NeuroRehabilitation - Volume 44, issue 1

Authors: Simonelli, Marilia | Ruoppolo, Giovanni | Iosa, Marco | Morone, Giovanni | Fusco, Augusto | Grasso, Maria Grazia | Gallo, Andrea | Paolucci, Stefano

Article Type: Research Article

Abstract: BACKGROUND: Oropharyngeal dysphagia is a common problem in subacute stroke patients leading to aspiration pneumonia and malnutrition. Non-invasive neuromuscular electrical stimulation (NMES) coupled with traditional therapy could be best treatment option for patients with post-stroke dysphagia, however results are still inconclusive and more studies are requested. OBJECTIVE: The aim of the study was to investigate the effect of laryngopharyngeal neuromuscular electrical stimulation on dysphagia caused by stroke. METHODS: Thirty-three patients affected by subacute stroke and dysphagia participated in this study. The subjects were divided into NMES plus traditional dysphagia training (n = 17) and traditional …dysphagia training alone in a time matched condition (n = 16). Both groups were treated 5 days/week for 8 weeks. All patients were evaluated before and after the treatment. The study was designed as a single blind randomized controlled trial. Primary outcomes were considered the status of swallowing function according to the Functional Oral Intake Scale (FOIS), the instrumental Fiberoptic Endoscopic Examination of Swallowing examination, the Penetration Aspiration Scale and the Pooling score and the presence of oropharyngeal secretion. Secondary outcomes were the type of diet taken by mouth; the need for postural compensations and the duration of the dysphagia training. RESULTS: A functional improvement was observed in both groups but treatment group showed a significant improvement for primary outcome with the exception of the pooling Score (p = 0.015, p = 0.203; p = 0.003; p = 0.048 respectively) and for secondary outcome p <0.005. The results confirm that laryngopharyngeal neuromuscular electrical stimulation in post-stroke patients with dysphonia improve outcome of the training. CONCLUSIONS: Laryngopharyngeal neuromuscular electrical stimulation may be considered as an additional and effective treatment option for dysphagia after stroke. Show more

Keywords: Stroke, dysphagia, neuromuscular electrical stimulation, rehabilitation, fiberoptic endoscopic evaluation of swallowing, deglutition

DOI: 10.3233/NRE-182526

Citation: NeuroRehabilitation, vol. 44, no. 1, pp. 103-110, 2019

Authors: Furkim, Ana Maria | da Silva, Roberta Gonçalves | Vanin, Gabriela | Martino, Rosemary

Article Type: Review Article

Abstract: INTRODUCTION: Temporal features of swallowing physiology vary with age in healthy normals and have the potential to impact swallow safety and efficiency in patients with dysphagia. We conducted a meta-analysis to assess the relation between temporal features of swallowing with penetration, aspiration and residue in adult patients with dysphagia regardless of etiology. METHODS: Operational definitions of relevant terms were defined a priori. A search of 5 databases was conducted to November 2016 without restriction to language. Two independent raters reviewed abstracts and full articles, with discrepancies resolved by consensus. All accepted articles advanced to data extraction and critical …appraisal according to Cochrane standards. Analysis of pooled data compared measures between groups. RESULTS: Of the 11 articles accepted, the temporal measures used in three or more studies were grouped into morphofunctional categories: bolus transit time; pharyngeal response time; laryngeal closure time; and upper esophageal opening time. Across all selected articles, definitions varied for abnormal swallow and only 4 articles reported rater blinding and reliability for measures related to timing. Pooled data identified two main findings: a. longer pharyngeal response time was associated with penetration and/or aspiration (MD = 0.40 95% CI 0.59 – 0.22), and longer upper esophageal opening duration was associated with only aspiration (PAS ≥ 6) (MD = 0.09 95% CI 0.16 – 0,02). No studies were found that related temporal measures and residue. CONCLUSION: Our pooled findings identified an association of two temporal measures with penetration and/or aspiration but none with residue. The current evidence remains limited due to the heterogeneity across studies in how swallow measures were operationalized. Future work with a standardized and reproducible approach is direly needed. Show more

Keywords: Deglutition, swallowing disorders, oropharyngeal, dysphagia, videofluoroscopy, temporal measures.

DOI: 10.3233/NRE-182553

Citation: NeuroRehabilitation, vol. 44, no. 1, pp. 111-129, 2019

Authors: Pardo, Vicky | Galen, Sujay

Article Type: Research Article

Abstract: BACKGROUND: Pusher syndrome (PS) is a clinical disorder that causes decreased postural balance and active pushing away from the non-hemiparetic side in patients with right or left brain damage. Therapists are challenged by needing to manage both the hemiparetic and the pushing/non-hemiparetic sides. There is a minimal amount of evidence about effective treatment interventions for PS. OBJECTIVE: To describe treatment interventions that reduce pushing behavior and improve functional outcomes in patients with PS. METHODS: Five individuals (aged 42–76, admitted 5–16 days post-stroke) with PS participated in this case series. The participants received 90 minutes of physical …therapy (5 days/week) with an average length of stay of 27 days. Treatment focused on regaining their sense of midline (balance and transfers), mobility retraining, and neuro re-education activities. Outcome measures examined pushing behavior, transfer ability, and sitting balance. RESULTS: All five participants demonstrated improvements in pushing behavior, balance and transfer status. CONCLUSIONS: These outcomes provide preliminary evidence of decreased pushing behavior, and improved balance and transfers following a program of interventions designed to improve the functional outcomes of patients with PS. Larger studies are needed to confirm these findings, and whether these interventions are effective for patients with less severe pushing behavior. Show more

Keywords: Stroke, pusher syndrome, case report, treatment interventions

DOI: 10.3233/NRE-182549

Citation: NeuroRehabilitation, vol. 44, no. 1, pp. 131-140, 2019

Authors: Honoré, H. | Eggertsen, K. | Sondergaard, S.

Article Type: Research Article

Abstract: BACKGROUND: Patients suffering brain injury may experience paroxystic sympathetic hyperactivity, presenting diagnostic and therapeutic challenges in neurointensive rehabilitation. The syndrome has been modelled as peripheral and central excitatory:inhibitory ratios of autonomous nervous activity. Another model represents the symptoms as oscillations of the two components of the autonomous nervous system. In therapeutic framework, the syndrome is perceived as the patient misconstruing sensory input relating to body positioning. OBJECTIVE: To investigate whether changes in frequency domain of heart rate variability reflect pharmacological and/or therapeutic measures in rehabilitation. METHODS: ECG was recorded before and after pharmacological and therapeutic interventions …in eight patients with high probability of the syndrome in a neurointensive step-down unit. Recordings were analysed off-line in frequency parameters. Appropriate statistical methods were applied. RESULTS: Low, high frequency and the LF/HF ratio changed significantly following therapeutic as well as pharmacological interventions. DISCUSSION: The cohort was small, the setting the immediate postictal period of intensive care with multidisciplinary rehabilitation. Still, changes in frequency domain were detected following therapeutic efforts. This opens up the venue of on-line monitoring of the intended therapeutic effect. Show more

Keywords: Acquired brain injury, rehabilitation, multidisciplinary, occupational therapy, physiotherapy, paroxystic sympathetic hyperactivity, heart rate variability, monitoring

DOI: 10.3233/NRE-182557

Citation: NeuroRehabilitation, vol. 44, no. 1, pp. 141-155, 2019

Authors: Laxe, Sara

Article Type: Research Article

Abstract: BACKGROUND: Spasticity is a frequent symptom after traumatic brain injury. OBJECTIVE: To assess the effects of different interventions used for muscle spasticity after TBI. METHODS: To summarize a rehabilitation perspective “Cochrane Review” conducted by Synnot et al. RESULTS: Nine studies were involved for the Cochrane review. Poor report on the results of the studies that tested the effectiveness of interventions in spasticity are responsible for the low quality of the evidence. Most of the studies reported results in terms of decreasing spasticity and limiting effects in terms of how the decrease spasticity and no …reports on the beneficial effects in terms of improving activities and participation. CONCLUSIONS: High quality adequately powered trials in patients with TBI should be encouraged. Show more

Keywords: TBI, spasticity, brain injury, muscle

DOI: 10.3233/NRE-189003

Citation: NeuroRehabilitation, vol. 44, no. 1, pp. 157-159, 2019