Article

The aim of this study was to compare the efficacy of neuromuscular
electrical stimulation (NMES) in addition to traditional dysphagia therapy (TDT)
including progressive resistance training (PRT) with that of TDT/PRT alone during
inpatient rehabilitation for treatment of feeding tube-dependent dysphagia in
patients who have had an acute stroke. DESIGN: This study is an inpatient
rehabilitation case-control study involving 92 patients who have had an acute
stroke with initial Functional Oral Intake Scale (FOIS) scores of 3 or lower and
profound to severe feeding tube-dependent dysphagia. Sixty-five patients, the
NMES group, received NMES with TDT/PRT, and 27 patients, the case-control group,
received only TDT/PRT. Treatment occurred in hourly sessions daily for a mean +/-
SD of 18 +/- 3 days. chi(2) Analyses/t tests revealed no significant statistical
differences between the groups for age (t = -0.85; P = 0.40), sex (chi(2) = 0.05;
P = 0.94), and stroke location (chi(2) = 4.2; P = 0.24). A Mann-Whitney U test
revealed a statistically significant difference between the groups for the
initial FOIS score (z = -2.4; P = 0.015), with the NMES group having worse
initial scores with a mean rank of 42.64 and the case-control TDT/PRT group
having a mean rank of 55.8. The main outcome measure was the comparison of the
FOIS scores after treatment. RESULTS: The mean +/- SD FOIS score after NMES with
TDT/PRT treatment was 5.1 +/- 1.8 compared with 3.3 +/- 2.2 in the case-control
TDT/PRT group. The mean gain for the NMES group was 4.4 points; and for the
case-control group, 2.4 points. Significant improvement in swallowing performance
was found for the NMES group compared with the TDT/PRT group (z = 3.64; P <
0.001). Within the NMES group, 46% (30 of 65) of the patients had minimal or no
swallowing restrictions (FOIS score of 5-7) after treatment, whereas 26% (7 of
27) of those in the case-control group improved to FOIS scores of 5-7, a
statistically significant difference (chi(2) = 6.0; P = 0.01). CONCLUSIONS: This
study suggests that NMES with TDT/PRT is significantly more effective than
TDT/PRT alone during inpatient rehabilitation in reducing feeding tube-dependent
dysphagia in patients who have had an acute stroke.

Langue : ANGLAIS