Özcan Esra Nur, Ünlüer Nezehat Özgül, Öztürk Mehmet, Erdur Ömer
Department of Therapy and Rehabilitation, Vocational School of Health Services, Karamanoğlu Mehmetbey University, Karaman, Turkey.
Department of Neurological Rehabilitation, Gulhane Faculty of Physiotherapy and Rehabilitation, Health Sciences University, Ankara, Turkey.
J Oral Rehabil. 2025 Jul 1. doi: 10.1111/joor.70000.
To investigate the effects of different exercise methods on swallowing function in dysphagic stroke patients.
Forty-two patients with dysphagia were divided into three groups: conventional swallowing exercises group; the proprioceptive neuromuscular facilitation (PNF) exercises + conventional swallowing exercises group and the Chin-tuck Against Resistance (CTAR) exercises + conventional swallowing exercises. Patients received swallowing rehabilitation twice a week for 8 weeks. Patients were evaluated for swallowing using Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with the Penetration-Aspiration Scale. Suprahyoid muscle thickness, tongue root area and hyolaryngeal elevation were measured by ultrasound before and after treatment. Furthermore, scales such as the National Institutes of Health (NIH) swallowing safety scale, Functional Oral Intake Scale (FOIS), Eating Assessment Tool-10 (EAT-10) and Swallowing Quality of Life Scale (SWAL-QOL) were utilised.
The clinical and demographic characteristics of all three groups were similar at baseline (p > 0.05). Positive improvements were identified following treatment in terms of muscle thickness, as determined by FEES evaluation of swallowing functions and ultrasound evaluations, in all groups (p < 0.05). In the PAS liquid food evaluation, the highest effect was found in the PNF group (η = 0.858). All ultrasound evaluations showed greater improvement in the PNF and CTAR groups compared to the conventional group (p < 0.05). The SWAL QOL also showed significant improvements in all groups after treatment (p < 0.05).
In this study, all three groups contributed to swallowing rehabilitation, but the PNF group improved the most. PNF exercises, delivered by physical therapists without the need for specialised equipment, will make swallowing rehabilitation more effective.
ClinicalTrials.gov identifier: NCT05678686.
探讨不同运动方法对吞咽困难的脑卒中患者吞咽功能的影响。
将42例吞咽困难患者分为三组：传统吞咽训练组；本体感觉神经肌肉促进技术（PNF）训练+传统吞咽训练组；抗阻下颌后缩训练（CTAR）+传统吞咽训练组。患者每周接受两次吞咽康复训练，共8周。采用吞咽功能纤维内镜评估（FEES）及渗透-误吸量表对患者的吞咽功能进行评估。治疗前后采用超声测量舌骨上肌群厚度、舌根面积及喉上抬情况。此外，还使用了美国国立卫生研究院（NIH）吞咽安全量表、功能性经口摄食量表（FOIS）、进食评估工具-10（EAT-10）和吞咽生活质量量表（SWAL-QOL）等量表。
三组患者的临床和人口统计学特征在基线时相似（p>0.05）。通过FEES吞咽功能评估和超声评估发现，所有组在治疗后肌肉厚度方面均有积极改善（p<0.05）。在PAS液体食物评估中，PNF组效果最佳（η=0.858）。所有超声评估均显示，与传统组相比，PNF组和CTAR组改善更明显（p<0.05）。治疗后所有组的SWAL QOL也有显著改善（p<0.05）。
在本研究中，三组均有助于吞咽功能康复，但PNF组改善最为明显。由物理治疗师进行的PNF训练无需专门设备，可使吞咽康复更有效。
ClinicalTrials.gov标识符：NCT05678686。
