Assessment And Treatment Rehabilitation Of Dysphagia Post-Stroke

Part one The validity and reliability of Tengdao's swallowing evaluation for stroke patients with dysphagiaObjective To study the validity and reliability of Tengdao's swallowing standard for stroke patients with dysphagia.Methods A total of 128 patients with poststroke dysphagia took swallowing test and then were divided into three sub-groups. Their scores on Tengdao's evaluation and their fluoroscopy results were analyzed using Spearman's correlation cofficient. Intra-class cofficients(ICCs) were used to exaine the intra-reter and inter-rater reliability of Tengdao's evaluation.Results Tengdao's evaluation possessed good validity and reliability. There was a high correlation between the scores of Tengdao's evaluation and fluoroscopy results.Conclusions Tengdao's evaluation is valid, reliable, simple and safe. It can be used in the clinic to evaluate the stroke patients with dysphagia. Part two Combination of Feeding-swallowing Training and Acupuncture:an Effective Rehabilitation Method of Dysphagia Post StrokeObjective To assess the effects of feeding-swallowing training combined with acupuncture on the swallow function improvement of patients with dysphagia following stroke.Methods One hundred and twenty patients with dysphagia after stroke were randomly divided into experimental group (n=60) and control group (n=60). The patients in experimental group were subjected to feeding-swallowing training and acupuncture treatment, while those in control group received feeding-swallowing training alone. SSA, VFSS, MBI and SWAL-QOL were used to assess the swallow function and life quality of patients in two groups before and at the week 1,2,3,4 after treatment.Results There was no significant difference in SSA scores between two groups before and one week after treatment. Compared with those before treatment, the VFSS, MBI and SWAL-QOL scores at the fourth week after treatment were significantly increased and the SSA scores were significantly decreased in both groups (p<0.05). The VFSS, MBI and SWAL-QOL scores of patients in experimental group were significantly higher and the SSA scores were significantly lower than those in control group. The SSA score was negatively correlated with VFSS, MBI and SWAL-QOL scores and the satisfactory score of patients in experimental group was significantly higher than that in control group.Conclusion Feeding-swallowing training combined with acupuncture was a better rehabilitation treatment for patients with swallowing disorders after stroke than conventional feeding-swallowing training alone.Part three VitalStim Therapy Coupled with Swallowing Training: an Effective Rehabilitation Method of Dysphagia Post StrokeObjective To investigate the effects of VitalStim therapy coupled with conventional swallowing training on recovery of post-stroke dysphagiaMethods a total of 120 patients with post-stroke dysphagia were randomly and evenly divided into three group:conventional swallowing therapy group, VitalStim therapy group, and VitalStim therapy plus conventional swallowing therapy group,Prior to an after the treatment,signals of surface electromyography (sEMG) of swallowing muscles were detected, swallowing function was evaluated by using the Standardized Swallowing Assessment(SSA) and Videofluoroscopic Swallowing Study(VFSS) tests, and swallowing-related quality of life (SWAL-QOL) was evaluated using the SWAL-QOL questionnaire. Water Swallowing Test (WST) was used to identify the presence of dysphagia and 124 stroke patients with dysphagia were divided into mild dysphagia group (n=58), moderate dysphagia group (n=50) and severe dysphagia group (n=16) according to the WST. VFSS, NIHSS, HAMD and SWAL-QOL questionnaire were used to assess the swallow function, neural function, metal status and life quality of patients respectively before and after 4-week rehabilitation training. The scores of VFSS, NIHSS, HAMD and SWAL-QOL of three groups were compared and analyzed.Results There were significant differences in sEMG value, SSA, VFSS, and SWAL-QOL scores in each group between prior to and after treatment. After 4-week treatment, sEMG value, SSA, VFSS and SWAL-QOL scores in each group between prior to and after treatment. After 4-week treatment, sEMG value, SSA, VFSS and SWAL-QOL scores were significantly greater in the VitalStim therapy plus conventional swallowing therapy group than in the conventional swallowing training group and VitalStim therapy group, but no significant difference existed between conventional swallowing therapy and VitalStim therapy groups. Before rehabilitation training, there was no statistic difference in scores of NIHSS, HAMD and SWAL-QOL among three groups. After rehabilitation training, the scores of VFSS increased and the scores of NIHSS, HAMD and SWAL-QOL decreased in mild or moderate dysphagia group but only the scores of NIHSS decreased in severe dysphagia group. VFSS scores negatively correlated with HAMD and SWAL-QOL scores, but did not correlate with NIHSS scores.Conclusion It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of post-stroke dysphagia. Dysphagia was common in stroke patients and rehabilitation training could improve the swallow function, thus improving depression and life quality of patients with mild or moderate dysphagia but not with severe dysphagia.