Effect of Transcutaneous Electrical Stimulation in Chronic Poststroke Patients with Oropharyngeal Dysphagia: 1-Year Results of a Randomized Controlled Trial
Por:
Arreola, V, Ortega, O, Alvarez-Berdugo, D, Rofes, L, Tomsen, N, Cabib, C, Muriana, D, Palomera, E and Clave, P
Publicada:
1 sep 2021
Ahead of Print:
1 jun 2021
Resumen:
Background. Chronic poststroke oropharyngeal dysphagia (CPSOD) is associated with impaired oropharyngeal sensory/motor function. We aimed to assess effect of sensory (SES) and motor (NMES) transcutaneous electrical stimulation (TES) on safety of swallow and clinical outcomes in patients with CPSOD in a one-year follow-up randomized controlled trial. Methods. Ninety patients (74.1 +/- 11.5 y, modified Rankin score 2.6 +/- 1.7) with CPSOD and impaired safety of swallow were randomized to (a) compensatory treatment (CT), (b) CT + SES, and (c) CT + NMES. Patients were treated with up to two cycles (6 months apart) of 15 x 1 hour TES sessions over two weeks and followed up with 4-5 clinical and videofluoroscopic assessments during one year. Key results. Baseline penetration-aspiration scale (PAS) was 4.61 +/- 1.75, delayed time to laryngeal vestibule closure (LVC) 396.4 +/- 108.7 ms, and impaired efficacy signs 94.25%. Swallowing parameters significantly improved between baseline and 1-year follow-up in SES and NMES groups for prevalence of patients with a safe swallow (P < .001), mean PAS (P < .001), time to LVC (P < .01), and need for thickening agents (P < .001). Patients in the CT presented a less intense improvement of signs of impaired safety of swallow without significant changes in time to LVC. No differences between groups were observed for 1-year mortality (6.1%), respiratory infections (9.6%), nutritional and functional status, QoL, and hospital readmission rates (27.6%). No significant adverse events related to TES were observed. Conclusions and inferences. Transcutaneous electrical stimulation is a safe and effective therapy for older patients with CPSOD. After 1-year follow-up, TES greatly improved the safety of swallow and reduced the need for fluid thickening in these patients.
Filiaciones:
Arreola, V:
Univ Autonoma Barcelona, Hosp Mataro, Gastrointestinal Physiol Lab, Mataro, Spain
Ortega, O:
Univ Autonoma Barcelona, Hosp Mataro, Gastrointestinal Physiol Lab, Mataro, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Alvarez-Berdugo, D:
Univ Autonoma Barcelona, Hosp Mataro, Gastrointestinal Physiol Lab, Mataro, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Rofes, L:
Univ Autonoma Barcelona, Hosp Mataro, Gastrointestinal Physiol Lab, Mataro, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Tomsen, N:
Univ Autonoma Barcelona, Hosp Mataro, Gastrointestinal Physiol Lab, Mataro, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Cabib, C:
Univ Autonoma Barcelona, Hosp Mataro, Gastrointestinal Physiol Lab, Mataro, Spain
:
Consorci Sanitari Maresme, Hosp Mataro, Neurol Unit, Barcelona, Spain
Palomera, E:
Fdn Salut Consorci Sanitari Maresme, Unitat Suport Recerca, Barcelona, Spain
Clave, P:
Univ Autonoma Barcelona, Hosp Mataro, Gastrointestinal Physiol Lab, Mataro, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
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