Ann Rehabil Med.  2018 Aug;42(4):542-550. 10.5535/arm.2018.42.4.542.

Efficacy of a 4-Week Swallowing Rehabilitation Program Combined With Pyriform Sinus Ballooning in Patients With Post-stroke Dysphagia

• Kim YK
• Lee KY
• Lee SH

• KMID: 2420046
• DOI: http://doi.org/10.5535/arm.2018.42.4.542

Abstract

OBJECTIVE
To assess the efficacy of a 4-week swallowing rehabilitation program combined with pyriform sinus ballooning in patients with post-stroke dysphagia (PSD).
METHODS
We evaluated a total of 30 patients (n=30) with PSD who were admitted to our medical institution between May of 2014 and October of 2016. These patients were randomly assigned to either the trial group (n=15; a 20-minute conventional rehabilitation followed by a 10-minute pyriform sinus ballooning) or the control group (n=15; a 30-minute conventional rehabilitation). In these patients, the efficacy outcome measures were pharyngeal remnant, the pharyngeal transit time, the Penetration Aspiration Scale (PAS) scores and the Videofluoroscopic Dysphagia Scale (VDS) scores. We compared the differences in efficacy outcome measures at 4 weeks from baseline between the two groups.
RESULTS
There were significant changes in the pharyngeal remnant, the pharyngeal transit time, the PAS scores and the VDS scores at 4 weeks from baseline between the two groups (p < 0.0001, p=0.0001, p < 0.0001, and p=0.0048, respectively). There were no treatment-emergent adverse events in our series.
CONCLUSION
Our 4-week rehabilitation program combined with pyriform sinus ballooning is an effective and safe modality in patients with PSD. However, further large-scale, long-term, and multi-center studies are needed to corroborate our results.

Keyword

Stroke; Deglutition disorders; Rehabilitation; Pharynx; Larynx

MeSH Terms

Deglutition Disorders*
Deglutition*
Humans
Larynx
Outcome Assessment (Health Care)
Pharynx
Pyriform Sinus*
Rehabilitation*
Stroke

Figure

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  Fig. 1. Study flow chart.

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  Fig. 2. Passage of the Foley balloon catheter in the videofluoroscopic swallowing study before and during pyriform sinus ballooning. A 12-Fr Foley catheter was placed in the pyriform sinus via a transnasal or transoral approach. It was filled with varying volumes of contrast media in increasing order: 0, 1, 2, 3, 4 and 5 mL, followed by meticulous monitoring of the swallowing process. Thus, we determined the greatest diameter of the balloon tolerated by the patients. (A) the passage of the balloon in the upper esophageal sphincter before and (B) during swallowing. The white arrow indicates the passage of the balloon.

Reference

1. Shi A, Tao Z, Wei P, Zhao J. Epidemiological aspects of heart diseases. Exp Ther Med. 2016; 12:1645–50.

2. Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono ML, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS One. 2016; 11:e0148424.

3. Gonzalez-Fernandez M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: an overview. Curr Phys Med Rehabil Rep. 2013; 1:187–96.

4. Paik NJ, Kim IS, Kim JH, Oh BM, Han TR. Clinical validity of the functional dysphagia scale based on videofluoroscopic swallowing study. J Korean Acad Rehabil Med. 2005; 29:43–9.

5. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003; 124:328–36.

6. Sharma JC, Fletcher S, Vassallo M, Ross I. What influences outcome of stroke: pyrexia or dysphagia? Int J Clin Pract. 2001; 55:17–20.

7. Martino R, Pron G, Diamant N. Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines. Dysphagia. 2000; 15:19–30.

8. Speyer R, Baijens L, Heijnen M, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia. 2010; 25:40–65.

9. Foley N, Teasell R, Salter K, Kruger E, Martino R. Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing. 2008; 37:258–64.

10. Terré R, Mearin F. Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury: a videofluoroscopy study. Neurogastroenterol Motil. 2012; 24:414–9.

11. Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of bedside exercise program on stroke patients with Dysphagia. Ann Rehabil Med. 2012; 36:512–20.

12. Kim YK, Choi SS, Choi JH, Yoon JG. Effectiveness of rehabilitative balloon swallowing treatment on upper esophageal sphincter relaxation and pharyngeal motility for neurogenic dysphagia. Ann Rehabil Med. 2015; 39:524–34.

13. Zheng L, Li Y, Liu Y. The individualized rehabilitation interventions for dysphagia: a multidisciplinary case control study of acute stroke patients. Int J Clin Exp Med. 2014; 7:3789–94.

14. Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002; 122:1314–21.

15. Kim JC, Kim JS, Jung JH, Kim YK. The effect of balloon dilatation through video-fluoroscopic swallowing study (VFSS) in stroke patients with cricopharyngeal dysfunction. J Korean Acad Rehabil Med. 2011; 35:23–6.

16. Kim YK, Lee SH, Lee JW. Effect of vallecular ballooning in stroke patients with dysphagia. Ann Rehabil Med. 2017; 41:231–8.

17. Kawada K, Kawano T, Sugimoto T, Matsui T, Okuda M, Ogo T, et al. Observation of the pharynx to the cervical esophagus using transnasal endoscopy with blue laser imaging. In : Amornyotin S, editor. Endoscopyinnovative uses and emerging technologies. London: InTech;2015.

18. Rensink M, Schuurmans M, Lindeman E, Hafsteinsdottir T. Task-oriented training in rehabilitation after stroke: systematic review. J Adv Nurs. 2009; 65:737–54.

19. Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg. 2005; 131:762–70.

20. Kim J, Oh BM, Kim JY, Lee GJ, Lee SA, Han TR. Validation of the videofluoroscopic dysphagia scale in various etiologies. Dysphagia. 2014; 29:438–43.

21. Vose A, Nonnenmacher J, Singer ML, Gonzalez-Fernandez M. Dysphagia management in acute and subacute stroke. Curr Phys Med Rehabil Rep. 2014; 2:197–206.

22. Alfonsi E, Merlo IM, Ponzio M, Montomoli C, Tassorelli C, Biancardi C, et al. An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment. J Neurol Neurosurg Psychiatry. 2010; 81:54–60.

23. Ferdjallah M, Wertsch JJ, Shaker R. Spectral analysis of surface electromyography (EMG) of upper esophageal sphincter-opening muscles during head lift exercise. J Rehabil Res Dev. 2000; 37:335–40.

24. Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016; 13:49–59.

25. de Lama Lazzara G, Lazarus C, Logemann JA. Impact of thermal stimulation on the triggering of the swallowing reflex. Dysphagia. 1986; 1:73–7.

26. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008; 19:691–707.

27. Buchholz DW, Bosma JF, Donner MW. Adaptation, compensation, and decompensation of the pharyngeal swallow. Gastrointest Radiol. 1985; 10:235–9.

28. Martin RE. Neuroplasticity and swallowing. Dysphagia. 2009; 24:218–29.

29. Humbert IA, Joel S. Tactile, gustatory, and visual biofeedback stimuli modulate neural substrates of deglutition. Neuroimage. 2012; 59:1485–90.

30. Crary MA, Groher ME. Basic concepts of surface electromyographic biofeedback in the treatment of dysphagia: a tutorial. Am J Speech Lang Pathol. 2000; 9:116–25.

31. Huckabee ML, Cannito MP. Outcomes of swallowing rehabilitation in chronic brainstem dysphagia: a retrospective evaluation. Dysphagia. 1999; 14:93–109.