Department of Orthopedics and Physical Medicine and Rehabilitation, University of Ioannina Medical School, Ioannina, Greece -
Department of Orthopedics and Physical Medicine and Rehabilitation, University of Ioannina Medical School, Ioannina, Greece.
Eur J Phys Rehabil Med. 2018 Dec;54(6):845-852. doi: 10.23736/S1973-9087.17.04952-8.
Hemiparesis following stroke can cause cervical spine scoliosis, kyphosis or hyperlordosis. These abnormal cervical alignments can contribute to dysphagia. The benefit of cervical isometric exercises to improve swallowing has not been previously studied.
To evaluate the use of cervical isometric exercises in dysphagic adult patients with cervical spine alignment disorders due to hemiparesis after stroke.
A randomized controlled trial.
University Hospital, PMR Department.
Dysphagic adult patients with hemiparesis after stroke in the rehabilitation phase.
In addition to the standard physical and speech therapy therapeutic approach for 12 weeks, cervical isometric exercises were conducted by a group of patients (experimental group). Patients had cervical spine radiographs in erect (sitting or standing) position coronal and sagittal C2-C7 Cobb angle and a videofluoroscopic swallowing study to evaluate deglutition (0=normal, 1=penetration, 2=aspiration) at 2 time points (at the beginning and at the end of the therapeutic program).
Seventy consecutive patients with hemiparesis of a mean (SD) age of 52±15 years were included in the study and were randomized in 2 groups. Thirty-seven of them (experimental group) conducted cervical isometric exercises in addition to their therapeutic program. At the last follow-up, patients had improved (P<0.001) cervical alignment, in both coronal and sagittal plane, and deglutition. Patients who conducted cervical isometric exercises (experimental group) had more pronounced correction (P<0.001) of cervical alignment in both planes and achieved greater improvement (P<0.05) of deglutition too, than patients who did not conduct such exercises (control group).
Dysphagic adult patients with hemiparesis after stroke in the rehabilitation phase who underwent cervical isometric strengthening exercises showed more significant correction of cervical alignment and more pronounced improvement in deglutition compared to patients who did not include cervical isometric exercises in their therapeutic program.
The additional use of cervical isometric exercises in hemiparetic stroke patients with dysphagic symptoms lead to more pronounced improvement of their swallowing function compared to such patients who are subjected to speech therapy only. Furthermore, these exercises are shown to be beneficial for cervical spine alignment too.
中风后的偏瘫可导致颈椎侧凸、后凸或前凸。这些异常的颈椎排列可能导致吞咽困难。之前尚未研究过颈椎等长运动对改善吞咽的益处。
评估颈椎等长运动在因中风后偏瘫导致颈椎排列障碍的吞咽困难成年患者中的应用。
随机对照试验。
大学医院，物理医学与康复科。
处于康复阶段的中风后偏瘫的吞咽困难成年患者。
除了标准的物理治疗和言语治疗方法 12 周外，一组患者（实验组）还进行了颈椎等长运动。患者在直立（坐或站）位进行颈椎正侧位 C2-C7 Cobb 角的颈椎 X 光检查，并进行视频荧光吞咽研究以评估吞咽（0=正常，1=渗透，2=吸入）在 2 个时间点（治疗计划开始时和结束时）。
70 名偏瘫的连续患者平均（SD）年龄为 52±15 岁，纳入研究并随机分为 2 组。其中 37 名（实验组）在治疗计划中进行了颈椎等长运动。在最后一次随访时，患者的颈椎排列在冠状面和矢状面均得到改善（P<0.001），吞咽功能也得到改善。进行颈椎等长运动的患者（实验组）在两个平面的颈椎排列矫正更为明显（P<0.001），吞咽功能改善也更为显著（P<0.05），而未进行此类运动的患者（对照组）则没有。
在康复阶段患有中风后偏瘫和吞咽困难的成年患者，在接受颈椎等长强化运动后，与未将颈椎等长运动纳入治疗计划的患者相比，颈椎排列的矫正更为显著，吞咽功能的改善更为明显。
与仅接受言语治疗的偏瘫中风伴吞咽困难患者相比，在有吞咽困难症状的偏瘫中风患者中额外使用颈椎等长运动可显著改善其吞咽功能。此外，这些运动对颈椎排列也有益。
