Article

OBJECTIVE: To evaluate the effectiveness of inspiratory/expiratory muscle
training (IEMT) and neuromuscular electrical stimulation (NMES) to improve
dysphagia in stroke. DESIGN: Prospective, single-blind, randomized-controlled
trial. SETTING: Tertiary public hospital. SUBJECTS:
Sixty-two patients with
dysphagia were randomly assigned to standard swallow therapy (SST) (Group I,
controls, n=21), SST+ IEMT (Group II, n=21) or SST+ sham IEMT+ NMES (Group III,
n=20). INTERVENTIONS: All patients followed a 3-week standard multidisciplinary
rehabilitation program of SST and speech therapy. The SST+IEMT group's muscle
training consisted of 5 sets/10 repetitions, twice-daily, 5 days/week. Group
III's sham IEMT required no effort; NMES consisted of 40-minute sessions, 5
days/week, at 80Hz. MAIN OUTCOMES: Dysphagia severity, assessed by
Penetration-Aspiration Scale, and respiratory muscle strength (maximal
inspiratory and expiratory pressures) at the end of intervention and 3-month
follow-up. RESULTS: Maximal respiratory pressures were most improved in Group II:
treatment effect was 12.9 (95% confidence interval 4.5-21.2) and 19.3 (95%
confidence interval 8.5-30.3) for maximal inspiratory and expiratory pressures,
respectively. Swallowing security signs were improved in Groups II and III at the
end of intervention. No differences in Penetration-Aspiration Scale or
respiratory complications were detected between the 3 groups at 3-month
follow-up. CONCLUSION: Adding IEMT to SST was an effective, feasible, and safe
approach that improved respiratory muscle strength. Both IEMT and NMES were
associated with improvement in pharyngeal swallowing security signs at the end of
the intervention, but the effect did not persist at 3-month follow-up and no
differences in respiratory complications were detected between treatment groups
and controls.

Langue : ANGLAIS