Based on his extensive clinical experience and the team's mechanistic research, Professor XU Nenggui has proposed the academic concept that "the governor vessel governs the brain and treats cerebral viscus diseases", and established a novel acupuncture approach for encephalopathy treatment centered on the integrated theory of "governor vessel-brain-mind", and developed a staged acupuncture protocol of "governor vessel regulating spirit" for ischemic stroke. This article introduces the academic features of this method in treating post-stroke dysphagia from four aspects: theoretical framework, treatment principles and point selection, mechanistic research, and clinical case studies. In clinical application, the method emphasizes syndrome differentiation based on meridians, harmonization between the conception and governor vessels; precise acupoint selection to treat both form and spirit; stage-specific differentiation with targeted needling. Furthermore, Professor XU integrates basic research with clinical practice, focusing on the neurobiological mechanisms underlying the efficacy of acupuncture in treating post-stroke dysphagia.
Acupuncture Therapy/methods* ; Humans ; Deglutition Disorders/psychology* ; Stroke/complications* ; Meridians ; Acupuncture Points

OBJECTIVE: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients in a rehabilitation hospital. METHODS: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) between January 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameters were assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla, cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functional ambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairment were assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE), respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervals of the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. RESULTS: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stage was associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of the VFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietary and fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed that the pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for the potential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlated with the dietary and fluid intake methods and pontine stroke, respectively. CONCLUSION: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higher risks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.
Activities of Daily Living ; Aspirations (Psychology) ; Basal Ganglia ; Brain ; Cerebellum ; Cognition Disorders ; Deglutition Disorders ; Deglutition* ; Diet ; Humans ; Medical Records ; Mesencephalon ; Multivariate Analysis ; Odds Ratio ; Oral Stage ; Pons ; Rehabilitation ; Retrospective Studies ; Stroke* ; Thalamus ; Walking

OBJECTIVE: To prospectively assess the association between impoverished sensorimotor integration of the tongue and lips and post-extubation dysphagia (PED). METHODS: This cross-sectional study included non-neurologic critically ill adult patients who required endotracheal intubation and underwent videofluoroscopic swallowing study (VFSS) between October and December 2016. Participants underwent evaluation for tongue and lip performance, and oral somatosensory function. Demographic and clinical data were retrieved from medical records. RESULTS: Nineteen patients without a definite cause of dysphagia were divided into the non-dysphagia (n=6) and the PED (n=13) groups based on VFSS findings. Patients with PED exhibited greater mean duration of intubation (11.85±3.72 days) and length of stay in the intensive care unit (LOS-ICU; 13.69±3.40 days) than those without PED (6.83±5.12 days and 9.50±5.96 days; p=0.02 and p=0.04, respectively). The PED group exhibited greater incidence of pneumonia, higher videofluoroscopy swallow study dysphagia scale score, higher oral transit time, and lower tongue power and endurance and lip strength than the non-dysphagia groups. The differences in two-point discrimination and sensations of light touch and taste among the two groups were insignificant. Patients intubated for more than 7 days exhibited lower maximal tongue power and tongue endurance than those intubated for less than a week. CONCLUSION: Duration of endotracheal intubation, LOS-ICU, and oromotor degradation were associated with PED development. Oromotor degradation was associated with the severity of dysphagia. Bedside oral performance evaluation might help identify patients who might experience post-extubation swallowing difficulty.
Adult ; Critical Illness* ; Cross-Sectional Studies ; Deglutition ; Deglutition Disorders* ; Discrimination (Psychology) ; Fluoroscopy ; Humans ; Incidence ; Intensive Care Units ; Intubation ; Intubation, Intratracheal ; Length of Stay ; Lip ; Medical Records ; Pneumonia ; Prospective Studies ; Sensation ; Tongue*

Percutaneous radiologic gastrostomy (PRG) is an enteral nutritional method that can be applied to a patient with dysphagia due to cerebrovascular accident, Parkinsonism, dementia, or head and neck cancer. PRG is a safe and cost-effective method with low morbidity and mortality rates compared with surgical gastrostomy, because it require less sedation and less invasive placement technique. PRG complications include wound infections, peritonitis, tube malfunctions, peristomal leakage, bleeding, ileus, pneumoperitoneum, aspiration pneumonia, and bowel perforation. But, bowel perforation after PRG is rare. We recently experienced a case of transverse colon penetration and tube displacement, which occurred as a PRG complication in a 60-year-old male with a cerebrovascular accident.
Colon, Transverse ; Deglutition Disorders ; Dementia ; Displacement (Psychology) ; Gastrostomy ; Head and Neck Neoplasms ; Hemorrhage ; Humans ; Ileus ; Male ; Middle Aged ; Parkinsonian Disorders ; Peritonitis ; Pneumonia, Aspiration ; Pneumoperitoneum ; Stroke ; Wound Infection

Collet-Sicard syndrome is a rare condition characterized by the unilateral paralysis of the 9th through 12th cranial nerves. We describe a case of a 46-year-old man who presented with dysphagia after a falling down injury. Computed tomography demonstrated burst fracture of the atlas. Physical examination revealed decreased gag reflex on the left side, decreased laryngeal elevation, tongue deviation to the left side, and atrophy of the left trapezius muscle. Videofluoroscopic swallowing study (VFSS) revealed frequent aspirations of a massive amount of thick liquid and incomplete opening of the upper esophageal sphincter during the pharyngeal phase. We report a rare case of Collet-Sicard syndrome caused by Jefferson fracture.
Aspirations (Psychology) ; Atrophy ; Cranial Nerve Injuries ; Cranial Nerves ; Deglutition ; Deglutition Disorders ; Esophageal Sphincter, Upper ; Humans ; Middle Aged ; Muscles ; Paralysis ; Physical Examination ; Reflex ; Tongue

Paraesophageal hernias are rare, accounting only for about 5% of all hiatal hernias but can sometimes lead to life-threatening complications such as bleeding, obstruction, incarceration, and strangulation. Accordingly, the surgical repair of paraesophageal hernia must be performed irrespectively of symptoms. Laparoscopic techniques of paraesophageal hernia offer several advantages compared with open techniques, including smaller incision, less traumatic handling of tissues, less postoperative pain. In this report, we describe a case of paraesophageal hernia complicated with gastric volvulus, which has been successfully repaired by the laparoscopic approach. A 79-year-old female was suffering from dysphagia, abdominal pain and intermittent vomiting for several months, and a paraesophageal hernia with partial gastric outlet obstruction due to gastric volvulus was diagnosed. The patient underwent the reduction of the hernia, dissection of the sac, crural repair and fundoplication via a laparoscopic approach. She recovered early and has been doing well on follow up with no recurrence.
Abdominal Pain ; Accounting ; Aged ; Deglutition Disorders ; Female ; Follow-Up Studies ; Fundoplication ; Gastric Outlet Obstruction ; Handling (Psychology) ; Hemorrhage ; Hernia ; Hernia, Hiatal ; Humans ; Laparoscopy ; Pain, Postoperative ; Recurrence ; Stomach Volvulus ; Stress, Psychological ; Vomiting

Acute complications following stroke may increase mortality and impede functional recovery. Most of the complications are treatable and preventable. Close monitoring of the complications and proper management are necessary for the better outcome of the patients. Common complications include aspiration pneumonia, dysphagia, urinary tract infection, incontinence, malnutrition, deep vein thrombosis, pressure sore, fall, pain, seizure, and depression. Proper positioning and early mobilization are recommended to prevent major complications. Aspiration pneumonia is one of the frequent causes of death in acute stroke setting. Dysphagia screening should be done to evaluate the risk of aspiration. If oral feeding is not safe, nasogastric tube feeding should be considered. The majority of urinary tract infections in acute stroke are associated with the use of indwelling catheters, therefore prolonged indwelling catheterization should be avoided. Nutritional assessment and supplements are necessary in acute stroke patients. Low dose subcutaneous heparin or low molecular weight heparin should be considered for patients with high risk of deep vein thrombosis. If heparin is contraindicated, compressive stockings are an alternative. Regular assessment for skin breakdown and fall risk is recommended for all patients. Shoulder pain is also one of the frequent complications in stroke patients. Proper handling and mobilization in acute stage may prevent shoulder pain. Administration of anticonvulsants may prevent recurrent post-stroke seizures. Depression may limit functional outcome by inhibiting patient motivation and treatment with antidepressants should be considered. Proper management of acute complications needs multidisciplinary team approach that consists of physicians, nurses, therapists, and nutritionists. Adequate prevention and management of complications may improve functional outcome of acute stroke.
Anticonvulsants ; Antidepressive Agents ; Catheters, Indwelling ; Cause of Death ; Deglutition Disorders ; Depression ; Early Ambulation ; Enteral Nutrition ; Handling (Psychology) ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Malnutrition ; Mass Screening ; Motivation ; Nutrition Assessment ; Pneumonia, Aspiration ; Pressure Ulcer ; Seizures ; Shoulder Pain ; Skin ; Stroke ; Urinary Tract Infections ; Venous Thrombosis