Biofeedback, Stroke, Swallowing (Dysphagia)

Biofeedback to improve swallowing after stroke

 The effect of using surface electromyographic feedback to treat dysphagia in stroke patients was studied by researchers at the University of Amsterdam, in the Netherlands.

First, the details.

  • 11 patients with chronic difficulty in swallowing after stroke were studied.
  • Treatment included the use of surface electromyography as biofeedback in addition to normal exercises.
    • Electromyography records the electrical activity in muscle.
  • These patients had been dysphasic for an average of 31 months.
  • All patients were previously treated by speech therapists without success.
  • Swallowing was estimated using the Functional Oral Intake Scale (FOIS).
    • FOIS is a 7-point scale used to estimate the type and amount of food that can be ingested safely.
  • At the start of treatment, 8 patients were being feed through tubes (FOIS: 4 or less), while 3 were on a restricted oral diet (FOIS: 5 or more).

And, the results.

  • Patients received an average of 7 treatments during a period that averaged 76 days.
  • Before treatment the average FOIS was 2.6, and after treatment it improved to 5.6 — a significant improvement in swallowing function.
  • In 6 of 8 patients being feed through tubes, it was possible to remove the feeding tube after treatment.

The bottom line?
The results suggest that “surface electromyography as biofeedback in the treatment of chronic dysphagia after stroke could be an effective adjunct to standard therapy for swallowing disorders,” concluded the authors.

Others have reported benefit and suggest that the practice is cost effective.

A review published in 2006 characterized the problem with this area of treatment. “Biofeedback for post-stroke dysphagia rehabilitation has been pioneered over recent years with commercial systems becoming more widely available. As yet, no randomized controlled trial has been reported.”

More recently, a Cochrane review in 2007 concluded electromyographic biofeedback plus standard physiotherapy does not produce improvements compared to physiotherapy alone. The biggest problem confronted by the reviewers was the lack of standardization of study design and measures of response to treatment.

We await the definitive randomized clinical study.

7/12/09 15:29 JR