Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial.
OBJECTIVE
To evaluate the effectiveness of inspiratory/expiratory muscle training (IEMT) and neuromuscular electrical stimulation (NMES) to improve dysphagia in stroke.


METHODS
Prospective, single-blind, randomized-controlled trial.


METHODS
Tertiary public hospital.


METHODS
Sixty-two patients with dysphagia were randomly assigned to standard swallow therapy (SST) (Group I, controls, n=21), SST+ IEMT (Group II, n=21) or SST+ sham IEMT+ NMES (Group III, n=20).


METHODS
All patients followed a 3-week standard multidisciplinary rehabilitation program of SST and speech therapy. The SST+IEMT group's muscle training consisted of 5 sets/10 repetitions, twice-daily, 5 days/week. Group III's sham IEMT required no effort; NMES consisted of 40-minute sessions, 5 days/week, at 80Hz.


RESULTS
Dysphagia severity, assessed by Penetration-Aspiration Scale, and respiratory muscle strength (maximal inspiratory and expiratory pressures) at the end of intervention and 3-month follow-up.


RESULTS
Maximal respiratory pressures were most improved in Group II: treatment effect was 12.9 (95% confidence interval 4.5-21.2) and 19.3 (95% confidence interval 8.5-30.3) for maximal inspiratory and expiratory pressures, respectively. Swallowing security signs were improved in Groups II and III at the end of intervention. No differences in Penetration-Aspiration Scale or respiratory complications were detected between the 3 groups at 3-month follow-up.


CONCLUSIONS
Adding IEMT to SST was an effective, feasible, and safe approach that improved respiratory muscle strength. Both IEMT and NMES were associated with improvement in pharyngeal swallowing security signs at the end of the intervention, but the effect did not persist at 3-month follow-up and no differences in respiratory complications were detected between treatment groups and controls.
1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain.|2 Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain.|3 Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain.
Anna
A
Guillén-Solà
1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain.
Monique
M
Messagi Sartor
1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain.
Neus
N
Bofill Soler
1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain.
Esther
E
Duarte
1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain.
Mª Camelia
MC
Barrera
1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain.|2 Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain.|3 Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain.
Ester
E
Marco
D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D001945:Breathing Exercises / Q000379:methods*; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013070:Speech Therapy / Q000379:methods*; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D000071939:Stroke Rehabilitation / Q000379:methods*; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
Neuromuscular electrical stimulation; oropharyngeal dysphagia; rehabilitation; respiratory muscle training; stroke