1.
The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia.
Meng, P, Zhang, S, Wang, Q, Wang, P, Han, C, Gao, J, Yue, S
Journal of back and musculoskeletal rehabilitation. 2018;(2):363-370
Abstract
OBJECTIVE To assess whether the clinical efficacy of a therapeutic protocol using surface neuromuscular electrical stimulation (sNMES) on patients with post-stroke dysphagia (PSD) is superior to that without sNMES, and whether swallowing functional outcome is different with regards to different electrode placement on patients' skin of neck. METHODS Thirty patients with PSD were randomly allocated into treatment group A (TGA), treatment group B (TGB) and control group according to a random number table. The three groups of patients all received traditional dysphagia therapy (TDT) and other general rehabilitation therapy such as physical therapy and occupational therapy as a basic treatment project. Besides this, sNMES treatment was applied on different sites of patients' neck skin in group A and B separately. All the patients received video-fluoroscopic swallowing study (VFSS) pre-treatment and 2 weeks post-treatment, during which the displacement of the hyolaryngeal complex towards the superior and anterior sides while swallowing semi-liquid diet were measured. Outcome of the VFSS was measured using dysphagia outcome and severity scale (DOSS). RESULTS Post-treatment evaluation was carried out using water swallow test (WST), repetitive saliva swallowing test (RSST) and dysphagia outcome and severity scale (DOSS) from the three study groups were all improved (P< 0.05). The results of post-treatment evaluation using WST from TGA and TGB were 2.40 ± 1.26 and 2.10 ± 0.99 respectively, using RSST from TGA and TGB were 5.30 ± 1.89 and 5.20 ± 1.69 respectively, using DOSS from TGA and TGB were 5.20 ± 1.40 and 5.10 ± 1.45 respectively. Compared to control group, the results of post-treatment evaluation using the three scales, there were significant improvement between TGA and TGB (P< 0.05), however, the inter-group differences of TGA and TGB indicated no statistically significant difference (P> 0.05). The post-treatment evaluation of the moving distance of hyoid bone towards anterior side in swallowing was significantly improved as compared to TGB (-8.40 ± 7.48, t=-3.552, P= 0.006), and was statistically significant as compared to the control group (P> 0.05). CONCLUSIONS Swallowing function in the patients with PSD was significantly improved using TDT combined with NMES. Stimulating electrodes placed at the suprahyoid region or on both suprahyoid and infrahyoid regions resulted in no difference of effect. However, NMES on suprahyoid region could further improve the moving distance of hyoid bone anteriorly.
2.
Mailuoning for acute ischaemic stroke.
Yang, W, Hao, Z, Zhang, S, Dong, W, Wu, T, Liu, GJ, Liu, M
The Cochrane database of systematic reviews. 2009;(2):CD007028
Abstract
BACKGROUND Mailuoning is widely used in the treatment of acute ischaemic stroke in China. OBJECTIVES To determine the efficacy and safety of mailuoning in the treatment of patients with acute ischaemic stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (January 2008), the Chinese Stroke Trials Register (December 2007), the Trials Register of the Cochrane Complementary Medicine Field (December 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2007), MEDLINE (1966 to December 2007), EMBASE (1980 to January 2008), AMED (1985 to December 2007), the China Biological Medicine Database (CBM-disc 1979 to December 2007) and the Chinese National Knowledge Infrastructure (1979 to December 2007). We searched clinical trials and research registers, handsearched 10 Chinese journals including relevant conference proceedings, scanned reference lists and contacted the pharmaceutical company manufacturing mailuoning. We also attempted to contact trial authors to obtain further data. SELECTION CRITERIA Randomised controlled trials comparing mailuoning with placebo or mailuoning plus other treatment compared with the other treatment in patients with acute ischaemic stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS Fifteen trials involving 1280 participants were included. Numbers of deaths and dependent patients at the end of follow up of at least three months were not reported in the included trials. From six trials that reported adverse events, five events occurred in two trials. Fourteen trials were assessed to be of inferior quality; when analysing these trials together, mailuoning was associated with a significant increase in the number of patients with improved neurological deficit (risk ratio (RR) 0.30; 95% confidence interval (CI) 0.22 to 0.42). One placebo-controlled trial, assessed to be of good methodological quality, failed to show an improvement of neurological deficit at the end of three months follow up (mean difference (MD) 0.69; 95% CI -3.42 to 4.80), or in activities of daily life. Quality of life, assessed in one trial, did not show significant improvement. AUTHORS' CONCLUSIONS We found no convincing evidence, from trials of sufficient methodological quality, to support the routine use of mailuoning to promote recovery after stroke. High-quality and large-scale randomised controlled trials are needed to confirm its efficacy.