University of Florida, College of Public Health and Health Professions, Rehabilitation Science, Gainesville, FL.
Swallowing Systems Core, University of Florida, Gainesville, FL.
PM R. 2019 Nov;11(11):1159-1169. doi: 10.1002/pmrj.12093. Epub 2019 Apr 22.
Dysphagia (swallowing impairment) is a common and often life-threatening problem after stroke. Submental surface electromyography (ssEMG) visual biofeedback is a commonly used clinical tool to train novel swallowing maneuvers, even though its effectiveness has been questioned.
To compare the effect of ssEMG and videofluoroscopy (VF) visual biofeedback on swallowing airway protection accuracy when training the volitional laryngeal closure swallowing maneuver (vLVC) in poststroke patients with dysphagia. Researchers also examined whether clinicians accurately judged vLVC performance. The hypothesis was that patient vLVC accuracy and clinician verbal cue accuracy will be greatest with VF (kinematic) visual biofeedback.
Nineteen patients with dysphagia post stroke.
Outpatient swallowing research laboratory.
Randomized clinical trial.
Patients underwent 2 study phases. Phase 1: first demonstrated ability to perform the vLVC accurately. Phase 2: vLVC training. Participants were randomized into three biofeedback groups including the ssEMG group (ssEMG biofeedback in both phases), the VF group (VF biofeedback in both phases), and the mixed group (VF phase 1, ssEMG phase 2). To promote the best vLVC performance, a clinician provided real-time, verbal cueing using only the visual biofeedback type also seen by the patient, although both VF and ssEMG were recorded for all participants.
Patient performance accuracy and clinician feedback accuracy for performing the vLVC maneuver.
Both accuracy of vLVC training performance and clinician feedback accuracy were worse in the ssEMG group compared with the VF and mixed groups (P < .001).
Swallowing airway protection requires precisely timed movements of small, hidden laryngeal and pharyngeal structures. Kinematic biofeedback (VF) may be required, at some point, to ensure that target swallowing movements are being trained during rehabilitation, rather than maladaptive movements.
I.
吞咽障碍（吞咽受损）是中风后常见且常常危及生命的问题。颏下表面肌电图（ssEMG）视觉生物反馈是一种常用于训练新的吞咽动作的临床工具，尽管其有效性受到质疑。
比较 ssEMG 和荧光透视（VF）视觉生物反馈在训练中风后吞咽障碍患者自主喉闭合吞咽动作（vLVC）时对吞咽气道保护准确性的影响。研究人员还检查了临床医生是否准确判断 vLVC 表现。假设是，患者 vLVC 准确性和临床医生口头提示准确性将在 VF（运动学）视觉生物反馈时最大。
19 名中风后吞咽障碍患者。
门诊吞咽研究实验室。
随机临床试验。
患者接受了 2 个研究阶段。第 1 阶段：首先证明能够准确执行 vLVC。第 2 阶段：vLVC 训练。参与者随机分为 3 个生物反馈组，包括 ssEMG 组（两个阶段均使用 ssEMG 生物反馈）、VF 组（两个阶段均使用 VF 生物反馈）和混合组（VF 阶段 1，ssEMG 阶段 2）。为了促进最佳 vLVC 表现，临床医生仅使用患者看到的视觉生物反馈类型提供实时口头提示，尽管所有参与者都记录了 VF 和 ssEMG。
执行 vLVC 动作时患者表现的准确性和临床医生反馈的准确性。
与 VF 和混合组相比，ssEMG 组的 vLVC 训练表现准确性和临床医生反馈准确性均较差（P<0.001）。
吞咽气道保护需要小而隐藏的喉部和咽部结构的精确定时运动。在康复期间，可能需要运动学生物反馈（VF）来确保正在训练目标吞咽运动，而不是适应性不良的运动。
I。
