Where the hell is the protocol located so that survivors can easily find it and bring it to their therapists and doctor's attention? Expecting your doctors and therapists to be up-to-date on stroke rehab is a complete exercise in futility.
Pharyngeal electrical stimulation for neurogenic dysphagia following stroke, traumatic brain injury or other causes: Main results from the PHADER cohort study
- et al.
Abstract
Background
Neurogenic
dysphagia is common and has no definitive treatment. We assessed
whether pharyngeal electrical stimulation (PES) is associated with
reduced dysphagia.
Methods
The
PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia
European Registry (PHADER) was a prospective single-arm observational
cohort study. Participants were recruited with neurogenic dysphagia
(comprising five groups – stroke not needing ventilation; stroke needing
ventilation; ventilation acquired; traumatic brain injury; other
neurological causes). PES was administered once daily for three days.
The primary outcome was the validated dysphagia severity rating scale
(DSRS, score best-worst 0–12) at 3 months.
Findings
Of
255 enrolled patients from 14 centres in Austria, Germany and UK, 10
failed screening. At baseline, mean (standard deviation) or median
[interquartile range]: age 68 (14) years, male 71%, DSRS 11·4 (1·7),
time from onset to treatment 32 [44] days; age, time and DSRS differed
between diagnostic groups. Insertion of PES catheters was successfully
inserted in 239/245 (98%) participants, and was typically easy taking
11·8 min. 9 participants withdrew before the end of treatment. DSRS
improved significantly in all dysphagia groups, difference in means (95%
confidence intervals, CI) from 0 to 3 months: stroke (n = 79) –6·7 (–7·8, –5·5), ventilated stroke (n = 98) –6·5 (–7·6, –5·5); ventilation acquired (n = 35) –6·6 (–8·4, –4·8); traumatic brain injury (n = 24)
-4·5 (–6·6, –2·4). The results for DSRS were mirrored for
instrumentally assessed penetration aspiration scale scores. DSRS
improved in both supratentorial and infratentorial stroke, with no
difference between them (p = 0·32). In previously ventilated participants with tracheotomy, DSRS improved more in participants who could be decannulated (n = 66) –7·5 (–8·6, –6·5) versus not decannulated (n = 33) –2·1 (–3·2, –1·0) (p<0·001). 74 serious adverse events (SAE) occurred in 60 participants with pneumonia (9·2%) the most frequent SAE.
Interpretation
In
patients with neurogenic dysphagia, PES was safe and associated with
reduced measures of dysphagia and penetration/aspiration.
Funding
Phagenesis Ltd.
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