Chih-Ming Li1, Tyng-Guey Wang2, Hsiao-Yu Lee3, Hsueh-Pei Wang4, Shang-Heng Hsieh5, Michelle Chou6, Jia-Jin Jason Chen7. 1. Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan, Republic of China(∗). 2. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, Republic of China(†). 3. Department of Digital Media Design and Management, Far East University, Xinshi District, Tainan City, Taiwan, Republic of China(‡). 4. Department of Speech and Hearing Disorder and Sciences, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan, Republic of China(§). 5. Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan, Republic of China(‖). 6. Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX(¶). 7. Department of Biomedical Engineering, National Cheng Kung University, No.1, University Road, Tainan City 70101, Taiwan, Republic of China(#). Electronic address: chenjj@mail.ncku.edu.tw.
Abstract
BACKGROUND: For patients with dysphagia due to stroke, in addition to compensatory strategies, exercises are used to help improve motor function. Biofeedback is used in neuromuscular training and is promising for swallowing training. OBJECTIVE: To evaluate the functional value of game-based biofeedback in swallowing therapy for patients with poststroke dysphagia. DESIGN: A case-control study. SETTING: Academic tertiary hospital. PARTICIPANTS: Subjects with poststroke dysphagia (n = 20) were individually matched to 2 separate groups, a game-based biofeedback group (n = 10) or a control group (n = 10), for age, gender, duration of dysphagia, and dysphagia grades. INTERVENTIONS: Each participant underwent 1-hour sessions 3 times per week for a total of 16 treatment sessions. Each session included a 30-minute session of traditional swallow treatment and a 30-minute session of laryngeal elevation exercises. In the experimental group, laryngeal elevation exercises were combined with additional game-based biofeedback. MAIN OUTCOME MEASURES: Outcomes assessed before and after interventions included hyoid bone displacement, Functional Oral Intake Scale (FOIS) scores, and nasogastric (NG) tube removal rate. RESULTS: Intergroup analyses showed larger differences in hyoid bone displacement and FOIS scores (before and after treatment) in the experimental group than in the control group, with statistical significance (P = .007 and P = .014, respectively). Intergroup analyses showed that the hyoid bone displacement change and FOIS scores before and after treatment exhibited statistically significant improvement only in the experimental group (P = .002 and P = .004, respectively). In all, 8 of 10 patients (80%) in the experimental group and 2 of 10 patients (20%) in the control group discontinued NG tube insertion after therapy. Participation in the experimental group was associated with an increased probability of tube removal (odds ratio = 6.00; 95% confidence interval = 1.08-33.27, P = .009). CONCLUSIONS: Laryngeal elevation training combined with game-based biofeedback augments the change in hyoid bone displacement and FOIS scores, and increases the NG tube removal rate in patients with poststroke dysphagia.
BACKGROUND: For patients with dysphagia due to stroke, in addition to compensatory strategies, exercises are used to help improve motor function. Biofeedback is used in neuromuscular training and is promising for swallowing training. OBJECTIVE: To evaluate the functional value of game-based biofeedback in swallowing therapy for patients with poststroke dysphagia. DESIGN: A case-control study. SETTING: Academic tertiary hospital. PARTICIPANTS: Subjects with poststroke dysphagia (n = 20) were individually matched to 2 separate groups, a game-based biofeedback group (n = 10) or a control group (n = 10), for age, gender, duration of dysphagia, and dysphagia grades. INTERVENTIONS: Each participant underwent 1-hour sessions 3 times per week for a total of 16 treatment sessions. Each session included a 30-minute session of traditional swallow treatment and a 30-minute session of laryngeal elevation exercises. In the experimental group, laryngeal elevation exercises were combined with additional game-based biofeedback. MAIN OUTCOME MEASURES: Outcomes assessed before and after interventions included hyoid bone displacement, Functional Oral Intake Scale (FOIS) scores, and nasogastric (NG) tube removal rate. RESULTS: Intergroup analyses showed larger differences in hyoid bone displacement and FOIS scores (before and after treatment) in the experimental group than in the control group, with statistical significance (P = .007 and P = .014, respectively). Intergroup analyses showed that the hyoid bone displacement change and FOIS scores before and after treatment exhibited statistically significant improvement only in the experimental group (P = .002 and P = .004, respectively). In all, 8 of 10 patients (80%) in the experimental group and 2 of 10 patients (20%) in the control group discontinued NG tube insertion after therapy. Participation in the experimental group was associated with an increased probability of tube removal (odds ratio = 6.00; 95% confidence interval = 1.08-33.27, P = .009). CONCLUSIONS: Laryngeal elevation training combined with game-based biofeedback augments the change in hyoid bone displacement and FOIS scores, and increases the NG tube removal rate in patients with poststroke dysphagia.