OBJECTIVETo study the surface electromyography (sEMG) changes of globus patients during swallowing and to discuss the cause of the globus.

METHODSThe sEMG during swallowing was recorded in 126 healthy volunteers (control group) and 34 globus patients (globus group).Swallow included dry swallow and 20 ml water swallow. The durations and amplitudes of muscle activities during every swallow were recorded. The durations and amplitudes of the sEMG in two groups were compared using t test.

RESULTSThe durations of sEMG at dry swallow and 20 ml water swallow were (1.128 ± 0.191)s and (1.091 ± 0.208)s, while the amplitudes were (0.313 ± 0.110) mV and (0.286 ± 0.106) mV in control group. The durations of sEMG at dry swallow and 20 ml water swallow were (1.178 ± 0.252)s and (1.127 ± 0.178)s, while the amplitudes were (0.341 ± 0.116) mV and (0.316 ± 0.094) mV in globus group. There were no significant differences between globus patients and healthy volunteers in the durations and amplitudes of sEMG at dry swallow and 20 ml water swallow (P > 0.05).Furthermore, there were also no significant differences in the durations and amplitudes of the sEMG between the two groups in the same gender (P > 0.05).

CONCLUSIONThe results of swallowing sEMG suggested that the swallowing function in globus patients has not been damaged and psychological intervention should be considered in the treatment.

Adult ; Deglutition ; physiology ; Deglutition Disorders ; physiopathology ; Electromyography ; Humans ; Mental Disorders

Deglutition ; physiology ; Deglutition Disorders ; physiopathology ; Humans ; Muscles ; physiopathology ; Stroke ; physiopathology ; Viscosity

This study evaluated the feasibility of mixed consistency foods test in patients with dysphagia which developed after stroke or other brain injuries. The findings of a videofluoroscopic swallow study (VFSS) were compared using single versus mixed consistency foods. Forty-nine patients with stroke or other brain injuries who had no significant abnormal findings in the single consistency food VFSS and started regular hospital diet were recruited for this study. Twenty-five (51%) of the 49 patients showed normal findings whereas 24 (49%) patients showed abnormal findings in the mixed consistency food VFSS. Abnormal findings included posterior spillage of liquid prematurely to pyriform sinus (n = 23), laryngeal penetration (n = 6), subglottic aspiration in the oral preparatory phase of swallowing (chewing), solid components (n = 2), and significant (more than 10%) residue in valleculae or pyriform sinus (n = 2). There was an increased risk of abnormal findings in mixed consistency food VFSS such as aspiration and penetration when a patient showed delayed pharyngeal delay time in single consistency food using liquids. In conclusion, VFSS protocols using mixed consistency foods would be useful before starting regular diet for patients after stroke or other brain injuries.
Brain Injuries/*physiopathology/radiography ; *Deglutition ; Deglutition Disorders/*physiopathology/radiography ; *Eating ; Fluoroscopy/*methods ; Food ; Humans ; Mastication ; Stroke/*physiopathology/radiography ; Video Recording

PURPOSE: To determine the effect of a 45degrees reclining sitting posture on swallowing in patients with dysphagia. MATERIALS AND METHODS: Thirty-four patients with dysphagia were evaluated. Videofluoroscopic swallowing study was performed for each patient in 90degrees upright and in 45degrees reclining sitting posture. Patients swallowed 5 types of boluses twice: sequentially 2 mL thin liquid, 5 mL thin liquid, thick liquid, yogurt, and cooked rice. Data such as the penetration-aspiration scale (PAS), oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time (PTT), residue in valleculae and pyriform sinuses, premature bolus loss, and nasal penetration were obtained. RESULTS: The mean PAS on the 2 mL thin liquid decreased significantly in the 45degrees reclining sitting posture (p=0.007). The mean PAS on 5 mL thin liquid in the 45degrees reclining sitting posture showed decreasing tendency. The residue in valleculae decreased significantly for all boluses in the 45degrees reclining sitting posture (p<0.001, p=0.002, p=0.003, p<0.001, p=0.020, respectively). The residue in pyriform sinuses increased significantly on 5 mL thin liquid, thick liquid, and yogurt (p=0.031, p=0.020, p=0.002, respectively). There were no significant differences in OTT, PDT, PTT, premature bolus loss, and nasal penetration between both postures. CONCLUSION: PAS on 2 mL thin liquid and residue in valleculae on all types of boluses were decreased in a 45degrees reclining sitting posture. Therefore, we believe that the 45degrees reclining sitting posture on swallowing is beneficial for the patients with penetration or aspiration on small amounts of thin liquid and large amounts of residue in valleculae.
Adult ; Deglutition/*physiology ; Deglutition Disorders/*physiopathology ; Female ; Fluoroscopy ; Humans ; Male ; Middle Aged ; Patient Positioning ; *Posture

OBJECTIVETo verify the clinical efficacy on post-stroke dysphagia treated with acupuncture at Lianquan (CV 23).

METHODSOne hundred and eighty patients were randomized into an acupuncture A group, an acupuncture B group and a rehabilitation group, 60 cases in each one. On the basis of the conventional medication, in the acupuncture A group, acupuncture was applied at Lianquan (CV 23); in the acupuncture B group, acupuncture was applied at Hegu (LI 4) and Neiguan (PC 6) and in the rehabilitation group, the swallowing rehabilitation training was adopted. The treatment was given once a day, 5 times a week, and the 4 weeks of treatment was required in all of the groups. The national institute of health stroke scale (NIHSS) and TV X-ray fluoroscope swallowing scale (VFSS) were used to evaluate neurologic deficit and swallowing function before and after treatment in the patients of each group. The morbidity of pneumonia and clinical efficacy were compared among the groups.

RESULTSThe scores of NIHSS and VFSS were improved apparently after treatment in the patients of the three groups (all P < 0.05) and the results in the acupuncture A group were superior to those in the other two groups (all P < 0.05). The morbidity of pneumonia in the acupuncture A group was lower than that in the acupuncture B group and the rehabilitation group [3.3% (2/60) vs 6.7% (4/60), 8.3% (5/60), both P < 0.05]. The effective rate in the acupuncture A group was better than that in either of the other two groups [95.0% (57/60) vs 81.7% (49/ 60), 75.0% (45/60), both P < 0.05].

CONCLUSIONOn the basis of the conventional medication, acupuncture at Lianquan (CV 23) effectively improves the swallowing function, relieves neurological deficit and reduces the morbidity of pneumonia in the patients of post-stroke dysphagia.

Acupuncture Therapy ; Aged ; Deglutition ; Deglutition Disorders ; etiology ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Quality of Life ; Stroke ; complications ; Treatment Outcome

OBJECTIVETo explore the therapeutic effect of dysphagia after stroke treated with different depth of Chonggu (EX-HN 27) by electroacupuncture.

METHODSTwo hundreds and eighty-three cases of dysphagia after stroke were randomly divided into Chonggu (EX-HN 27) deep insertion group (99 cases), Chonggu (EX-HN 27) shallow insertion group (94 cases) and traditional acupuncture group (90 cases) based on multi-central randomized control and blinding methods. Besides routine therapy, Chonggu (EX-HN 27) and Lianquan (CV 23) were selected in the Chonggu (EX-HN 27) deep insertion group and the Chonggu (EX-HN 27) shallow insertion group; the needles were inserted for 60-75 mm and 30 mm respectively and the electroacupuncture was applied in both groups; in traditional acupuncture group, Fengchi (GB 20), Yifeng (TE 17), Wangu (GB 12) and Lianquan (CV 23), etc. were selected. The needles were retained for 30 min, twice a day and 30 treatments totally in 3 groups. The clinical therapeutic effects were evaluated by Kubota's Water Drinking Test Scale, Standard Swallowing Function Scale and TCM Scale of Dysphagia After Stroke.

RESULTSThe total effective rate was 97.0% (96/99) in the Chonggu (EX-HN 27) deep insertion group, superior to that of 64.9% (61/94) in Chonggu (EX-HN 27) shallow insertion group and 70.0% (63/90) in traditional acupuncture group (both P < 0.05). Compared with the scores before and after treatment, significant differences were presented statistically in score reduction of TCM Scale in Chonggu (EX-HN 27) shallow insertion group (P < 0.01); the scores of Kubota's Water Drinking Test Scale, Standard Swallowing Function Scale and TCM Scale of Dysphagia After Stroke were obviously reduced in Chonggu (EX-HN 27) deep insertion group and traditional acupuncture group (all P < 0.01); compared with the scores between groups after treatment, the reduction of scores in Chonggu (EX-HN 27) deep insertion group was superior to those in Chonggu (EX-HN 27) shallow insertion group and traditional acupuncture group ( P < 0.05, P < 0.01) respectively.

CONCLUSIONPuncture at Chonggu (EX-HN 27) can improve the dysfunction of swallowing after stroke; it is safe and effective, and the needle should be inserted deeply.

Acupuncture Points ; Adult ; Aged ; Deglutition ; Deglutition Disorders ; etiology ; physiopathology ; therapy ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Stroke ; classification

OBJECTIVETo optimize primarily acupuncture program for dysphagia after cerebral infarction.

METHODSSixty-three patients with pseudobulbar palsy dysphasia after cerebral infarction were selected as the subjects. Water swallow test was adopted for observation index. Orthogonal design was used to study the different combinations of treatment programs among four factors and three levels, named acupuncture opportunity (factor A: A1: 1-10 d, A2: 11-20 d, A3: 21-40 d), point combination (factor B: B1: points in the neck, B2: points in the neck + points in the glossopharyngeal part, B3: points in the neck + points in the glossopharyngeal part + differentiating point), needling depth (factor C: C1: shallow puncture, C2: moderate puncture, C3: deep puncture), and treatment session (factor D: D1: 2 sessions, D2: 4 sessions, D3: 6 sessions); as well as the influences on pseudobulbar palsy dysphagia after cerebral infarction so as to determine primarily the optimized acupuncture program for dysphagia after cerebral infarction.

RESULTSThe direct analysis of orthogonal design indicated that the best level and the combination of four factors and three levels were A1 (or A2), B3, C3 and D3. It meant that for the patients less than 20 days for sickness, the points in the neck, points in the glossopharyngeal part and points selected according to syndrome differentiation were selected for deep puncture and the treatment lasted for 6 sessions. This program achieved the best improvement in water swallow test. The comparison between the primary effect and secondary effect among four factors (variance analysis) showed that factor A and C were the significant factors (P < 0.05), factor B and D were not significant (P > 0.05). It was suggested that acupuncture opportunity and needling depth played the significant roles in clinical efficacy. The comparison among different levels in terms of the significant factors A and C (multiple comparison) presented that A1 and A2 were superiorly significant than A3 (P < 0.001), A1 was not different in significance from A2 (P > 0.05). C3 was superiorly significant than C2 and C1 (P < 0.001, P < 0.01) and C2 was superiorly significant than C1 (P < 0.05).

CONCLUSIONBy the comprehensive summarization of direct analysis, variance analysis and multiple comparison combined with actual clinical situation, the optimal program of acupuncture treatment for pseudobulbar palsy dysphasia after cerebral infarction is that in terms of the four factors and three levels, for the patients within 1 to 20 days for sickness, acupuncture is applied to the points in the neck or combined with points in the glossopbaryngeal part or the points se-i lected according to syndrome differentiation, with deep puncture, for 4 to 6 sessions of treatment.

Acupuncture Therapy ; Aged ; Aged, 80 and over ; Cerebral Infarction ; complications ; Deglutition ; Deglutition Disorders ; etiology ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged

OBJECTIVE: To evaluate the swallowing function and the incidence of swallowing dysfunction in the elderly, and study the effect of age on swallowing function. METHOD: A total of 1040 (age > or = 55 years) elderly-to-be and elderly who undertaken the health examination in health examination center of our hospital from March 16, 2012 to April 9, 2012 were included in this study. The incidence of swallowing dysfunction in the elderly and the effect of age on swallowing function were evaluated. The subjects with stroke, esophageal cancer, parkinson's disease, deglutition syncope, esophageal spasm, thyrohyoid cyst and so on were defined as basic disease group, the other as normal group. The incidence of swallowing dysfunction was compared between the two groups. RESULT: The incidences of swallowing dysfunction in basic disease group and normal group were 74.4% (29/39) and 5.5% (55/1001), and there was a significant difference between the two groups (P < 0.001). The swallowing dysfunction rates of elderly-to-be and elderly in normal group were 2.9% (9/311) and 6.7/% (46/690) and the difference between the two groups was significant (P < 0.05). With the growth of age, the swallowing dysfunction rate in different age group increased, and the number of rapid swallow in 30 s decreased gradually (P < 0. 001). CONCLUSION Stroke, esophageal cancer, Parkinson's disease and so on are the main causes of swallowing dysfunction in elderly. The swallowing dysfunction rate is 6.7% in the normal elderly. With the growth of age, the incidence of swallowing dysfunction is increased and the swallowing speed is decreased.
Age Factors ; Aged ; Aged, 80 and over ; Case-Control Studies ; Deglutition ; physiology ; Deglutition Disorders ; epidemiology ; physiopathology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Parkinson Disease ; physiopathology ; Stroke ; physiopathology

OBJECTIVETo compare the therapeutic effect of five-needle-in-nape acupuncture treatment and the routine acupuncture treatment for poststroke pesudobulbar paralysis dysphagia.

METHODSSixty cases were randomly divided into a five-needle-in-nape (FNN) group and a routine acupuncture (RA) group (n=30 in each group). Ya-men (GV 15), Tianzhu (BL10), Zhiqiang acupoint (Extra) were needled and the training of swallowing was practiced when needling in FNN group. Lianquan (CV 23), Tongli (HT 5), Zhaohai (KI 6) were needled in RA group. The course of acupuncture treatment consisted of needling once time every day, six times a week for two weeks. The therapeutic effects were evaluated after two courses of acupuncture treatment.

RESULTSThe effective rate was 93.3% in FNN group, better than that of 80.0% in RA group (P < 0.05).

CONCLUSIONThe therapeutic effect in FNN group was better than that of RA group for poststroke pesudobulbar paralysis dysphagia.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Bulbar Palsy, Progressive ; etiology ; physiopathology ; therapy ; Deglutition ; Deglutition Disorders ; etiology ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications ; Treatment Outcome

OBJECTIVE: To study the reliability and validity of the Chinese Eating Assessment Tool (EAT-10) in evaluation of acute stroke patients with dysphagia.
 METHODS: The inpatients of stroke were assessed with Chinese EAT-10. As a golden standard for evaluation of dysphagia, videofluoroscopic swallow study (VFSS) test was used to judge the reliability and validity of EAT-10.
 RESULTS: A total of 130 qualified questionnaires were collected. The Cronbach's alpha coefficient for Chinese EAT-10 scale was 0.845. The total score of each item was related. The lowest or highest correlation coefficient for the item 2 or 3 was 0.271 or 0.772. The retest reliability was greater than 0.7, which met the requirements. According to the investigator consistency reliability test, the value collected from the investigator in the item 2 kept constant. The consistent correlation coefficient of the remaining nine items was more than 0.7. The consistency between each item and the mean score was high. The EAT-10 with the cut-off point at 1 was an optimal cut-off point. With the cut-off value of 1 (EAT-10 score ≥ 1), the sensitivity and specificity for EAT-10 was 77.9% and 66.1%, respectively. The positive predictive value (PPV) and negative value (NPV) was 71.6% and 73.2%, respectively, with 2.30 LHR+ and 0.33 LHR- for dysphagia. 
 CONCLUSION The Chinese EAT-10 has a good reliability and validity in evaluation of the acute stroke patients with dysphagia. The sensitivity and negative value are the best with the cut-off value of 1 (EAT-10 score ≥ 1). It offers a good way to discriminate dysphagia, impaired efficacy, penetrations, and aspirations in acute stroke patients.
Asian Continental Ancestry Group ; Deglutition Disorders ; physiopathology ; Eating ; Humans ; Inpatients ; Reproducibility of Results ; Sensitivity and Specificity ; Stroke ; physiopathology ; Surveys and Questionnaires