Journal of Rehabilitation Medicine 51-2 | Page 22

J Rehabil Med 2019; 51: 97–102 ORIGINAL REPORT EFFECTS OF MECHANICAL INSPIRATION AND EXPIRATION EXERCISE ON VELOPHARYNGEAL INCOMPETENCE IN SUBACUTE STROKE PATIENTS Kyung Won JANG, MD 1 , Sook Joung LEE, MD, PhD 2 , Sang Beom KIM, MD, PhD 1 , Kyeong Woo LEE, MD, PhD 1 , Jong Hwa LEE, MD, PhD 1 and Jin Gee PARK, MD 1 From the 1 Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, and 2 Department of Physical Medicine and Rehabilitation, Daejeon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon, Republic of Korea Objective: To investigate the therapeutic effects of mechanical inspiration and expiration exercise using mechanical cough assist on velopharyngeal incom- petence in patients with subacute stroke. Design: Pilot, randomized controlled study. Setting: University-based rehabilitation centre. Subjects: Thirty-six patients with subacute stroke diagnosed with velopharyngeal incompetence by vi- deofluoroscopic swallowing study. Methods: Subjects were randomly assigned to 2 groups. The study group received conventio- nal dysphagia therapy and additional mechanical inspiration and expiration exercise. The control group received conventional dysphagia therapy only. Swallowing function was evaluated according to the American Speech-Language-Hearing association scale, functional dysphagia score, and the penetra- tion aspiration scale, based on the videofluoroscopic swallowing study. Coughing function was measured using peak cough flow. Results: Eighteen patients in each group completed the protocol and were analysed. After treatment, the study group showed significant improvement in functional dysphagia score with regard to nasal penetration degree. Comparing the treatment effect between the 2 groups, nasal penetration degree and peak cough flow showed greater improvement in the study group. Conclusion: Mechanical inspiration and expiration exercise had a therapeutic effect on velopharyng- eal incompetence in subacute stroke patients with dysphagia. This therapy is easy to provide clinically and could be a useful therapeutic strategy for velo­ pharyngeal incompetence with dysphagia in patients with stroke. Key words: stroke; velopharyngeal incompetence; mecha- nical inspiration and expiration exercise; videofluoroscopic swallowing study; deglutition disorders. Accepted Oct 23, 2018; Epub ahead of print Nov 14, 2018 J Rehabil Med 2019: 51: 97–102 Correspondence address: Sook Joung Lee, Department of Physical Medicine and Rehabilitation, Daejeon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Republic of Korea. E-mail: [email protected] A fter a stroke, many patients experience swal- lowing and coughing dysfunction. The reported LAY ABSTRACT Dysfunctional swallowing and coughing are common af- ter stroke. These functions are closely related as they both use the same expiration-related muscles. Velopha- ryngeal incompetence (VPI) is one of the symptoms of swallowing and coughing dysfunction. However, there have been few studies regarding treatment of VPI. This study investigated the therapeutic effects of mechanical inspiration and expiration (MIE) exercise, using mecha- nical cough assist, on VPI in subacute stroke patients with dysphagia. The degree of nasal penetration and peak cough flow were improved to a greater extent in patients in the MIE exercise group. MIE exercise was ef- fective on both swallowing and coughing function. This therapy is easy to apply in the clinical setting. Thus, MIE exercise may be a useful therapeutic strategy for VPI with dysphagia in patients with stroke. incidence of post-stroke dysphagia ranges from 37% to 64%, and it is one of the most common and seri- ous clinical symptoms during the acute stage (1, 2). Complications of dysphagia include dehydration, malnutrition, aspiration pneumonia, and asphyxia, all of which may be fatal (3, 4). Coughing is an important protective mechanism for maintaining a clear airway. Several studies have revealed that stroke patients can experience a decrease in coughing function (5–7) and decreased coughing may be a predictive factor for as- piration pneumonia after stroke (7–9). Cough function is closely related to swallowing function and plays an important role in airway protection after stroke, since afferent and efferent pathways of the cough reflex are shared with that of the swallowing reflex (9, 10). Previous studies of post-stroke swallowing or coughing dysfunction have focused exclusively on food aspiration or aspiration pneumonia (3, 6, 7, 11). However, there are various clinical manifestations of dysphagia after stroke apart from aspiration, including oral, pharyngeal, and oesophageal phase disorders. Therefore, early detection of dysphagia and appropriate management according to the dysphagia symptoms are important for post-stroke rehabilitation (3, 4). Velopharyngeal incompetence (VPI), which could be shown as nasal penetration, is one of the symptoms of cough and swallowing dysfunction after stroke. VPI This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2506