ABSTRACT
BACKGROUND: Stroke is the main cause of oropharyngeal neurogenic dysphagia. Electrostimulation has been used as a therapeutic tool in these cases. However, there are few studies that prove its effectiveness. We evaluated the effect of functional electrostimulation as a complement to conventional speech therapy in patients with dysphagia after a stroke in a stroke unit. METHODS: We performed a clinical, randomized, and controlled trial divided into intervention group (IG) (n = 16) and control group (CG) (n = 17). All patients were treated with conventional speech therapy, and the IG also was submitted to the functional electrotherapy. Primary outcomes were Functional Oral Ingestion Scale (FOIS) and Swallowing videoendoscopy (FEES). The degree of dysphagia was scored in functional, mild, moderate and severe dysphagia according to FEES procedure. Dysphagia Risk Evaluation Protocol (DREP) was considered a secondary outcome. RESULTS: There was a significant difference regarding FOIS scores after 5 days of intervention in groups. Both groups also showed a tendency to improve dysphagia levels measured by FEES, although not statistically significant. Improvements on oral feeding was seen in both groups. No significant differences between groups before and after the intervention were detected by DREP scores. Electrical stimulation did not show additional benefits beyond conventional therapy when comparing outcomes between groups. CONCLUSION: Conventional speech therapy improved oral ingestion even regardless the use of electrostimulation in a stroke unit. TRIAL REGISTRATION: This research was registered in ClinicalTrials.gov (Identifier: NCT03649295 ) in 28/08/2018 and in the Brazilian Registry of Clinical Trials (ReBEC) (Register Number: RBR-56QK5J), approval date: 18/12/2018. HGF Ethics Committee Approval Number: N. 2.388.931.
Subject(s)
Deglutition Disorders , Electric Stimulation Therapy , Stroke Rehabilitation , Stroke , Deglutition , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Electric Stimulation/adverse effects , Electric Stimulation Therapy/methods , Humans , Speech Therapy , Stroke/complications , Stroke/therapy , Stroke Rehabilitation/methods , Treatment OutcomeABSTRACT
BACKGROUND: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. OBJECTIVE: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. METHODS: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. RESULTS: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. CONCLUSIONS: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.
Subject(s)
Deglutition Disorders , Stroke Rehabilitation , Stroke , Adult , Deglutition , Deglutition Disorders/etiology , Deglutition Disorders/rehabilitation , Humans , Stroke/complicationsABSTRACT
ABSTRACT Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.
RESUMO Antecedentes: A disfagia é caracterizada como uma dificuldade no padrão de deglutição em qualquer fase desse processo neuromuscular. É um sintoma frequente após o Acidente Vascular Cerebral. Objetivos: O objetivo deste estudo foi investigar as intervenções fonoaudiológicas mais utilizadas como terapia para o tratamento dos distúrbios da deglutição em pacientes com disfagia pós AVC. Métodos: Realizamos uma revisão dos estudos indexados no MEDLINE-PubMed, LILACS, Cochrane e Clinical trials.gov com foco nas intervenções fonoaudiológicas em pacientes adultos e disfágicos após AVC entre janeiro de 2008 e janeiro de 2021. Resultados: Foram selecionados trinta e seis artigos de ensaios clínicos e estudados onze tipos de terapia. Os estudos sobre a eficácia de intervenções terapêuticas para a reabilitação destes pacientes adultos ainda são restritos. A maioria das técnicas é aplicada em combinação com a terapia convencional, tornando inconclusiva a medição da eficácia de outras técnicas isoladamente. Conclusões: As intervenções terapêuticas devem ser escolhidas de acordo com as possibilidades e limitações dos pacientes e, principalmente, com os achados da avaliação clínica e seu objetivo.
Subject(s)
Humans , Adult , Deglutition Disorders/etiology , Deglutition Disorders/rehabilitation , Stroke/complications , Stroke Rehabilitation , DeglutitionABSTRACT
ABSTRACT Objective: to analyze the competencies of the interprofessional team in the care of dysphagic stroke patients. Methods: an exploratory-descriptive, qualitative study. The research participants i.e., nursing technicians, nurses, physiotherapists, speech therapists and physicians that provided care to patients with stroke in the acute and subacute phase, were randomly selected. The study setting was a stroke unit and neurological ward of the neurology referral hospital for Ceará State, Brazil. Data collection was performed through a semi-structured and recorded interview. The recorded data were organized and analyzed, according to the thematic analysis technique proposed by Bardin. Results: based on the statements, three main categories were developed: "conceptualizing and identifying dysphagia", "knowledge about the prevention of bronchoaspiration in stroke patients" and "bronchoaspiration as a complication of dysphagia". The providers' statements revealed that some experienced doubts and even unawareness about what dysphagia is. Conclusion: the present study showed a complexity of care for stroke patients with dysphagia. Therefore, this scenario reflects the need for continuing education in the service and for interdisciplinarity among professional categories.
RESUMO Objetivo: analisar as competências da equipe interprofissional no cuidado ao paciente disfágico acometidos por Acidente Vascular Cerebral (AVC). Métodos: trata-se de uma pesquisa exploratório-descritiva na perspectiva da investigação qualitativa. Os participantes da pesquisa foram selecionados aleatoriamente, sendo técnicos de enfermagem, enfermeiros, fisioterapeutas, fonoaudiólogos e médicos que prestam assistência a pacientes acometidos por AVC na fase aguda e sub-aguda. O cenário de estudo foi a unidade de AVC e a enfermaria neurológica do hospital referência em Neurologia do estado do Ceará, Brasil. A coleta de dados foi realizada por meio de uma entrevista semiestruturada e gravada. Os dados obtidos foram organizados e analisados segundo a técnica de análises temáticas proposta por Bardin. Resultados: com base nos depoimentos, elencaram-se três categorias temáticas: "conceituando e identificando a disfagia", "saberes sobre a prevenção da broncoaspiração em pacientes acometidos por AVC" e "a broncoaspiração como complicação da disfagia". As falas dos profissionais revelaram que alguns profissionais mostraram dúvida e até mesmo desconhecimento sobre o que é a disfagia. Conclusão: o presente estudo evidenciou a complexidade da assistência ao paciente com disfagia pós AVC. Dessa forma, esse cenário nos faz refletir sobre a necessidade da educação permanente no serviço de atuação e da interdisciplinaridade entre as categorias profissionais.
