Impact of Physical Therapy of Dysphagia on Preventing Pneumonia in Acute Stroke Patients

Study Overview
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Brief Summary
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To investigate the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients

Detailed Description
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Thirty acute ischemic cerebrovascular stroke patients suffering from dysphagia were selected from the stroke unit in El-Kasr EL Ainy Hospital. Their ages ranged from 49 -65 years. Stroke dysphagia was diagnosed by a neurologist. Gugging swallowing screen and A2DS2 score was used to assess risk of developing pneumonia. Stroke associated pneumonia was diagnosed by: Recommended Diagnostic Criteria for Definite and Probable SAP in Patients Not Receiving Mechanical Ventilation Based on the CDC Criteria. The selected patients were randomly assigned into two equal groups control group (A) and study group (B). Control group (A) was treated by nasogastric tube and oral care. Study group (B) was treated as the control group in addition to a designed physical therapy program consisting of neuromuscular electrical stimulation in addition to exercises for oropharyngeal muscles. Assessment was done before treatment, at the middle and at the end of treatment for each patient. Treatment was conducted for five sessions per week for one month.

Official Title
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Impact of Physical Therapy of Dysphagia on Preventing Pneumonia in Acute Stroke Patients

Conditions
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Stroke, Acute, Dysphagia, Pneumonia

Intervention / Treatment
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* Dietary Supplement: Dietary supplement
* Other: Physical therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients were diagnosed of stroke dysphagia by a neurologist. Severity of stroke ranged from mild to moderate according to NIHSS score (NIHSS less than or equal 16). Patients' age ranged from 49 to 65 years old. Patients had the ability to understand and follow instructions. Patients were able to sit in upright position. Exclusion Criteria: History of previous stroke. History of any swallowing problem. History of any disease, head and neck surgery or tumor that causes swallowing dysfunction. Any lung disease or pneumonia on admission. Patients with cognitive deficits or disturbed conscious level. Patients on mechanical ventilator. Patients with sensory or global aphasia.

Ages Eligible for Study
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Minimum Age: 49 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: control group<br>Control group (A) was treated by nasogastric tube and oral care. | Dietary Supplement: Dietary supplement<br>* nasogastric tube and oral care<br>|
| Experimental: study group<br>Study group (B) was treated as the control group in addition to a designed physical therapy program consisting of neuromuscular electrical stimulation in addition to exercises for oropharyngeal muscles. | Dietary Supplement: Dietary supplement<br>* nasogastric tube and oral care<br>Other: Physical therapy<br>* Designed physical therapy program consisting of neuromuscular electrical stimulation in addition to exercises for oropharyngeal muscles.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Gugging swallowing screen test score | Test used to detect dysphagia and aspiration risk. Score ranged from 0 to 20 where 0 indicates sever dysphagia and 20 indicates normal swallowing | at baseline | 
| The Gugging swallowing screen test score | Test used to detect dysphagia and aspiration risk. Score ranged from 0 to 20 where 0 indicates sever dysphagia and 20 indicates normal swallowing | post intervention (after one month) | 
| Clinical Score (A2DS2) | It is a scale to detect risk of pneumonia. Consists of five items of scale which are: age, atrial fibrillation, dysphagia, sex and stroke severity. Total score of A2DS2 is 10. A2DS2 scoring tool: age more than 75 years=1, atrial fibrillation=1, dysphagia=2, male sex=1; stroke severity: is detected by NIHSS score. If NIHSS score is from 0-4=0, 5-15=3, and more than16=5. Patients with score of 6 or more are at high risk of pneumonia | at baseline | 
| Clinical Score (A2DS2) | It is a scale to detect risk of pneumonia.Consists of five items of scale which are: age, atrial fibrillation, dysphagia, sex and stroke severity. Total score of A2DS2 is 10. A2DS2 scoring tool: age more than 75 years=1, atrial fibrillation=1, dysphagia=2, male sex=1; stroke severity: is detected by NIHSS score. If NIHSS score is from 0-4=0, 5-15=3, and more than16=5. Patients with score of 6 or more are at high risk of pneumonia | post intervention (after one month) | 
| Number of participant with stroke associated pneumonia | Measuring number of participants with stroke associated pneumonia in each group according to the modified Center for Disease Control and Prevention criteria that include; Fever (>38°C) , Leukopenia (<4000 WBC/mm3), worsening cough...etc | at baseline | 
| Number of participant with stroke associated pneumonia | Measuring number of participants with stroke associated pneumonia in each group according to the modified Center for Disease Control and Prevention crI,teria that include; Fever (>38°C) , Leukopenia (<4000 WBC/mm3), worsening cough...etc | At middle of intervention (after two weeks) | 
| Number of participant with stroke associated pneumonia | Measuring number of participants with stroke associated pneumonia in each group according to the modified Center for Disease Control and Prevention criteria that include; Fever (>38°C) , Leukopenia (<4000 WBC/mm3), worsening cough...etc | post intervention (after one month) |