Ji-Su Park

Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial

Expiratory muscle strength training (EMST) involves forcible blowing as a means of generating high expiratory pressure, against adjustable resistance. EMST has recently been introduced as a potential treatment for dysphagia. This study was performed to investigate the effects of EMST on the activity of suprahyoid muscles, aspiration and dietary stages in stroke patients with dysphagia. Twenty-seven stroke patients with dysphagia were randomly divided into two groups. The experimental group performed EMST with a 70% threshold value of maximal expiratory pressure, using an EMST device, 5 days a week for 4 weeks. The placebo group trained with a sham device. The EMST regime involved 5 sets of 5 breaths through the EMST device for a total of 25 breaths per day. Activity in the suprahyoid muscle group was measured using surface electromyography (sEMG). Further, the penetration-aspiration scale (PAS) was used to assess the results of the videofluoroscopic swallowing study (VFSS). In addition, dietary stages were evaluated using the Functional Oral Intake Scale (FOIS). The experimental group exhibited improved suprahyoid muscle group activity and PAS results, when compared to the placebo group. Following intervention, statistical analysis indicated significant differences in measured suprahyoid muscle activity (P = 0·01), liquid PAS outcomes (P = 0·03) and FOIS results (P = 0·06), but not semisolid type PAS outcomes (P = 0·32), between the groups. This study confirms EMST as an effective treatment for the development of suprahyoid muscle activity in stroke patients with dysphagia. Additionally, improvements in aspiration and penetration outcomes were observed.

Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial.

Neuromuscular electrical stimulation (NMES) has been used as a therapeutic intervention for dysphagia. However, the therapeutic effects of NMES lack supporting evidence. In recent years, NMES combined with traditional swallowing therapy has been used to improve functional recovery in patients with post-stroke dysphagia. This study aimed to investigate the effects of effortful swallowing combined with neuromuscular electrical stimulation on hyoid bone movement and swallowing function in stroke patients. Fifty stroke patients with mild dysphagia who were able to swallow against the resistance applied by using NMES and cooperate actively in training were included. This study was designed as a 6-week single-blind, randomised, controlled study. In the experimental group, two pairs of electrodes were placed horizontally in the infrahyoid region to depress the hyoid bone. The NMES intensity was increased gradually until the participants felt a grabbing sensation in their neck and performed an effortful swallow during the stimulation. In the placebo group, the same procedure was followed except for the intensity, which was increased gradually until the participants felt an electrical sensation. All participants underwent this intervention for 30 min per session, 5 sessions per week, for 6 weeks. Videofluoroscopic swallowing studies (VFSS) were carried out before and after the intervention and kinematics of the hyoid bone and swallowing function were analysed based on the VFSS. The experimental group revealed a significant increase in anterior and superior hyoid bone movement and the pharyngeal phase of the swallowing function. This intervention can be used as a novel remedial approach in dysphagic stroke patients.

Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial

OBJECTIVE This study aimed to investigate the effect of expiratory muscle strength training (EMST) on swallowing-related muscle strength in community-dwelling elderly individuals. BACKGROUND Expiratory muscle strength training is an intervention for patients with oropharyngeal dysphagia. This training is associated with respiration, coughing, speech and swallowing, and its effectiveness has been proven in previous studies. However, the effects of EMST on elderly individuals and evidence are still lacking. MATERIALS AND METHODS This study included 24 community-dwelling senior citizens aged ≥65 years (12 men and 12 women). The experimental group trained at the 70% threshold value of the maximum expiratory pressure using an EMST device 5 days per week for 4 weeks and comprised five sets of five breaths through the device for 25 breaths per day. The placebo group trained with a resistance-free sham device. Post-intervention, muscle strength of the bilateral buccinator and the orbicularis oris muscles (OOM) was measured using the Iowa Oral Performance Instrument. Surface electromyography was used to measure activation of the suprahyoid muscles (SM). RESULTS After intervention, the strength of the buccinator and the OOM in the experimental group showed statistically significant improvement. There was also statistically significant activation of the SM. In the placebo group, the strength of the orbicularis oris muscle alone improved. No statistically significant differences between groups were found for the strength of the buccinator and the OOM and the activation of the SM. CONCLUSION EMST had a positive effect on swallowing-related muscle strength in elderly participants.

Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia

[Purpose] The aim of this study was to evaluate the effectiveness of a structured program of resistance training for the tongue in order to improve swallowing function in stroke patients with dysphagia. [Subjects and Methods] Twenty-seven stroke patients with dysphagia were randomly divided into two groups. The experimental group participated in a resistance-training program involving a 1-repetition maximum, with an intensity of 80%, along with 50 repetitions per day each for the anterior and posterior regions of the tongue. Both groups received conventional therapy for dysphagia for 30 min per day, 5 times per week, for 6 weeks. [Results] The experimental group showed statistically significant improvements in both, the anterior and posterior regions of the tongue. In contrast, the control group showed significant improvements only in the anterior region of the tongue. In the videofluoroscopic dysphagia scale evaluation, improvement was noted at both, the oral and pharyngeal stages in the experimental group, whereas significant improvements were only noted in the oral stage and total score in the control group. [Conclusion] Our study confirmed that tongue resistance training is an effective intervention for stroke patients with dysphagia, offering improved tongue muscle strength and overall improvement in swallowing.

Effects of combining mental practice with electromyogram-triggered electrical stimulation for stroke patients with unilateral neglect

[Purpose] The aim of this study was to investigate the effect of mental practice combined with electromyogram-triggered electrical stimulation on neglect and activities of daily living in stroke patients with unilateral neglect. [Subjects and Methods] Thirty-three stroke patients with unilateral neglect were recruited from a local university hospital, and were divided into two groups. The experimental group received an intervention consisting of mental practice combined with electromyogram-triggered electrical stimulation on the neglected side, while the control group received cyclic electrical stimulation at the same site. In addition, both groups received an identical intervention of conventional occupational and physical therapy. [Results] After the intervention, the experimental group showed a statistically significant improvement in the line bisection test result, star cancellation test result, and Catherine Bergego Scale scores. The control group showed a significant improvement only in the line bisection test result. [Conclusion] These data suggest that mental practice combined with electromyogram-triggered electrical stimulation is an effective, novel treatment for reducing unilateral neglect in stroke patients.

Effect of neuromuscular electrical stimulation on lip strength and closure function in patients with dysphagia after stroke

[Purpose] This study aimed to investigate the effect of neuromuscular electrical stimulation (NMES) on lip strength and closure function of patients with dysphagia after stroke. [Subjects and Methods] Eight patients with dysphagia were recruited. NMES was applied to the orbicularis oris muscle. All the participants received NMES for 30 min/d, 5 d/wk, for 4 weeks. Lip strength was measured using the Iowa Oral Performance Instrument. To assess lip closure, the lip closure subitem of the videofluoroscopic dysphagia scale was used. [Results] Lip strength showed significant improvement and lip closure function showed a significant decrease. [Conclusion] This study demonstrates that NMES is useful for improving lip strength and closure function.

Comparison of maximal tongue strength and tongue strength used during swallowing in relation to age in healthy adults.

[Purpose] The aim of this study was to measure and compare the maximal tongue strength and tongue strength used during swallowing in young and older adults. [Subjects and Methods] The study recruited 80 healthy young (aged 20 to 39 years) and older adults (aged ≥65 years) in public places. The Iowa Oral Performance Instrument was used to measure maximal tongue strength and tongue strength used during swallowing. For each subject, the peak value of three measurements was recorded and analyzed. [Results] Maximal tongue strength was statistically significantly higher for the young adults group than the older adults group. Conversely, tongue strength used during swallowing was statistically significantly higher for the older adults group than the young adults group. The percentages of tongue strength used during swallowing for the young adults and older adults groups were approximately 38.8% and 53.8%, respectively. [Conclusion] This study confirmed that older adults have a lower maximal tongue strength than young adults, but a higher tongue strength used during swallowing.

Differences in maximal isometric tongue strength and endurance of healthy young vs. older adults

[Purpose] The aim of this study was to measure and compare the maximal tongue strength and endurance of young and older adults. [Subjects and Methods] This study recruited 60 healthy young (aged 20 to 39 years) and older adults (aged 67 to 75 years) at a university and in public places. The Iowa Oral Performance Instrument was used to measure maximal tongue strength and endurance. [Results] Maximal tongue strength was significantly higher in the young adult group than the older adult group. Maximal tongue endurance was longer in the young adult group than in the older adult group, but the difference between the groups was not significant. [Conclusion] This study confirmed that older adults have a lower maximal tongue strength and endurance than young adults.

Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke

BACKGROUND Recently, resistance expiratory muscle strength training (EMST) has been reported as a remedial treatment for dysphagia. OBJECTIVE To investigate the effect of resistance EMST on the swallowing function in stroke patients with oropharyngeal dysphagia. METHODS Forty-two stroke patients with dysphagia were randomly assigned to two groups: an experimental group (n = 13) and a placebo group (n = 13). The experimental group performed EMST using a portable EMST device, while the placebo group performed EMST using a sham EMST device with no loading. The intervention was performed 5 days per week for 4weeks, in five sets of 5 breaths through the device for a total of 25 breaths per day. Both groups underwent conventional dysphagia treatment for 30 minutes/day, 5 days/week, for 4 weeks. Videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study (VFSS) were assessed to analyze the oropharyngeal swallowing function. RESULTS The experimental group showed more improvement in pharyngeal phase of the VDS (p = 0.018 and 0.006, respectively) and PAS compared to the placebo group (p = 0.014). CONCLUSIONS We suggest that EMST could improve the effects of dysphagia observed in post-stroke elderly patients based on swallowing function.

Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia

BACKGROUND Dysphagia after stroke can cause a variety of complications, especially aspiration pneumonia, which can be life-threatening. Therefore, rehabilitation methods to reduce aspiration in patients with dysphagia are important. OBJECTIVE In the present study, we aimed to investigate the effects of Shaker exercise on aspiration and oral diet level in stroke survivors with dysphagia. METHODS Participants were randomly assigned to an experimental group (n = 16) or a control group (n = 16). Participants in the experimental group performed Shaker exercise and conventional dysphagia therapy, whereas those in the control group performed only conventional dysphagia therapy. All participants performed training 5 days a week for 4 weeks. Degree of aspiration was assessed using the Penetration-Aspiration Scale (PAS) based on videofluoroscopic swallowing study, while oral diet level was assessed using the Functional Oral Intake Scale (FOIS). RESULTS The experimental group showed greater improvement on both the PAS (p < 0.05) and FOIS (p < 0.05) compared with the control group. CONCLUSIONS The results of this study suggest that Shaker exercise is a effective exercise for recovery of swallowing function in stroke survivors with dysphagia.