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Effects of motor and sensory stimulation in stroke patients with long-lasting dysphagia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
2004 (English)In: Dysphagia (New York. Print), ISSN 0179-051X, E-ISSN 1432-0460, Vol. 19, no 4, 219-230 p.Article in journal (Refereed) Published
Abstract [en]

Dysphagia is a common poststroke symptom with negative effects on recovery and rehabilitation. However, the orofacial regulation therapy, developed by Castillo Morales, comprising body regulation and orofacial regulation in combination with a palatal plate application has shown promising results in stroke patients. This therapy is based not only on muscle exercises but also on an improvement of the entire sensory-motor reflex arc involved in normal deglutition, and on the knowledge that the function of face and oropharynx at deglutition is closely interrelated with the entire body posture as well as with appropriate breathing. The treatment concept is relatively unknown to caregivers, partly due to lack of scientific evaluation of treatment results. The present investigation aimed to assess the effect of motor and sensory stimulation in stroke patients with dysphagia persisting for more than six months. Seven patients were evaluated with respect to orofacial and pharyngeal motility and sensory function before and two weeks after a five-week treatment period. The evaluation comprised a swallowing capacity test, a meal observation test, clinical examination of oral motor and sensory function, a velopharyngeal closure test, and videofluoroscopy. In addition, the symptoms were scored by the patients. An overall single-blind estimation showed objective and self-assessed swallowing improvement in all seven patients. Kappa coefficients are calculated on all reliability data, both inter- and intrarater reliabilities. Sensory and motor stimulation seems to be a promising therapy in stroke patients with long-lasting and persistent oropharyngeal dysphagia.

Place, publisher, year, edition, pages
2004. Vol. 19, no 4, 219-230 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96516DOI: 10.1007/s00455-004-0016-3PubMedID: 15667056OAI: oai:DiVA.org:uu-96516DiVA: diva2:171117
Available from: 2007-11-23 Created: 2007-11-23 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Sensorimotor Brain Plasticity in Stroke Patients with Dysphagia: A Methodological Study on Investigation and Treatment
Open this publication in new window or tab >>Sensorimotor Brain Plasticity in Stroke Patients with Dysphagia: A Methodological Study on Investigation and Treatment
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims

The aims of the thesis were to validate investigation instruments for stroke patients with dysphagia, and to improve oropharyngeal dysphagia therapies.

Methods/Results

A Lip Force Meter, LF 100, affirmed excellent intra- and inter-reliability, sensitivity and specificity. Controls had significantly stronger lip force (LF) and swallowing capacity (SC) than stroke patients. A normal lower limit of LF was set to 15 Newton. Dysphagia symptoms improved in 7 stroke patients after a 5-week sensorimotor stimulation therapy comprising manual body and facial regulation in combination with palatal plate application. Impaired LF and impaired SC were parallel phenomena in 22 acute stroke patients and did not differ regardless of presence or absence of facial palsy. LF and SC improved and were parallel phenomena in 30 stroke patients and did not differ regardless of presence or absence of facial palsy, time lag between stroke attack and start of treatment, or age. SC was normalized in 19 of 30 dysphagia patients after a 5-8-week daily lip muscle self-training with an oral screen.

Conclusions

LF100 is an appropriate and reliable instrument for measuring lip force. Dysphagia improvement, by body and facial sensorimotor stimulation in combination with palatal plate application, or by training with an oral screen is excellent examples of brain plasticity and cortical reorganisation. . Swallowing capacity and lip force in stroke patients are parallel phenomena. A sub clinical facial paresis seems to be present in most stroke patients. Training with an oral screen can improve LF and SC in stroke patients with oropharyngeal dysphagia.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 79 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 299
Keyword
Otorhinolaryngology, Brain plasticity, Controls, Dysphagia, Deglutition, Facial palsy, Lip force, Muscle training, Orofacial regulation, Reliability, Sensitivity, Specificity, Stroke, Swallowing capacity, Otorhinolaryngologi
Identifiers
urn:nbn:se:uu:diva-8337 (URN)978-91-554-7042-5 (ISBN)
Public defence
2007-12-14, Baranysalen, University Hospital, Entrance 78-79, Uppsala, 13:00
Opponent
Supervisors
Available from: 2007-11-23 Created: 2007-11-23Bibliographically approved

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