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

Affiliations
  • 1Department of Physical Medicine and Rehabilitation, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea. shf3226@naver.com

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

  • Fig. 1. Study flow chart.

  • 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.


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