Department of Occupational Therapy and Physiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Research Unit of Nursing and Health Care, Health, Aarhus University, Aarhus, Denmark.
BMJ Open. 2021 Dec 2;11(12):e053244. doi: 10.1136/bmjopen-2021-053244.
Dysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly compensatory strategies to the retraining of swallowing function using principles from neuroscience. However, there are no studies that map interventions available to retrain swallowing function in patients with moderate-to-severe ABI.
To systematically map the accessible research literature to answer the research question: DESIGN: Scoping review based on the methodology of Arksey and O'Malley and methodological advancement by Levac DATA SOURCES: MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, OTseeker, speechBITE and PEDro were searched up until 14 March 2021.
All studies reporting rehabilitative interventions within 6 months of injury for patients with moderate-to-severe ABI and dysphagia were included.
Data was extracted by two independent reviewers and studies were categorised based on treatment modality.
A total of 21 396 records were retrieved, and a final of 26 studies were included. Interventions were categorised into or stimulation of the swallowing network. Cortical stimulation interventions were repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. Non-cortical were complex swallowing interventions, neuromuscular electrical stimulation, pharyngeal electrical stimulation (PES), sensory stimulation, strengthening exercises and respiratory muscle training.
This scoping review provides an overview of rehabilitative dysphagia interventions for patients with moderate and severe ABI, predominantly due to stroke, in the acute and subacute phase. Positive tendencies towards beneficial effects were found for rTMS, complex swallowing interventions, PES and cervical strengthening. Future studies could benefit from clear reporting of patient diagnosis and disease severity, the use of more standardised treatment protocols or algorithms and fewer but standardised outcome measures to enable comparison of effects across studies and interventions.
吞咽困难是获得性脑损伤（ABI）的常见且严重的后果，并可导致严重并发症。吞咽困难的康复治疗正从主要的代偿策略转变为基于神经科学原理的吞咽功能再训练。然而，目前尚无研究针对中重度 ABI 患者的吞咽功能再训练来进行干预措施的映射。
系统地对可获取的研究文献进行映射，以回答研究问题：
基于 Arksey 和 O'Malley 方法以及 Levac 方法学进展的范围综述
MEDLINE、Embase、Cochrane 图书馆、CINAHL、PsycINFO、Web of Science、OTseeker、speechBITE 和 PEDro 数据库均检索至 2021 年 3 月 14 日。
所有报告在 ABI 后 6 个月内针对中重度 ABI 伴吞咽困难患者进行康复干预的研究均被纳入。
两名独立的审查员提取数据，并根据治疗方式对研究进行分类。
共检索到 21396 条记录，最终纳入 26 项研究。干预措施分为[口部肌肉]或[吞咽网络]刺激。皮质刺激干预措施为重复经颅磁刺激（rTMS）和经颅直流电刺激。非皮质刺激为复杂吞咽干预、神经肌肉电刺激、咽部电刺激（PES）、感觉刺激、强化训练和呼吸肌训练。
本范围综述提供了一个关于中重度 ABI 患者吞咽困难康复干预的概述，这些患者主要因中风导致 ABI，发生在急性和亚急性期。rTMS、复杂吞咽干预、PES 和颈肌强化的效果有积极倾向。未来的研究可能受益于患者诊断和疾病严重程度的清晰报告、使用更标准化的治疗方案或算法以及更少但标准化的结果测量，以实现对研究和干预措施之间的效果进行比较。
