INTERMITTENT ORAL CATHETERIZATION (IOC) FOR DYSPHAGIC PATIENTS
Yoshio Tokuda, Toshiro Kisa, Masayuki Igo (Shimane Prefectural Central Hospital, Izumo, Japan)
Abstract: Intermittent oral catheterization (IOC) is a potential treatment for patients with decreased pharyngeal reflexes. The method was tested on 29 hemiplegic stroke patients with feeding dysphagia.
In the experimental group, 23 patients (79%) became nasal catheter-free, and 20 patients (69%) were able to consume "specially cooked foods for feeding dysphagia" or almost normal foods, a significantly higher incidence than that for the control group (p<0.01). Pharyngeal reflexes recovered slightly in 16 (64%) of the 25 patients in the subject group. Passage time through the pharynx was shortened in 12 recent patients examined by videofluorography.
IOC should prove a useful adjunct to other therapy and management methods used with feeding dysphagia.
THE PROGNOSIS OF DYSPHAGIA IN INDIVIDUALS WITH BRAIN STEM STROKE
Nai-Hsin Men (National Taiwan University, Taipei, Taiwan), Tyng-Guey Wang (National Taiwan University, Taipei, Taiwan), Hsin-Shui Chen (China Medical College, TaiChung, Taiwan), Fu-Mai Hsieh (National Taiwan University, Taipei, Taiwan), I-Nan Lien (National Taiwan University, Taipei, Taiwan)
Objective: To define the outcome of dysphagia in patients with brain stem stroke (BSS) and further analyze the probably relative factors of their prognosis in an attempt to better understanding the full picture of swallowing disorder in BSS patients.
Methods: Chart review of 39 consecutive BSS patients referred to a rehabilitation unit within one month of their stroke over a three and haft-year period for evaluation and training of swallowing disorder. Clinical evaluation of swallowing function was performed by an expert speech pathologist on all patients. Videofluoroscopic modified barium swallow test was done on the patients who had ability to do it. The swallowing condition was reevaluated at two months and one year after their stroke. Two patients were excluded in the initial evaluation because of inadequate information and three more loss of follow-up at one year.
Result: Thirty of the 37 (81%) BSS patients had swallowing disorder at the initial evaluation and 23 of them (61%) depended on nasogastric (NG) tube feeding. At the third month of their stroke, only nine patients (24%) still had swallowing problem and can not be fed by mouth. After one year from onset of stroke, 8% (3/34) patients remained severe dysphagia and needed NG or gastrostomy tube. The patients with medulla lesion, reduced gag reflex, delayed swallow reflex, as well as wet voice in initial evaluation had significant high risk of prolonging dysphagia.
Conclusion: For patients with BSS, 80% had swallowing problem in acute stage but only 20% can not intake food by oral when they discharged from hospital. 8% of BSS patients would suffer permanent dysphagia. Those with medulla lesion, impaired gag reflex, delayed swallow reflex and presence of wet voice were risky in dysphagia.