Effect of thickeners combined with swallowing exercises for patients with post‑stroke dysphagia&nbsp;

Pham,Van Minh; Nguyen,Thi Van; Nguyen,Thi Thanh Hoa; Le,Thi Huong

doi:10.3892/wasj.2024.239

Effect of thickeners combined with swallowing exercises for patients with post‑stroke dysphagia

Authors:
- Van Minh Pham
- Thi Van Nguyen
- Thi Thanh Hoa Nguyen
- Thi Huong Le
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Affiliations: Rehabilitation Department, Hanoi Medical University, Hanoi 100000, Vietnam, Clinical Nutrition Center, Vietnam National Cancer Hospital, Hanoi 100000, Vietnam
Published online on: March 27, 2024 https://doi.org/10.3892/wasj.2024.239
Article Number: 24
Copyright : © Pham et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

The present study examined the effect of thickeners combined with swallowing exercises on patients with dysphagia following stroke. A non‑control, one‑group pre‑test/post‑test quasi‑experiment was conducted. A convenience sampling method was used to recruit patients between July, 2020 and May, 2021. A total of 33 patients were treated by swallowing rehabilitation and oral feeding with thickeners. Their swallowing status was measured using the Mann Assessment of Swallowing Ability (MASA) scale. The proportion of patients with severe dysphagia decreased from 12.1 to 9.1% after 5 days, to 3% after 10 days and to no dysphagia after 15 days of treatment. The number of patients who were no longer at risk of developing aspiration pneumonia increased from 33.3 to 54.6% after 5 days, to 75.8% after 10 days and to 90.9% after 15 days of treatment. All symptoms of dysphagia improved. As regards early intervention (1‑4 weeks), the percentage of patients without dysphagia after 15 days was higher than that of those with moderate and severe dysphagia. On the whole, the present study demonstrates that a combination of swallowing exercises and using thickeners to adjust the diet for patients with dysphagia helps to reduce the severity of swallowing dysfunction and aspiration. Patients who received early intervention had a better prognosis. Swallowing exercises combined with thickeners should thus be used in adults in post‑stroke dysphagia rehabilitation programs.

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1	Krishnamurthi RV, Ikeda T and Feigin VL: Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: A systematic analysis of the global burden of disease study 2017. Neuroepidemiology. 54:171–179. 2020.PubMed/NCBI View Article : Google Scholar
2	Carr C, Kahn L, Mathkour M, Biro E, Bui CJ and Dumont AS: The shifting burden of neurosurgical disease: Vietnam and the middle-income nations. Neurosurg Focus. 45(E12)2018.PubMed/NCBI View Article : Google Scholar
3	Takizawa C, Gemmell E, Kenworthy J and Speyer R: A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson's disease, Alzheimer's disease, head injury, and pneumonia. Dysphagia. 31:434–441. 2016.PubMed/NCBI View Article : Google Scholar
4	Vesey S: Dysphagia and quality of life. Br J Community Nurs. 18:S14–19. 2013.PubMed/NCBI View Article : Google Scholar
5	Newman R, Vilardell N, Clavé P and Speyer R: Effect of bolus viscosity on the safety and efficacy of swallowing and the kinematics of the swallow response in patients with oropharyngeal dysphagia: White paper by the European society for swallowing disorders (ESSD). Dysphagia. 31:232–249. 2016.PubMed/NCBI View Article : Google Scholar
6	Kuhlemeier KV, Palmer JB and Rosenberg D: Effect of liquid bolus consistency and delivery method on aspiration and pharyngeal retention in dysphagia patients. Dysphagia. 16:119–122. 2001.PubMed/NCBI View Article : Google Scholar
7	Clavé P, Arreola V, Romea M, Medina L, Palomera E and Serra-Prat M: Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr. 27:806–815. 2008.PubMed/NCBI View Article : Google Scholar
8	Diniz PB, Vanin G, Xavier R and Parente MA: Reduced incidence of aspiration with spoon-thick consistency in stroke patients. Nutr Clin Pract. 24:414–418. 2009.PubMed/NCBI View Article : Google Scholar
9	Rofes L, Arreola V and Clavé P: The volume-viscosity swallow test for clinical screening of dysphagia and aspiration. Nestle Nutr Inst Workshop Ser. 72:33–42. 2012.PubMed/NCBI View Article : Google Scholar
10	Jongprasitkul H and Kitisomprayoonkul W: Effectiveness of conventional swallowing therapy in acute stroke patients with Dysphagia. Rehabil Res Pract. 2020(2907293)2020.PubMed/NCBI View Article : Google Scholar
11	Mann G: MASA, the mann assessment of swallowing ability. Vol. 1 New York, NY: Cengage Learning; (2002).
12	Antonios N, Carnaby-Mann G, Crary M, Miller L, Hubbard H, Hood K, Sambandam R, Xavier A and Silliman S: Analysis of a physician tool for evaluating dysphagia on an inpatient stroke unit: The modified mann assessment of swallowing ability. J Stroke Cerebrovasc Dis. 19:49–57. 2010.PubMed/NCBI View Article : Google Scholar
13	Kwon S, Sim J, Park J, Jung Y, Cho KH, Min K, Kim MY, Kim KM and Im SH: Assessment of aspiration risk using the mann assessment of swallowing ability in brain-injured patients with cognitive impairment. Front Neurol. 10(1264)2019.PubMed/NCBI View Article : Google Scholar
14	Mann G, Hankey GJ and Cameron D: Swallowing disorders following acute stroke: Prevalence and diagnostic accuracy. Cerebrovasc Dis. 10:380–386. 2000.PubMed/NCBI View Article : Google Scholar
15	Terré R and Mearin F: Oropharyngeal dysphagia after the acute phase of stroke: Predictors of aspiration. Neurogastroenterol Motil. 18:200–205. 2006.PubMed/NCBI View Article : Google Scholar
16	Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA and Foundas AL: Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 79:14–19. 1998.PubMed/NCBI View Article : Google Scholar
17	Warms T and Richards J: ‘Wet Voice’ as a predictor of penetration and aspiration in oropharyngeal dysphagia. Dysphagia. 15:84–88. 2000.PubMed/NCBI View Article : Google Scholar
18	Murray J, Langmore SE, Ginsberg S and Dostie A: The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia. 11:99–103. 1996.PubMed/NCBI View Article : Google Scholar
19	McCullough GH, Rosenbek JC, Wertz RT, McCoy S, Mann G and McCullough K: Utility of clinical swallowing examination measures for detecting aspiration post-stroke. J Speech Lang Hear Res. 48:1280–1293. 2005.PubMed/NCBI View Article : Google Scholar
20	Palmer JB, Pelletier CA and Matsuo K: Rehabilitation of patients with swallowing disorders. In: Braddom R. L., Chan L., Harrast M. A. et al., Editors. Physical Medicine and Rehabilitation. 4th. Philadelphia: Elsevier Saunders, 2011.
21	Lazarus CL, Logemann JA, Rademaker AW, Kahrilas PJ, Pajak T, Lazar R and Halper A: Effects of bolus volume, viscosity, and repeated swallows in nonstroke subjects and stroke patients. Arch Phys Med Rehabil. 74:1066–1070. 1993.PubMed/NCBI View Article : Google Scholar
22	Bülow M, Olsson R and Ekberg O: Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia. 16:190–195. 2001.PubMed/NCBI View Article : Google Scholar
23	Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M and Dikeman K: Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 122:1314–1321. 2002.PubMed/NCBI View Article : Google Scholar
24	Kwakkel G, Kollen B and Lindeman E: Understanding the pattern of functional recovery after stroke: Facts and theories. Restor Neurol Neurosci. 22:281–299. 2004.PubMed/NCBI