Kinematic Visual Biofeedback Improves Accuracy of Swallowing Maneuver Training and Accuracy of Clinician Cues During Training in Stroke Patients with Dysphagia.
Biofeedback, Psychology
Biomechanical Phenomena
Deglutition Disorders
/ diagnostic imaging
Electromyography
/ methods
Female
Fluoroscopy
/ methods
Follow-Up Studies
Humans
Male
Middle Aged
Patient Education as Topic
/ methods
Physical Therapy Modalities
Recovery of Function
Stroke
/ complications
Time Factors
Treatment Outcome
Journal
PM & R : the journal of injury, function, and rehabilitation
ISSN: 1934-1563
Titre abrégé: PM R
Pays: United States
ID NLM: 101491319
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
30
03
2018
accepted:
17
12
2018
pubmed:
1
2
2019
medline:
25
8
2020
entrez:
1
2
2019
Statut:
ppublish
Résumé
Dysphagia (swallowing impairment) is a common and often life-threatening problem after stroke. Submental surface electromyography (ssEMG) visual biofeedback is a commonly used clinical tool to train novel swallowing maneuvers, even though its effectiveness has been questioned. To compare the effect of ssEMG and videofluoroscopy (VF) visual biofeedback on swallowing airway protection accuracy when training the volitional laryngeal closure swallowing maneuver (vLVC) in poststroke patients with dysphagia. Researchers also examined whether clinicians accurately judged vLVC performance. The hypothesis was that patient vLVC accuracy and clinician verbal cue accuracy will be greatest with VF (kinematic) visual biofeedback. Nineteen patients with dysphagia post stroke. Outpatient swallowing research laboratory. Randomized clinical trial. Patients underwent 2 study phases. Phase 1: first demonstrated ability to perform the vLVC accurately. Phase 2: vLVC training. Participants were randomized into three biofeedback groups including the ssEMG group (ssEMG biofeedback in both phases), the VF group (VF biofeedback in both phases), and the mixed group (VF phase 1, ssEMG phase 2). To promote the best vLVC performance, a clinician provided real-time, verbal cueing using only the visual biofeedback type also seen by the patient, although both VF and ssEMG were recorded for all participants. Patient performance accuracy and clinician feedback accuracy for performing the vLVC maneuver. Both accuracy of vLVC training performance and clinician feedback accuracy were worse in the ssEMG group compared with the VF and mixed groups (P < .001). Swallowing airway protection requires precisely timed movements of small, hidden laryngeal and pharyngeal structures. Kinematic biofeedback (VF) may be required, at some point, to ensure that target swallowing movements are being trained during rehabilitation, rather than maladaptive movements. I.
Sections du résumé
BACKGROUND
Dysphagia (swallowing impairment) is a common and often life-threatening problem after stroke. Submental surface electromyography (ssEMG) visual biofeedback is a commonly used clinical tool to train novel swallowing maneuvers, even though its effectiveness has been questioned.
OBJECTIVE
To compare the effect of ssEMG and videofluoroscopy (VF) visual biofeedback on swallowing airway protection accuracy when training the volitional laryngeal closure swallowing maneuver (vLVC) in poststroke patients with dysphagia. Researchers also examined whether clinicians accurately judged vLVC performance. The hypothesis was that patient vLVC accuracy and clinician verbal cue accuracy will be greatest with VF (kinematic) visual biofeedback.
PATIENTS
Nineteen patients with dysphagia post stroke.
SETTING
Outpatient swallowing research laboratory.
DESIGN
Randomized clinical trial.
METHODS
Patients underwent 2 study phases. Phase 1: first demonstrated ability to perform the vLVC accurately. Phase 2: vLVC training. Participants were randomized into three biofeedback groups including the ssEMG group (ssEMG biofeedback in both phases), the VF group (VF biofeedback in both phases), and the mixed group (VF phase 1, ssEMG phase 2). To promote the best vLVC performance, a clinician provided real-time, verbal cueing using only the visual biofeedback type also seen by the patient, although both VF and ssEMG were recorded for all participants.
MAIN OUTCOME MEASURE
Patient performance accuracy and clinician feedback accuracy for performing the vLVC maneuver.
RESULTS
Both accuracy of vLVC training performance and clinician feedback accuracy were worse in the ssEMG group compared with the VF and mixed groups (P < .001).
CONCLUSIONS
Swallowing airway protection requires precisely timed movements of small, hidden laryngeal and pharyngeal structures. Kinematic biofeedback (VF) may be required, at some point, to ensure that target swallowing movements are being trained during rehabilitation, rather than maladaptive movements.
LEVEL OF EVIDENCE
I.
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1159-1169Subventions
Organisme : NIDCD NIH HHS
ID : R01 DC014285
Pays : United States
Informations de copyright
© 2019 American Academy of Physical Medicine and Rehabilitation.
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