Department of Medicine, University of Wisconsin, Madison, Wisconsin Geriatric Research Education Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
Top Stroke Rehabil. 2013 Sep-Oct;20(5):450-70. doi: 10.1310/tsr2005-450.
Isometric progressive resistance oropharyngeal (I-PRO) therapy improves swallowing function; however, current devices utilize a single sensor that provides limited information or are prohibitively expensive. This single-subject study presents results of I-PRO therapy, detraining, and maintenance using the 5-sensor Madison Oral Strengthening Therapeutic (MOST) device combined with upper esophageal sphincter (UES) dilatation.
A 56-year-old female nurse who was 27 months post stroke and subsequent to traditional behavioral interventions and UES dilatations presented limited to gastrostomy tube intake only and expectorating all saliva. She completed 8 weeks of I-PRO therapy, 5 weeks of detraining, and 9 weeks of I-PRO maintenance (reduced frequency) followed by a third UES dilatation post intervention. Data included diet inventory, lingual pressures (MOST), lingual volume (magnetic resonance imaging), postswallow residue (videofluoroscopy), UES and pharyngeal pressures (high-resolution manometry), and quality of life (QOL).
Findings after 8 weeks of I-PRO therapy were progression to general oral diet, 15 lb weight gain, increased isometric pressures (Δ ≯16 kPa) with transference to swallowing pressures, increased lingual volume (8.3%), reduced pharyngeal wall residue (P = .03), increased pharyngeal pressures (Δ ≯ 43 mm Hg) and increased UES opening (nadir) pressures (Δ ≯ 9 mm Hg) with improved temporopressure coordination across the pharynx, and improved QOL. After detraining, decreased isometric pressures and reduced UES opening were noted. After I-PRO maintenance, isometric anterior lingual pressures returned to levels noted after the 8 weeks of intervention.
I-PRO therapy, facilitated by the MOST device combined with instrumental UES dilatation, improved swallow safety, increased oropharyngeal intake, and facilitated UES opening while enriching QOL.
等长渐进性阻力口腔（I-PRO）疗法可改善吞咽功能；然而，目前的设备仅使用单个传感器，提供的信息有限，或者价格昂贵。本单病例研究介绍了使用 5 传感器麦迪逊口腔强化治疗（MOST）设备联合上食管括约肌（UES）扩张进行 I-PRO 治疗、脱训和维持的结果。
一位 56 岁的女护士，中风后 27 个月，在接受传统行为干预和 UES 扩张后，仅能通过胃造口管摄入食物，并将所有唾液咳出。她完成了 8 周的 I-PRO 治疗、5 周的脱训和 9 周的 I-PRO 维持（减少频率），然后在干预后进行第三次 UES 扩张。数据包括饮食清单、舌压（MOST）、舌体积（磁共振成像）、吞咽后残留（视频透视）、UES 和咽压（高分辨率测压法）以及生活质量（QOL）。
I-PRO 治疗 8 周后的发现为进展到常规口服饮食、体重增加 15 磅、等长压力增加（Δ≯16 kPa）并转移到吞咽压力、舌体积增加（8.3%）、咽壁残留减少（P=0.03）、咽压增加（Δ≯43 mmHg）和 UES 开口（最低点）压增加（Δ≯9 mmHg），同时改善了咽段 temporopressure 协调性，以及 QOL 改善。脱训后，等长压力和 UES 开口减少。I-PRO 维持后，I-PRO 治疗前舌压恢复到干预 8 周后的水平。
通过 MOST 设备辅助 I-PRO 治疗，结合仪器 UES 扩张，可改善吞咽安全性，增加口咽部摄入量，促进 UES 开放，同时丰富生活质量。
