Effects of Different Modes of Action Observation Therapy on Swallowing Function After Stroke: a Study Based on fNIRS

Qilu Hospital of Shandong University90 enrolled

Overview

Dysphagia is one of the most common symptoms of stroke patients, which seriously affects the quality of life of patients and delays the progress of rehabilitation. At present, the commonly used clinical swallowing treatment methods can achieve certain therapeutic effects, but the treatment effect of some patients is still not ideal. Therefore, we need to explore more and more effective treatment methods to improve the swallowing function of patients. Action observation therapy, which was developed based on the mirror neuron theory, has been widely used in the rehabilitation of limb motor function, and its therapeutic effect has been verified by a large number of clinical trials. There are few clinical studies on action observation therapy in swallowing function rehabilitation, and most of the current studies use swallowing videos to allow patients to observe actions, and then guide patients to imitate actions. Some studies have found that oral mirror neurons can be formed in the context of familiar environment, people and emotional communication. Therefore, this study proposes a new mode of action observation therapy for dysphagia, that is, to observe the real swallowing movement in actual daily life, in order to better improve the swallowing function of stroke patients with dysphagia. This study was a single-center, assessor-blinded, randomized controlled study. After enrollment, all patients received swallowing assessment, including scale assessment (WST, FOIS, SSA, BMI, SWAL-QOL, VAS satisfaction survey, KVIQ motor imagery assessment, total oral intake/eating time), neck ultrasound and FNIRS brain function assessment. According to the random number table method, the patients were divided into three groups, A: control group, B: video swallowing movement observation therapy group, C: daily actual swallowing movement observation therapy group. All three groups were given routine swallowing function training. In group B, action observation therapy with video was added, that is, watching a video of swallowing action with sound, and then performing simulated swallowing action. Group C added the actual swallowing movement observation therapy in daily life, that is, in actual daily life, to observe the real eating and swallowing movement of relatives, and then imitate the swallowing movement. The training sessions were 30min each time, once a day, 5 days a week, for a total of 3 weeks. After the treatment, the scale assessment, neck ultrasound and FNIRS brain function assessment were performed again.

Study Type

INTERVENTIONAL

Allocation

Interventions

Daily life actual swallowing movement observation therapyBEHAVIORAL

This group adds the therapy of observing actual swallowing movements in daily life, that is, in real daily life, observing the real eating and swallowing movements of relatives. They select meals that the patient likes or those that are complete in color, aroma and taste and look appetizing. The swallowing movements should be as slow and exaggerated as possible, and a look of savoring and enjoying the food should be shown, so that the patient can better observe the movements of the mouth and larynx during swallowing. Then, the patient imitates the swallowing movements.

Video swallowing action observation therapyBEHAVIORAL

Video swallowing action observation therapy

Traditional swallowing trainingBEHAVIORAL

Traditional swallowing training

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 1: 1.n accordance with the diagnostic criteria formulated by the Fourth National Academic Conference on Cerebrovascular disease; 2: 2.Dysphagia was detected by water swallowing test; 3: 3.First onset, course of disease within 6 months, the condition is stable; 4: 4.Mini-mental state examination (MMSE) score, literacy \>=17 points, primary education \>=20 points, secondary education \>=24 points, can understand and cooperate with treatment; 5: 5.Have a certain degree of sitting balance ability, can maintain a sitting position for 30 minutes; 6: 6.Aged 18-80 years old; 7: 7.The patient was informed and consented to this study, and the patient's family was informed and trained, and could cooperate with the adjuvant treatment of swallowing movement observation therapy in daily life. Exclusion Criteria: * 1: Patients with impaired swallowing function due to other reasons; 2: Presence of tumors or other lesions in the mouth or throat; 3: Visual and hearing dysfunction; 4: The presence of agnosia, apraxia or unilateral neglect; 5: Severe cognitive impairment and mental and emotional instability can not cooperate with treatment; 6: Implantation or retention of ferromagnetic metals in the brain.

Outcomes

Primary Outcomes

Functional Oral Intake Scale（FOIS）

This scale is divided into 7 levels in total, which is used to assess the oral feeding ability of the subjects. The higher the level, the better the function. Level 1: Unable to take food orally; Level 2: Dependent on tube feeding, able to attempt very small amounts of food or liquids orally; Level 3: Dependent on tube feeding, able to take food or liquids of a single texture orally; Level 4: Completely able to take food of a single texture orally; Level 5: Completely able to take food of multiple textures orally, but requiring special preparation or compensatory measures; Level 6: Completely able to take food orally without special preparation, but with specific food restrictions; Level 7: Completely able to take food orally without any restrictions.

Time frame: Assessment before intervention and 3 weeks after intervention after enrollment.