Pilot study of a neurophysiological dysphagia therapy for neurological patients

Abstract

Objective: To investigate the success of a neurophysiological dysphagia therapy in patients with neurological disorders. Design: A pre- and post-intervention group study. Setting: Acute rehabilitation unit. Subjects: Ten patients (swallowing rate <1/5 minutes, Frühreha—Barthel Index <—150, tracheostomy as a result of a swallowing disorder) with dysphagia as a result of a head injury or cerebral haemorrhage. Interventions: Therapy was given based on facio-oral tract therapy for three weeks (15 sessions of 1 hour each). Measures: The general scales used were the Frühreha—Barthel Index and Coma Remission Scale. Measures of swallowing rate, alertness and swallowing ability were undertaken before, during and after the treatment sessions and at intervals of 30 minutes for 2 hours after the treatment sessions. Results: On the treatment days, the therapy did not lead to an increase in swallowing rate, but did lead to a significant increase in alertness. After completion of a single treatment session, there was a statistically significant decrease in alertness and swallowing rate for 90 minutes. An increase in alertness (Frühreha—Barthel Index and Coma Remission Scale), swallowing ability (measured using an endoscopic examination) and protection of the respiratory tract was observed over the entire therapy period. Conclusion: Facio-oral tract therapy led to a statistically significant increase in alertness during the treatment session and, over the entire therapy period, to an increase in swallowing rate, alertness and swallowing ability. The decrease in alertness following therapy sessions must be taken into account in planning rehabilitative measures. Further studies on larger populations as well as studies currently in progress should further elucidate the strategies employed to rehabilitate dysphagic patients.