group. There was a significant differenee in the markedly effective rate between the two groups (P<0.01). The differenee in the clinical efficacy between the two groups was statistically significant (P<0.01). Con elusion: Gao's n ape acupu ncture plus swallowi ng training is an effective approach for post-stroke phary ngeal deglutiti on disorder. Its therapeutic efficacy is more significant than that of swallowing training alone.

Observation on mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in the convalescent stage

Objective： To observe the clinical effect of mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus for deglutition disorder of stroke patients in convalescence stage. Methods： A total of 136 patients conforming to the inclusion criteria were randomized into three groups by the random number table, including group A of 46 cases, group B of 44 cases and group C of 46 cases. Patients in group A received swallowing disorder therapeutic apparatus treatment, patients in group B received mind-refreshing and orifice-opening needling method treatment, and patients in group C received mind-refreshing and orifice-opening needling method plus swallowing disorder therapeutic apparatus treatment. The treatment was given once a day for 10 d as a course, the whole treatment lasted for 4 courses. Therapeutic evaluation items including water-swallowing test （WST）, standardized swallowing assessment （SSA） and modified Barthel index （MBI） were measured before treatment, after treatment and at follow-up visit （2 months after treatment）. Results： After treatment, scores of WST and MBI in all three groups increased significantly （all P〈0.05）, while the SSA score dropped significantly （all P〈0.05）. After treatment and during follow-up visit period, score of WST in group C was significantly higher than that in group A and group B （both P〈0.05）, while the difference between group A and group B showed no statistical significance （P〉0.05）; the SSA score in group C was substantially lower than that in group A and group B （all P〈0.05）, the difference between group A and group B showed no statistical significance （P〉0.05）; the MBI scores in group B and group C were substantially higher than that in group A （all P〈0.05）, the difference between group B and group C showed no statistical significance （P〉0.05）. After treatment and during follow-up visit period, the differences in overall therapeutic effect between group A and group B showed no statistical significance （P〉0.05）, while the overall therapeutic effect in group C was substantially better than that in group A and group B （all P〈0.05）. Conclusion： Both mind-refreshing and orifice-opening needling method and swallowing disorder therapeutic apparatus can alleviate symptoms of deglutition disorder of stroke patients respectively, and the combination of two methods can improve the therapeutic effect.

Clinical observation on acupoint massage plus Vitalstim electrical stimulation for deglutition disorder after stroke

Objective:To observe the effect of acupoint massage plus Vitalstim electrical stimulation on deglutition function and surface electromyography(SEMG)of deglutition muscle groups.Methods:A total of 60 patients with deglutition disorder after stroke were selected and divided into an electrical stimulation group,a massage group and an integrated group according to the random number table method,with 20 cases in each group.Patients in these three groups were given the same routine rehabilitation training for deglutition.In addition,patients in the electrical stimulation group were given extra Vitalstim electrical stimulation,patients in the massage group were given extra acupoint massage on the head,face and neck,and patients in the integrated group were given extra acupoint massage plus Vitalstim electrical stimulation.Fujishima Ichiro food intake level scale(FILS)was scored before and after treatment.The swallowing duration and maximal amplitude of masseter muscle in SEMG were evaluated before and after treatment.Results:After treatment,the FILS score and the maximal amplitude of recruitment potential generated by muscular contraction of masseter muscle group in the three groups were higher than those before treatment(all P<0.05),and the swallowing duration of masseter muscle group was shortened compared with that in the same group before treatment(all P<0.05).After treatment,the FILS score in the integrated group was higher than that in the electrical stimulation group and the massage group(both P<0.05).The swallowing duration of masseter muscle group measured by SEMG was lower than that in the electrical stimulation group and the massage group(both P<0.05),while the maximal amplitude was higher than that of the electrical stimulation group and the massage group(P<0.05).After treatment,there were no significant differences in the FILS score,swallowing duration and maximal amplitude of masseter muscle group between the electrical stimulation group and the massage group(all P>0.05).Conclusion:Both acupoint massage and electrical stimulation can improve the deglutition function in patients with deglutition disorder after stroke,and improve the coordination and flexibility of masseter muscle.The integration of the two is more effective.

Therapeutic Observation on Acupoint Injection for Post-stroke Deglutition Disorder

Objective： To observe the clinical effect of acupoint injection in treating post-stroke deglutition disorder. Methods： Eighty patients with post-stroke deglutition disorder were randomized into a treatment group and a control group, 40 in each. The treatment group received acupoint injection in addition to routine Western medication, and the control group received the routine Western medication only. The treatment results in the two groups were compared and analyzed. Result： After treatment, the patients in the two groups had improvements in the scores of symptoms and signs. In comparison of water drinking test, the result in the treatment group was superior to that in the control group （P〈0.01）. Conclusion： Acupoint injection can achieve a satisfactory result in treating post-stroke deglutition disorder.

Effects of nape acupuncture combined with swallowing rehabilitation on dysphagia in pseudobulbar palsy

OBJECTIVE: To evaluate the therapeutic effects of nape acupuncture combined with rehabilitative swallowing training for dysphagia caused by pseudobulbar palsy, and to compare it with rehabilitative swallowing training alone, and to observe the improvement in quality of life after the therapy.METHODS: One hundred patients were randomly divided into two groups: the rehabilitative swallowing training group(control group, n = 50) and the nape acupuncture combined with rehabilitative swallowing training group(experimental group,n = 50). Each group had 8 weeks' therapy, 5 times a week. Patients in the control group received rehabilitative swallowing training, while those in the experimental group received nape acupuncture therapy based on swallowing rehabilitation. The out-comes were assessed by the repetitive saliva-swallowing test(RSST), water swallow test(WST), standardized swallowing assessment(SSA), and a swallow quality-of-life questionnaire(SWAL-QOL). Correlations of onset age, onset frequency and lesion location with the efficacy of the acupuncture treatment were also observed.RESULTS: The scores for RSST, WST, and SSA in both groups were lower than before the therapy(P <0.001), although the changes were more marked in the experimental group than in the control group(RSST and WST, P < 0.005; SSA, P < 0.001). Both groups recorded changes in SWAL-QOL index after the therapy(P < 0.001); and the experimental group scored higher than the control group(P < 0.001). The efficacy of acupuncture was not correlated with location(P > 0.05), but was related to onset age(P < 0.05) and onset frequency(P < 0.01).CONCLUSION: Nape acupuncture combined with rehabilitative swallowing training has an effect on dysphagia caused by pseudobulbar palsy and improves quality of life.

Treatment of Swallowing Dysfunction after Cerebral Apoplexy by Acupuncture:A Report of 56 Cases

Fifty-six patients with swallowing dysfunction after cerebral apoplexy were treated by acupuncture and swallowing function training. The curative effect is satisfactory and the total effective rate was 96.4%.

Clinical Observations on Acupuncture Treatment of Post-Stroke Dysphagia

To seek a treatment that can improve the effect on dysphagia following post-stroke pseudobulbar palsy. Methods： Sixty patients were randomly allocated into observation and control groups, 30 cases each. The observation group was treated with Western drugs plus acupuncture at Tiantu （CV 22） and other three acupoints around Lianquan （CV 23） and the control group with simple Western drugs. Results： The effective rate was 86.7% in the observation group and 30.0% in the control group. Conclusion： Acupuncture can improve the curative effect of Western drugs on dysphagia following post-stroke pseudobulbar palsy.

Influence of acupoint-injection on TXB_2 and 6-keto-PGF_(1a) in patients with pseudobulbar palsy: a randomized controlled trial

Objective： To prove the feasibility and validity of Xing Nao Jing acupoint-injection （XNJ-AI） at Fengchi （GB 20） for pseudobulbar palsy caused by ischemic stroke （PBP-IS）. Methods： An assessor-blinded, two-parallel-group, randomized controlled trial was conducted, and the patients with PBP-IS were recruited and randomly divided into two groups. Patients in the control group received oral aspirin （100 mg per day for 2 weeks）. In addition to oral aspirin; patients in the treatment group received XNJ-AI at Fengchi （GB 20）, once a day, for two weeks. The primary outcome was assessed by the water-swallowing test （WST）. Thromboxane B2 （TXB2） and 6-keto-prostaglandin F1α （6-keto-PGF1α） in plasma were measured before and after the treatment. Results： In the treatment group, the percentage of swallowing function no less than grade 3 before and after the treatment was 32% and 88%, respectively; in the control group, it was 28% and 76% before and after the treatment, respectively; the difference after the treatment between the two groups was statistically significant （P〈0.05）. There were statistical differences between pre- and post-treatment levels of plasma TXB2 and 6-keto-PGF1α in the two groups （both P〈0.05）. After the treatment, there were significant differences in the levels of plasma TXB2 and 6-keto-PGF1α between the two groups （both P〈0.05）. Conclusion： XNJ-AI at Fengchi （GB 20） can improve the patients＇ swallowing function and balance the levels of TXB2 and 6-keto-PGF1α in plasma.