Dysphagia After Different Swallowing Therapies

NCT ID: NCT03048916

Last Updated: 2017-02-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

58 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-08-01

Study Completion Date

2013-07-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Dysphagia after stroke is associated to increased pulmonary complications and mortality. The swallowing therapies could decrease the pulmonary complications and improve the quality of life after stroke. The swallowing therapies include dietary modifications, thermal stimulation, compensatory positions, and oropharyngeal muscle stimulation. Most researchers used clinical assessments and videofluoroscopy to evaluate the effect of the swallowing therapies. Some authors performed functional magnetic resonance imaging (fMRI) to investigate the brain neuroactivity during swallowing with tasks in normal adults and unilateral hemispheric stroke patients. The aim of this study is to explore the effect of swallowing therapies not only in clinical swallowing function but also brain plasticity of acute stroke patients with dysphagia by videofluoroscopy and fMRI.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

In the study, 10 healthy controls and 48 patients with a single and acute hemispheric or brain stem stroke will be enrolled. Both 24 hemispheric and 24 brain stem stroke patients will be divided into 3 groups. General swallowing therapy, oropharyngeal neuromuscular electrical stimulation (NMES), and combined general and NMES therapies will be randomly provided for the 3 groups. Each patient will receive clinical assessment of food oral intake scale, functional dysphagia scale of videofluoroscopy, and brain neuroactivity in fMRI.

The investigators hope to find the benefit of the swallowing therapies both in clinical swallowing function and in brain functional neuroactivity/reorganization after acute stroke. While comparing the 3 swallowing therapies, different functional neuroactivity may be facilitated by different swallowing therapies. Finally, the investigators could also find out the most effective swallowing therapy among the 3 therapies in acute stroke patients with dysphagia according to the findings of videofluoroscopy and fMRI.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Dysphagia Videofluoroscopy Stroke

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

general swallowing therapy

including:

* oral exercises
* tactile stimulation
* compensatory techniques
* swallowing maneuvers

Group Type OTHER

general swallowing therapy

Intervention Type OTHER

including a session of oral exercises, tactile stimulation, compensatory techniques, swallowing maneuvers that are taught to the participants by a speech therapist.

the NMES therapy with VitalStim therapeutic device

The placement of 2-channel electrodes is depended on the dysphagic types and the findings on VFS

Group Type EXPERIMENTAL

NMES therapy

Intervention Type OTHER

he NMES therapy with VitalStim therapeutic device will be done by one physician who is licensed practitioner and certified in use of the VitalStim device. The placement of 2-channel electrodes is depended on the dysphagic types and the findings on VFS.

: the combined NMES and general swallowing therapies

Group Type ACTIVE_COMPARATOR

general swallowing therapy

Intervention Type OTHER

including a session of oral exercises, tactile stimulation, compensatory techniques, swallowing maneuvers that are taught to the participants by a speech therapist.

NMES therapy

Intervention Type OTHER

he NMES therapy with VitalStim therapeutic device will be done by one physician who is licensed practitioner and certified in use of the VitalStim device. The placement of 2-channel electrodes is depended on the dysphagic types and the findings on VFS.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

general swallowing therapy

including a session of oral exercises, tactile stimulation, compensatory techniques, swallowing maneuvers that are taught to the participants by a speech therapist.

Intervention Type OTHER

NMES therapy

he NMES therapy with VitalStim therapeutic device will be done by one physician who is licensed practitioner and certified in use of the VitalStim device. The placement of 2-channel electrodes is depended on the dysphagic types and the findings on VFS.

Intervention Type OTHER

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* normal neurological examination
* no history of stroke
* no active neurological disorder


* a single cerebral hemispheric stroke
* swallowing difficulty: detected by bedside swallow assessment by a physician while admitting to the rehabilitation unit.


* a single brain stem stroke without prior stroke history
* swallowing difficulties: detected by bedside swallow assessment by a physician while admitting to the rehabilitation unit

Exclusion Criteria

* multiple brain lesions due to one episode of stroke
* impaired communication ability due to cognition deficit
* other central or peripheral neurological deficit leading to swallowing difficulty.
* use of an electrically sensitive biomedical device (eg. cardiac pacemaker)
* metal clip in the brain
* pneumonia at the time of enrollment.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Chang Gung Memorial Hospital

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Yu Chi Huang, Bachelor

Role: PRINCIPAL_INVESTIGATOR

Chang Gung Memorial Hospital

References

Explore related publications, articles, or registry entries linked to this study.

Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry. 1989 Feb;52(2):236-41. doi: 10.1136/jnnp.52.2.236.

Reference Type BACKGROUND
PMID: 2564884 (View on PubMed)

Meng NH, Wang TG, Lien IN. Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil. 2000 Mar-Apr;79(2):170-5. doi: 10.1097/00002060-200003000-00010.

Reference Type BACKGROUND
PMID: 10744192 (View on PubMed)

Paciaroni M, Mazzotta G, Corea F, Caso V, Venti M, Milia P, Silvestrelli G, Palmerini F, Parnetti L, Gallai V. Dysphagia following Stroke. Eur Neurol. 2004;51(3):162-7. doi: 10.1159/000077663. Epub 2004 Apr 1.

Reference Type BACKGROUND
PMID: 15073441 (View on PubMed)

Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005 Dec;36(12):2756-63. doi: 10.1161/01.STR.0000190056.76543.eb. Epub 2005 Nov 3.

Reference Type BACKGROUND
PMID: 16269630 (View on PubMed)

Foley N, Teasell R, Salter K, Kruger E, Martino R. Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing. 2008 May;37(3):258-64. doi: 10.1093/ageing/afn064.

Reference Type BACKGROUND
PMID: 18456790 (View on PubMed)

Smithard DG, Smeeton NC, Wolfe CD. Long-term outcome after stroke: does dysphagia matter? Age Ageing. 2007 Jan;36(1):90-4. doi: 10.1093/ageing/afl149. Epub 2006 Dec 15.

Reference Type BACKGROUND
PMID: 17172601 (View on PubMed)

Goulding R, Bakheit AM. Evaluation of the benefits of monitoring fluid thickness in the dietary management of dysphagic stroke patients. Clin Rehabil. 2000 Apr;14(2):119-24. doi: 10.1191/026921500667340586.

Reference Type BACKGROUND
PMID: 10763787 (View on PubMed)

Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurol. 2006 Jan;5(1):31-7. doi: 10.1016/S1474-4422(05)70252-0.

Reference Type BACKGROUND
PMID: 16361020 (View on PubMed)

DePippo KL, Holas MA, Reding MJ, Mandel FS, Lesser ML. Dysphagia therapy following stroke: a controlled trial. Neurology. 1994 Sep;44(9):1655-60. doi: 10.1212/wnl.44.9.1655.

Reference Type BACKGROUND
PMID: 7936292 (View on PubMed)

Dennis MS, Lewis SC, Warlow C; FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. 2005 Feb 26-Mar 4;365(9461):764-72. doi: 10.1016/S0140-6736(05)17983-5.

Reference Type BACKGROUND
PMID: 15733717 (View on PubMed)

Hamidon BB, Abdullah SA, Zawawi MF, Sukumar N, Aminuddin A, Raymond AA. A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke. Med J Malaysia. 2006 Mar;61(1):59-66.

Reference Type BACKGROUND
PMID: 16708735 (View on PubMed)

Burnett TA, Mann EA, Cornell SA, Ludlow CL. Laryngeal elevation achieved by neuromuscular stimulation at rest. J Appl Physiol (1985). 2003 Jan;94(1):128-34. doi: 10.1152/japplphysiol.00406.2002.

Reference Type BACKGROUND
PMID: 12486019 (View on PubMed)

Park CL, O'Neill PA, Martin DF. A pilot exploratory study of oral electrical stimulation on swallow function following stroke: an innovative technique. Dysphagia. 1997 Summer;12(3):161-6. doi: 10.1007/PL00009531.

Reference Type BACKGROUND
PMID: 9190102 (View on PubMed)

Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respir Care. 2001 May;46(5):466-74.

Reference Type BACKGROUND
PMID: 11309186 (View on PubMed)

Leelamanit V, Limsakul C, Geater A. Synchronized electrical stimulation in treating pharyngeal dysphagia. Laryngoscope. 2002 Dec;112(12):2204-10. doi: 10.1097/00005537-200212000-00015.

Reference Type BACKGROUND
PMID: 12461342 (View on PubMed)

Ludlow CL, Bielamowicz S, Daniels Rosenberg M, Ambalavanar R, Rossini K, Gillespie M, Hampshire V, Testerman R, Erickson D, Carraro U. Chronic intermittent stimulation of the thyroarytenoid muscle maintains dynamic control of glottal adduction. Muscle Nerve. 2000 Jan;23(1):44-57. doi: 10.1002/(sici)1097-4598(200001)23:13.0.co;2-e.

Reference Type BACKGROUND
PMID: 10590405 (View on PubMed)

Hagg M, Larsson B. Effects of motor and sensory stimulation in stroke patients with long-lasting dysphagia. Dysphagia. 2004 Fall;19(4):219-30. doi: 10.1007/s00455-004-0016-3.

Reference Type BACKGROUND
PMID: 15667056 (View on PubMed)

Martin RE, Sessle BJ. The role of the cerebral cortex in swallowing. Dysphagia. 1993;8(3):195-202. doi: 10.1007/BF01354538.

Reference Type BACKGROUND
PMID: 8359039 (View on PubMed)

Hamdy S, Rothwell JC, Aziz Q, Thompson DG. Organization and reorganization of human swallowing motor cortex: implications for recovery after stroke. Clin Sci (Lond). 2000 Aug;99(2):151-7.

Reference Type BACKGROUND
PMID: 10918049 (View on PubMed)

Ertekin C, Aydogdu I. Neurophysiology of swallowing. Clin Neurophysiol. 2003 Dec;114(12):2226-44. doi: 10.1016/s1388-2457(03)00237-2.

Reference Type BACKGROUND
PMID: 14652082 (View on PubMed)

Hamdy S, Aziz Q, Rothwell JC, Crone R, Hughes D, Tallis RC, Thompson DG. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke. Lancet. 1997 Sep 6;350(9079):686-92. doi: 10.1016/S0140-6736(97)02068-0.

Reference Type BACKGROUND
PMID: 9291902 (View on PubMed)

Hamdy S, Aziz Q, Rothwell JC, Power M, Singh KD, Nicholson DA, Tallis RC, Thompson DG. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology. 1998 Nov;115(5):1104-12. doi: 10.1016/s0016-5085(98)70081-2.

Reference Type BACKGROUND
PMID: 9797365 (View on PubMed)

Hamdy S, Aziz Q, Rothwell JC, Singh KD, Barlow J, Hughes DG, Tallis RC, Thompson DG. The cortical topography of human swallowing musculature in health and disease. Nat Med. 1996 Nov;2(11):1217-24. doi: 10.1038/nm1196-1217.

Reference Type BACKGROUND
PMID: 8898748 (View on PubMed)

Hamdy S, Rothwell JC, Aziz Q, Singh KD, Thompson DG. Long-term reorganization of human motor cortex driven by short-term sensory stimulation. Nat Neurosci. 1998 May;1(1):64-8. doi: 10.1038/264.

Reference Type BACKGROUND
PMID: 10195111 (View on PubMed)

Robbins J, Levin RL. Swallowing after unilateral stroke of the cerebral cortex: preliminary experience. Dysphagia. 1988;3(1):11-7. doi: 10.1007/BF02406275. No abstract available.

Reference Type BACKGROUND
PMID: 3248391 (View on PubMed)

Li S, Luo C, Yu B, Yan B, Gong Q, He C, He L, Huang X, Yao D, Lui S, Tang H, Chen Q, Zeng Y, Zhou D. Functional magnetic resonance imaging study on dysphagia after unilateral hemispheric stroke: a preliminary study. J Neurol Neurosurg Psychiatry. 2009 Dec;80(12):1320-9. doi: 10.1136/jnnp.2009.176214. Epub 2009 Jun 9.

Reference Type BACKGROUND
PMID: 19515639 (View on PubMed)

Robbins J, Levine RL, Maser A, Rosenbek JC, Kempster GB. Swallowing after unilateral stroke of the cerebral cortex. Arch Phys Med Rehabil. 1993 Dec;74(12):1295-300. doi: 10.1016/0003-9993(93)90082-l.

Reference Type BACKGROUND
PMID: 8259895 (View on PubMed)

Hamdy S, Mikulis DJ, Crawley A, Xue S, Lau H, Henry S, Diamant NE. Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol. 1999 Jul;277(1):G219-25. doi: 10.1152/ajpgi.1999.277.1.G219.

Reference Type BACKGROUND
PMID: 10409170 (View on PubMed)

Mosier K, Patel R, Liu WC, Kalnin A, Maldjian J, Baredes S. Cortical representation of swallowing in normal adults: functional implications. Laryngoscope. 1999 Sep;109(9):1417-23. doi: 10.1097/00005537-199909000-00011.

Reference Type BACKGROUND
PMID: 10499047 (View on PubMed)

Mosier KM, Liu WC, Maldjian JA, Shah R, Modi B. Lateralization of cortical function in swallowing: a functional MR imaging study. AJNR Am J Neuroradiol. 1999 Sep;20(8):1520-6.

Reference Type BACKGROUND
PMID: 10512240 (View on PubMed)

Kern MK, Jaradeh S, Arndorfer RC, Shaker R. Cerebral cortical representation of reflexive and volitional swallowing in humans. Am J Physiol Gastrointest Liver Physiol. 2001 Mar;280(3):G354-60. doi: 10.1152/ajpgi.2001.280.3.G354.

Reference Type BACKGROUND
PMID: 11171617 (View on PubMed)

Martin RE, Goodyear BG, Gati JS, Menon RS. Cerebral cortical representation of automatic and volitional swallowing in humans. J Neurophysiol. 2001 Feb;85(2):938-50. doi: 10.1152/jn.2001.85.2.938.

Reference Type BACKGROUND
PMID: 11160524 (View on PubMed)

O'Donoghue S, Bagnall A. Videofluoroscopic evaluation in the assessment of swallowing disorders in paediatric and adult populations. Folia Phoniatr Logop. 1999 Jul-Oct;51(4-5):158-71. doi: 10.1159/000021494.

Reference Type BACKGROUND
PMID: 10450023 (View on PubMed)

Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996 Spring;11(2):93-8. doi: 10.1007/BF00417897.

Reference Type BACKGROUND
PMID: 8721066 (View on PubMed)

Han TR, Paik NJ, Park JW. Quantifying swallowing function after stroke: A functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001 May;82(5):677-82. doi: 10.1053/apmr.2001.21939.

Reference Type BACKGROUND
PMID: 11346847 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

NMRPG896021

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Fine Motor Skills and Post-Stroke Swallowing
NCT05224973 ACTIVE_NOT_RECRUITING NA
Cough and Swallow Rehab Following Stroke
NCT01907321 COMPLETED PHASE1/PHASE2