Application value research of swallowing treatment device combined with swallowing rehabilitation training in the treatment of swallowing disorders after stroke

BACKGROUND Stroke is a common disabling disease,whether it is ischemic stroke or hemorrhagic stroke,both can result in neuronal damage,leading to various manifestations of neurological dysfunction.AIM To explore of the application value of swallowing treatment device combined with swallowing rehabilitation training in the treatment of swallowing disorders after stroke.METHODS This study selected 86 patients with swallowing disorders after stroke admitted to our rehabilitation department from February 2022 to December 2023 as research subjects.They were divided into a control group(n=43)and an observation group(n=43)according to the treatment.The control group received swallowing rehabilitation training,while the observation group received swallowing treatment device in addition to the training.Both groups underwent continuous intervention for two courses of treatment.RESULTS The total effective rate in the observation group(93.02%)was higher than that in the control group(76.74%)(P=0.035).After intervention,the oral transit time,swallowing response time,pharyngeal transit time,and laryngeal closure time decreased in both groups compared to before intervention.In the observation group,the oral transit time,swallowing response time,and pharyngeal transit time were shorter than those in the control group after intervention.However,the laryngeal closure time after intervention in the observation group was compared with that in the control group(P=0.142).After intervention,average amplitude value and duration of the genioglossus muscle group during empty swallowing and swallowing 5 mL of water are reduced compared to before intervention in both groups.After intervention,the scores of the chin-tuck swallowing exercise and the Standardized Swallowing Assessment are both reduced compared to pre-intervention levels in both groups.However,the observation group scores lower than the control group after intervention.Additionally,the Functional Oral Intake Scale scores of both groups are increased after intervention compared to pre-intervention levels,with the observation group scoring higher than the control group after intervention(P<0.001).The cumulative incidence of complications in the observation group is 9.30%,which is lower than the 27.91%in the control group(P=0.027).CONCLUSION The combination of swallowing therapy equipment with swallowing rehabilitation training can improve the muscle movement level of the genioglossus muscle group,enhance swallowing function,and prevent the occurrence of swallowing-related complications after stroke.

Study on the treatment of dysphagia after stroke with electromyographic biofeedback intensive training

BACKGROUND Dysphagia,or swallowing disorder,is a common complication following stroke,significantly impacting patients'quality of life.Electromyographic biofeedback(EMGBF)therapy has emerged as a potential rehabilitation technique to improve swallowing function,but its efficacy in comparison with conventional treatments remains to be further explored.AIM To investigate the effects of different treatment intensities of EMGBF on swallowing function and motor speed after stroke.METHODS The participants were divided into three groups,all of which received routine neurological drug therapy and motor function rehabilitation training.On the basis of routine swallowing disorder training,the EMGBF group received additional EMGBF training,while the enhanced EMGBF group received two additional training sessions.Four weeks before and after treatment,the degree of swallowing disorder was evaluated using the degree of swallowing disorder score(VGF)and the Rosenbek penetration-aspiration scale(PAS).RESULTS Initially,there was no significant difference in VGF and PAS scores among the groups(P>0.05).After four weeks,all groups showed significant improvement in both VGF scores and PAS scores.Furthermore,the standardized swallowing assessment and videofluoroscopic dysphagia scale scores also improved significantly post-treatment,indicating enhanced swallowing function and motor function of the hyoid-bone laryngeal complex,particularly in the intensive EMGBF group.CONCLUSION EMGBF training is more effective than traditional swallowing training in improving swallowing function and the movement rate of the hyoid laryngeal complex in patients with post-stroke dysphagia.

Tongguan Liqiao acupuncture therapy improves dysphagia after brainstem stroke

Tongguan Liqiao acupuncture therapy has been shown to effectively treat dysphagia after stroke-based pseudobulbar paralysis. We presumed that this therapy would be effective for dysphagia after bulbar paralysis in patients with brainstem infarction. Sixty-four patients with dysphagia following brainstem infarction were recruited and divided into a medulla oblongata infarction group（n = 22）, a midbrain and pons infarction group（n = 16）, and a multiple cerebral infarction group（n = 26） according to their magnetic resonance imaging results. All patients received Tongguan Liqiao acupuncture for 28 days. The main acupoints were Neiguan（PC6）, Renzhong（DU26）, Sanyinjiao（SP6）, Fengchi（GB20）, Wangu（GB12）, and Yifeng（SJ17）. Furthermore, the posterior pharyngeal wall was pricked. Before and after treatment, patient swallowing functions were evaluated with the Kubota Water Test, Fujishima Ichiro Rating Scale, and the Standard Swallowing Assessment. The Barthel Index was also used to evaluate their quality of life. Results showed that after 28 days of treatment, scores on the Kubota Water Test and Standard Swallowing Assessment had decreased, but scores on the Fujishima Ichiro Rating Scale and Barthel Index had increased in each group. The total efficacy rate was 92.2% after treatment, and was most obvious in patients with medulla oblongata infarction（95.9%）. These findings suggest that Tongguan Liqiao acupuncture therapy can repair the connection of upper motor neurons to the medulla oblongata motor nucleus, promote the recovery of brainstem infarction, and improve patient＇s swallowing ability and quality of life.

Multiple Cranial Nerve Palsies in Otolaryngology Consultation: An Atypical Clinical Presentation Revealing Myasthenia Gravis

Introduction: Myasthenia gravis is a chronic autoimmune neuromuscular disease, presents with weakness and fatigability of striated skeletal muscles. It is a rare disease in Cameroon. We report an uncommon case of myasthenia gravis in a patient with feeding difficulties, notion of oronasal reflux and swallowing disorders as first complaints. Observation: We report the case of a 29-year-old woman consulted at our department of Otolaryngology and Cervico-Facial Surgery for dysphagia and swallowing disorders. She also presented with facial diplegia, oculomotor paralysis, nasal voice, and dysarthria which has been evolving for several years now. The clinical examination revealed multiple cranial nerve palsies. The complementary workup showed a decrement of more than 50% in the electroneuromyography and the presence of anti-acetylcholine receptor autoantibodies in the blood workup. A diagnosis of myasthenia confirms clinical presumption. We initially observed a worsening of neuromuscular disorders despite the pyridostigmine treatment and subsequently a clear improvement of the clinical features concerning swallowing and speech disorders, oculomotricity and facial diplegia under a treatment combining prednisone and azathioprine. Conclusion: Myasthenia gravis is a rare and potentially fatal autoimmune neuromuscular disease. We thus highlight the atypical clinical presentation and therapeutic itinerary of our patient and the importance to think about this clinical diagnosis in front of any multiple cranial nerve paralysis in otolaryngology consultation.

Therapeutic efficacy of swallowing neuromuscular electrical stimulation combined with acupuncture for post-stroke dysphagia

Objective To seek a better therapy for treating post-stroke dysphagia. Methods Patients with stroke and swallowing disorders were randomly divided into ordinary acupuncture group （group A, 58 cases） and swallowing neuromuscular electrical stimulation combined with acupuncture group （group B, 62 cases）. Two-group patients were given the same basic internal medical treatment. In addition, group A was given normal acupuncture treatment with the choice of local points： Junjin （金津 EX-HN 12）, Yuye（玉液 EX-HN 23）, Fengchi （风池 GB 20）, Yifeng （翳风 TE 17）, Lianquan （廉泉 CV 23）, Wangu （完骨 GB 12）. Group B was given swallowing neuromuscular electrical stimulation combined with acupuncture： GB 20, Fengfu （风夜 GV 16）, TE 17, Yiming （翳明 EX-HN 14）, Yamen （哑门 GV 15）, Tianrong（天容 SI 17）, Tianchuang （天窗 SI 16）, CV 23, the uniform reinforcing-reducing manipulation was used; EX- HN 12, EX-HN 13, the piercing and blood-letting method （1-2 mL blood） was used; at the same time, the swallowing neuromuscular electrical stimulation therapy device was used to electrically stimulate the nerves and muscles in the throat and neck at specific output pulse current （50-100 Hz）. Treatment was made twice a day, 30 minutes each time. Two weeks after the treatment, the patients were assessed in symptoms improvement and clinical efficacy. Results The total effective rate in group B was 91.4% and 75.8% in group A; in the total efficiency comparison in both groups, χ^2=5.232, P〈0.05. The difference in improvement of symptoms with post-stroke dysphagia treated with above mentioned combination treatment was statistically significant between both groups （P〈0.05）. Conclusion The above mentioned swallowing neuromuscular electrical stimulation combined with acupuncture treatment has a better clinical effect when compared with ordinary acupuncture.

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.

Severe aspiration pneumonia in the elderly

The global population is aging at an unprecedented rate,resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities.In this context,severe aspiration pneumonia,a condition that carries substantial morbidity,mortality,and financial burden,especially among elderly patients requiring admission to the intensive care unit,has attracted greater concern.Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology.Prior episodes of coughing on food or liquid intake,a history of relevant underlying conditions,abnormalities on videofluoroscopy or water swallowing,and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration.Patients with aspiration pneumonia tend to be elderly,frail,and suffering from more comorbidities than those without this condition.Here,we comprehensively address the epidemiology,clinical characteristics,diagnosis,treatment,prevention,and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic,enhance outcomes,and minimize the healthcare costs associated with this illness.Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

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.