Efficacy of Feedback Based Therapy for Dysphagia in Post Stroke Patients

Abstract

Background and Purpose: Nearly one third of stroke survivors experiencing swallowing dysfunction called Dysphagia, in addition to the motor and sensory impairments. Post stroke dysphagia is associated with increased mortality and morbidity due to aspiration pneumonia, and malnutrition. Feedback can be advocated for enhancing outcomes in dysphagia rehabilitation. However, biofeedback in swallowing therapy is not routinely used. Hence, we tested the functional outcome of cumulative effect of surface Electromyograpy (sEMG) biofeedback adjunct to swallowing exercises summated with visual, auditory and tactile feedback which engross and stimulates active participation of the patients during the therapy of dysphagia rehabilitation. Methods: This study included 12 stroke patients with swallowing difficulty allocated into control and interventional group with 6 subjects in each. Swallowing function was evaluated using Functional Oral Intake Scale (FOIS), Baseline Surface Electromyography (sEMG) of Suprahyoid muscle and Presence of Nasogastric tube.  Interventional group received Feedback based therapy along with conventional therapy for 30 to 40 minutes a day for10 days and control group received conventional therapy for 10 days. The post interventional outcome of FOIS, Average of surface Electromyography (sEMG) of suprahyoid muscle was evaluated. Results: The Nasogastric tube was removed in all patients of experimental group after intervention and established initiation of oral feeding. The result showed improvement in functional oral intake scale after intervention. The muscle activity noted in experimental group was greater than the control group (p<0.05). Conclusion: We conclude that Feedback based therapy protocol shows good improvement in post stroke patients with dysphagia. Inclusion of this protocol in therapy may influence standards of care and best practices for post stroke dysphagia patients. The Registration Number: This trial was registered in Clinical Trials Registry – India and the trial registration number is CTRI/2020/05/025356.