Changes of Swallowing Function and Oropharyngeal Muscle Mass on Sonography After Comprehensive Swallowing Therapy and Neuromuscular Electrical Stimulation in Stroke Patients With Dysphagia
Condition: Stroke
MeSH terms: Deglutition Disorders; Stroke
Study type: Interventional

Summary: 
      1. The inter-rater and intra-rater reliability of sonography.

        2. To explore that sonography is a clinically practical tool for assessing the changes of
           oropharyngeal muscles mass.

        3. The Comparisons the differences in clinical swallowing function, general muscle mass,
           and muscle strength/ sonographic findings of oropharyngeal muscles among the stroke
           patients with dysphagia in different swallowing training programs.

        4. To investigate the associations among clinical swallowing function, general muscle mass,
           muscle strength and sonographic findings of oropharyngeal muscles in stroke patients
           with dysphagia.

        5. The changes of clinical swallowing function, and muscle strength of oropharyngeal
           muscles in stroke patients with dysphagia after different swallowing training programs.

        6. The changes in sonographic findings of oropharyngeal muscles in stroke patients with
           dysphagia after different swallowing training programs.

        7. Effect of different swallowing therapies in clinical swallowing function, general muscle
           mass, and muscle strength/ sonographic findings of oropharyngeal muscles in stroke
           patients with dysphagia.

        8. The associations between clinical swallowing function, oropharyngeal muscle strength,
           and sonographic findings of oropharyngeal muscles in stroke patients with dysphagia.
    

Detailed description: 
      After acute stroke, 25∼45% of patients show difficulties in swallowing, which is associated
      with a high risk of pneumonia, malnutrition, and mortality. In addition to traditional
      swallowing therapies for post-stroke dysphagia (PSD), the Iowa Oral Performance Instrument
      (IOPI) is used to provide tongue exercise program which improving swallowing function.
      Additionally, neuromuscular electrical stimulation (NMES) is also beneficial to manage PSD.
      In rehabilitation unit, ultrasound is a convenient tool and is more widely used in
      investigating oropharyngeal muscles mass and quality in PSD. Therefore, the investigators
      hope to assess the effects on swallowing function and oropharyngeal muscle mass on sonography
      after IOPI swallowing training and neuromuscular electrical stimulation in PSD.

      First, the investigators will enroll 20 normal people, whose ages should be from 40-80 years
      old, to verify the inter-rater and intra-rater reliability of sonography and use IOPI to
      assess maximal muscle strength and endurance of oropharyngeal muscles. Second, 40 stroke
      patients with different levels in dysphagia will be enrolled. Each patient will receive
      clinical assessments of swallowing and tongue functions, general and oropharyngeal muscles
      mass and quality by sonography, and life quality. These stroke patients with dysphagia will
      be randomly allocated in two groups. the investigators will provide two interventions
      including combined simple and IOPI therapies(n=20), and combined swallowing therapy with
      NMES(n=20) for the 2 groups.

      The investigators will investigate the differences of swallowing and tongue functions,
      oropharyngeal muscles on sonography in patients with PSD. The effects of the swallowing
      therapies in swallowing function, oropharyngeal muscle mass, and life quality will be
      explored in PSD by using different swallowing therapies. The investigators will find out the
      most effective swallowing therapy from these 2 interventions for PSD. Furthermore, the
      investigators could explore that sonography is a clinically practical tool for assessing
      oropharyngeal muscles mass and quality in PSD.
    

Intervention name(s): swallowing therapy; IOPI therapy; neuromuscular electrical stimulation (NMES) therapy
Intervention type(s): Other; Other; Other
Intervention description(s): oral exercises, tongue movement, and compensatory techniques, swallowing maneuvers and food modifications, will be performed by an experienced speech and language therapist during intervention; tongue muscle strengthening and endurance exercises by using 15-min IOPI biofeedback program. The biofeedback will be 50%-60% of maximal strength. (total 1 hour/session for 10 sessions); The neuromuscular electrical stimulation (NMES) therapy with VitalStim therapeutic device will be done by one physician who is licensed practitioner and certified in use of the VitalStim device. The placement of 2-channel electrodes is depended on the dysphagic types and the clinical swallowing disorders with for oropharyngeal muscles
(1 hour/session for 10 sessions)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: stroke; dysphagia; sonography; tongue exercises; swallowing therapy