Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA.
Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA.
Am J Speech Lang Pathol. 2022 Nov 16;31(6):2539-2556. doi: 10.1044/2022_AJSLP-22-00045. Epub 2022 Nov 8.
Previously, externally placed vibratory laryngeal stimulation increased rates of swallowing in persons with and without dysphagia. This study examined the feasibility of using a vibratory device on the skin over the thyroid cartilage for home-based swallowing rehabilitation in long-standing dysphagia.
Only participants with long-standing dysphagia (> 6 months) following cerebrovascular accident or head/neck cancer who had not previously benefited from dysphagia therapy participated. The device had two modes used daily for 90 days. In automatic mode, participants wore the device when awake, which vibrated for 4-8 s every 5 min to trigger a volitional swallow. In manual mode, participants practiced by activating vibration while swallowing rapidly. Study-related adverse events, such as pneumonia, and device-recorded adherence were tracked. Swallowing function on a modified barium swallow study was assessed at baseline and after 3 months of device use. Outcome measures included the Dysphagia Outcome and Severity Scale (DOSS), Penetration-Aspiration Scale (PAS), and swallowing timing measures. Participants' perceptions of the vibratory device and training were obtained.
The intent to treat analysis showed seven of 11 participants completed the study, all with severe chronic dysphagia. Of those seven participants completing the study, two developed respiratory complications (possibly due to pneumonia) that cleared after antibiotic intervention. For prescribed practice trials, adherence was 80% or greater in four of seven participants (57%) whereas prescribed automatic stimulations were met in only two of seven participants (29%). Three participants (43%) had a modest benefit on DOSS. The time to vestibule closure after the bolus passed the ramus was reduced in five participants (71%) on the modified barium swallow study.
Overall, the results have indicated that intensive home-based practice with stimulation may provide limited functional benefits in severe chronic dysphagia.
先前，外部放置的声带振动刺激可提高吞咽障碍患者和无吞咽障碍患者的吞咽频率。本研究旨在探讨在长期吞咽障碍患者（中风或头颈部癌症后超过 6 个月且之前未从吞咽障碍治疗中获益的患者）中，使用甲状软骨皮肤表面的振动设备进行家庭吞咽康复的可行性。
只有患有长期吞咽障碍（中风或头颈部癌症后超过 6 个月）且之前未从吞咽障碍治疗中获益的参与者参加了该研究。该设备有两种模式，每天使用 90 天。在自动模式下，参与者在清醒时佩戴设备，每 5 分钟振动 4-8 秒以触发自主吞咽。在手动模式下，参与者通过快速吞咽时激活振动来进行练习。跟踪了与研究相关的不良事件，如肺炎，以及设备记录的依从性。在基线和使用设备 3 个月后，使用改良钡吞咽研究评估吞咽功能。评估指标包括吞咽障碍结局和严重程度量表（DOSS）、渗透-误吸量表（PAS）和吞咽时间测量。获得了参与者对振动设备和训练的看法。
意向治疗分析显示，11 名参与者中有 7 名完成了研究，所有参与者均患有严重的慢性吞咽障碍。在完成研究的 7 名参与者中，有 2 名参与者出现了呼吸并发症（可能是由于肺炎），在抗生素干预后痊愈。对于规定的练习试验，7 名参与者中有 4 名（57%）的依从性达到 80%或更高，而仅 7 名参与者中有 2 名（29%）符合规定的自动刺激。3 名参与者（43%）的 DOSS 有适度改善。在改良钡吞咽研究中，5 名参与者（71%）的食团通过下颌后静脉后咽隐窝关闭时间缩短。
总体而言，结果表明，在家中进行强化练习和刺激可能会为严重的慢性吞咽障碍提供有限的功能益处。
