Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Am J Phys Med Rehabil. 2013 Jun;92(6):486-95. doi: 10.1097/PHM.0b013e31828762ec.
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.
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. χ(2) Analyses/t tests revealed no significant statistical differences between the groups for age (t = -0.85; P = 0.40), sex (χ(2) = 0.05; P = 0.94), and stroke location (χ(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.
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 (χ(2) = 6.0; P = 0.01).
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.
本研究旨在比较神经肌肉电刺激（NMES）联合传统吞咽治疗（TDT），包括渐进性抗阻训练（PRT）与单纯 TDT/PRT 在急性卒中后住院康复期间治疗依赖饲管吞咽障碍的疗效。
这是一项涉及 92 例急性卒中患者的住院康复病例对照研究，这些患者的初始功能性口腔摄入量表（FOIS）评分为 3 或更低，且存在严重到极重度依赖饲管的吞咽障碍。65 例患者（NMES 组）接受 NMES 联合 TDT/PRT 治疗，27 例患者（对照组）仅接受 TDT/PRT 治疗。治疗每天进行 1 小时的治疗，平均持续 18±3 天。χ(2)分析/t 检验显示，两组在年龄（t=-0.85；P=0.40）、性别（χ(2)=0.05；P=0.94）和卒中部位（χ(2)=4.2；P=0.24）方面无统计学差异。Mann-Whitney U 检验显示两组初始 FOIS 评分存在统计学差异（z=-2.4；P=0.015），NMES 组初始评分较差，平均秩次为 42.64，对照组 TDT/PRT 组的平均秩次为 55.8。主要观察指标为治疗后 FOIS 评分的比较。
NMES 联合 TDT/PRT 治疗后的平均 FOIS 评分为 5.1±1.8，而对照组 TDT/PRT 组为 3.3±2.2。NMES 组的平均增益为 4.4 分，对照组为 2.4 分。与 TDT/PRT 组相比，NMES 组的吞咽功能明显改善（z=3.64；P<0.001）。NMES 组中，46%（30/65）的患者治疗后吞咽受限最小或无（FOIS 评分为 5-7），而对照组中，26%（7/27）的患者改善至 FOIS 评分为 5-7，差异有统计学意义（χ(2)=6.0；P=0.01）。
本研究表明，在急性卒中患者住院康复期间，NMES 联合 TDT/PRT 比单纯 TDT/PRT 更能有效减少依赖饲管的吞咽障碍。
