Dysphagia, Oral Phase, Stroke
Conditions
Keywords
Dysphagia, stroke, cortical swallowing network, Oral Phase
Brief summary
Up to 84% of patients after stroke are accompanied by dysphagia, of which 53% are oral dysphagia. The oral phase is the initial phase of swallowing activity and the only stage of swallowing that is completely discretionary. Swallowing activity in the oral stage is not only related to the formation and push of food pellets, but also affects the continuity between the transition from spontaneous swallowing to the swallowing reflex.
Detailed description
After stroke, patients are prone to oral dysphagia, poor control of food masses and liquids in the mouth, resulting in food spillover, residual and premature overflow, resulting in dehydration, malnutrition, aspiration, pneumonia and other serious consequences, which greatly reduce the eating safety and quality of life of patients after stroke. Therefore, the rehabilitation of oral swallowing function is a way for patients with swallowing disorder after stroke to return to society and improve their quality of life. Previous studies have found that acupuncture is an effective intervention to improve swallowing disorder in oral stage after stroke. Whether acupuncture promotes the improvement of swallowing function in oral stage by regulating the synergic activity of cortical swallowing network and muscle group has not been fully clarified.
Interventions
OTHERAcupuncture
The patient was placed in a supine position, selected Lianquan, Fengchi, and acupoints.
BEHAVIORALConventional rehabilitation
swallowing training included breathing training, masticatory muscle training, oral movement training and feeding training.
Sponsors
Fujian University of Traditional Chinese Medicine
Qingqing Zhang
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Since acupuncture intervention could not blind subjects and investigators, evaluators and statisticians were secretly grouped to avoid measurement bias as much as possible
Intervention model description
This study was a parallel, randomized controlled trial. Qualified subjects were numbered according to the inclusion order and randomly assigned to the swallowing training treatment group and the acupuncture combined swallowing training treatment group in a 1:1 ratio.
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Patients meeting the diagnostic criteria for acute ischemic stroke established by the Neurology Society of the Chinese Medical Association and confirmed by craniocerebral CT or MRI; 2. Oral dysphagia caused by stroke; 3. Currently diet is restricted, FOIS score is 5 or less; WST score 3 or above; 4. MoCA score of 21 or above, able to understand and follow simple instructions from the treatment staff, able to cooperate and willing to undergo examination and treatment; 5. 40 to 75 years old; 6. Conscious and stable vital signs; 7. Convalescent patients with stroke course and dysphagia duration between 1-6 months; 8. Voluntary participation and informed consent.
Exclusion criteria
1. Patients with dysphagia not caused by stroke or non-stroke oral dysphagia; 2. Previous history of stroke or dysphagia; 3. Patients with serious primary diseases or mental disorders of other systems; 4. Suffering from various bleeding prone diseases; 5. Severe needle fainting; 6. People with metal implants. 7. Patients with poor compliance are not treated as prescribed
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Oral functional score | 4 weeks (Before and after intervation) | To assess participants' oral swallowing function |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Water swallowing test (WST) | 4 weeks (Before and after intervation) | The severity of dysphagia was assessed by the WST. Level 1: Can drink 30ml water successfully within 5 seconds; Level 2: Drink water more than 2 times, can swallow without choking. Level 3: Can be drunk once, but cough. Level 4: swallowed more than twice, but with choking. Level 5: Frequent choking, unable to swallow all. Normal: Level 1, Suspicious: Level 1, more than 5 seconds or level 2; Abnormal: Level 3 to 5 |
| Standardized Swallowing Assessment (SSA) | 4 weeks (Before and after intervation) | To assess the severity of swallowing. The lowest score on this scale is 18 points, the highest score is 46 points, the higher the score, the worse the swallowing function. |
| Surface electromyography | 4 weeks (Before and after intervation) | To assess the swallowing muscle activity |
| Teacher salivation rating (TDS) | 4 weeks (Before and after intervation) | Assess salivation. Level 1: No salivation; Level 2: Small amount, occasional flow. Level 3: Stream from time to time; Level 4: Flow frequently, but not linearly; Level 5: Flow in line, chest often wet |
| Swallowing Related Daily Quality of Life Scale (SWAL-QOL) | 4 weeks (Before and after intervation) | Assessed patients' quality of life. The SWAL-QOL scale consists of 11 dimensions, covering 44 items, of which 10 dimensions measure patients' quality of life and one dimension measures patients' swallowing symptoms. The 10 quality of life dimensions included 30 items, of which 8 (25 items in total) were related to swallowing, including psychological burden, eating time, appetite, food choice, verbal communication, fear of eating, mental health, and social interaction: the common dimension had 2 (5 items in total), including fatigue and sleep. The dimension of swallowing symptoms included 14 items. The SWAL-OOL scale was scored by Likert scoring method. The higher the score of five levels (1-5 respectively), the better the quality of life. |
| Functional Oral Intake Scale (FOIS) | 4 weeks (Before and after intervation) | To assess the condition of swallowing. The grade of FOIS was categorized as level 1 to 3 (poor FOIS: tube feeding), levels 4 and 5 (moderate FOIS: total oral diet requiring special preparation) or levels 6 and 7 (good FOIS: total oral diet without special preparation). |
Contacts
Primary ContactQingqing Zhang
Outcome results
None listed