腦中風後吞嚥障礙的復健治療與近期發展

Poststroke Swallowing Rehabilitation and Recent Development

10.6315/TJPMR.202112_49(2).0001

孫淑芬(Shu-Fen Sun)；張炳鑫(Ping-Hsin Chang)；許健威(Chien-Wei Hsu)；劉亦修(I-Hsiu Liou)

吞嚥障礙（dysphagia） ； 電刺激（electrical stimulation） ； 腦中風（stroke） ； 中風相關的肺炎（stroke-associated pneumonia） ； 吞嚥復健（swallowing rehabilitation） ； dysphagia ； electrical stimulation ； stroke ； stroke-associated pneumonia ； swallowing rehabilitation

台灣復健醫學雜誌

49卷2期（2021 / 12 / 01）

129 - 145

繁體中文

吞嚥障礙是腦中風常見的併發症，和吸入、營養不良、脫水、失能有關，且會增加肺炎甚至死亡的風險。早期診斷及治療吞嚥障礙的病人不但可減少併發症，也可減少住院日數及總醫療支出。腦中風後口咽部吞嚥障礙有相當多樣性的吞嚥異常型態，症狀臨床不易診斷，腦中風病人在住院及以口進食前都應儘早接受吞嚥篩檢，未通過篩檢或有吞嚥風險的病人，需由語言治療師（或適當的專業人員）進行專業臨床評估，必要時需安排吞嚥儀器檢查，例如透視螢光吞嚥檢查或光纖內視鏡吞嚥檢查，以判定吞嚥障礙嚴重程度，了解吞嚥的生理異常，並引導治療的方向。腦中風後口咽部吞嚥障礙有許多的治療方法，包括代償策略與復健策略，有許多有潛力的治療方法漸出現，包括神經電刺激、用藥及加強吞嚥肌力的儀器等。建立多專業吞嚥團隊整合介入照護，可有效減少急性中風後肺炎的發生。雖然吞嚥復健是有效的，但腦中風後吞嚥障礙的處理仍屬被忽略的研究領域，未來仍需更多研究來找出最適宜的處置，包括診斷、評估及治療方法。

Dysphagia is a common poststroke complication. It is associated with aspiration, malnutrition, dehydration, and disability, and it may increase the risk of pneumonia, and even death. Early diagnosis and treatment of patients with dysphagia reduces not only the aforementioned risks, but also the length of hospitalization and overall healthcare expenditures. Patients with poststroke oropharyngeal dysphagia exhibit highly variable patterns of swallowing abnormalities, and the related symptoms remain challenging to identify clinically. Patients who have experienced stroke should be screened for dysphagia as early as possible on admission and prior to any form of oral intake. Those who fail dysphagia screening or are evaluated to be at risk for dysphagia should be assessed by a speech-language pathologist (or an appropriate professional), where indicated investigation involving instrumental swallowing examinations such as videofluoroscopy or fiberoptic endoscopic evaluation of swallowing should be undertaken to determine the functional severity, understand the swallowing physiology and guide treatments. Treatment strategies for poststroke oropharyngeal dysphagia include compensatory and rehabilitation strategies. Promising therapies are emerging, including neurostimulation techniques and medication and devices to strengthen the muscles involved in swallowing. The establishment of a multidisciplinary swallowing team approach effectively reduces the risk of pneumonia in patients who have experienced acute stroke. Although swallowing rehabilitation is effective, the management of poststroke dysphagia remains a neglected area of research. More research is needed to determine the optimal management protocols in areas including diagnosis, investigation and treatment.

1. Smithard DG, O’Neill P, England R, et al. The natural history of dysphagia following a stroke. Dysphagia 1997;12:188-93.
   連結：
2. Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis 2000;10:380-6.
   連結：
3. Paciaroni M, Mazzotta G, Corea F, et al. Dysphagia following stroke Eur Neurol 2004;51:162-7.
   連結：
4. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36:2756-63.
   連結：
5. Arnold M, Liesirova K, Broeg-Morvay A, et al.Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS One 2016;11:e0148424
   連結：
6. Ekberg O, Hamdy S, Woisard V, et al. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 2002;17:139-46.
   連結：
7. Nguyen VQ, PrvuBettger J, Guerrier T, et al. Factors associated with discharge to home versus discharge to institutional care after inpatient stroke rehabilitation. Arch Phys Med Rehabil 2015;96:1297-303.
   連結：
8. Feng MC, Lin YC, Chang YH, et al. The mortality and the risk of aspiration pneumonia related with dysphagia in stroke patients. J Stroke Cerebrovasc Dis. 2019,28:1381-7.
   連結：
9. Smithard DG, O'Neill PA, Parks C, et al. Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996;27:1200-4.
   連結：
10. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999;30:744-8.
    連結：
11. Leder SB, Sasaki CT, Burrell MI. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia 1998;13:19-21.
    連結：
12. Ramsey D, Smithard D, Kalra L. Silent aspiration: what do we know? Dysphagia 2005;20:218-25.
    連結：
13. Titsworth WL, Abram J, Fullerton A, et al. Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke. Stroke 2013;44:3154-60.
    連結：
14. Ramsey DJC, Smithhard DG, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke 2003;34:1252-7.
    連結：
15. Smith C, Logemann J, Colangelo L, et al. Incidence and patient characteristics associated with silent aspiration in the acute care setting. Dysphagia 1999;14:1-7.
    連結：
16. Aviv J, Martin J, Samlo R, et al. Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia. Ann Otol Rhinol Laryngol 1996;105:92-7.
    連結：
17. Lee ML, Kim JU, Oh DH, et al. Oropharyngeal swallowing function in patients with presbyphagia. J Phys Ther Sci 2018;30:1357-8.
    連結：
18. Baijens LW, Clave P, Cras P, et al. European Society for Swallowing Disorders—European Union Geriatric Medicine Society white paper: Oropharyngeal dysphagia as a geriatric syndrome. Clin. Interv Aging 2016;11:1403-28.
    連結：
19. Wang ZY, Chen JM, Ni GX. Effect of an indwelling nasogastric tube on swallowing function in elderly post-stroke dysphagia patients with long-term nasal feeding. BMC Neurol 2019;19:83.
    連結：
20. Wilmskoetter J, Daniels SK, Miller AJ. Cortical and Subcortical Control of Swallowing-Can We Use Information From Lesion Locations to Improve Diagnosis and Treatment for Patients With Stroke? Am J Speech Lang Pathol 2020;29:1030-43.
    連結：
21. Babaei A, Ward BD, Siwiec RM, et al. Functional connectivity of the cortical swallowing network in humans. Neuroimage 2013;76:33-44.
    連結：
22. Lowell SY, Reynolds RC, Chen G, et al. Functional connectivity and laterality of the motor and sensory components in the volitional swallowing network. Exp Brain Res 2012;219:85-96.
    連結：
23. Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev 2001;81:929-69.
    連結：
24. Wilmskoetter J, Daniels SK, Miller AJ. Cortical and subcortical control of swallowing-can we use information from lesion locations to improve diagnosis and treatment for patients with stroke? Am J Speech-Lang Pathol 2020;29:1030-43.
    連結：
25. Daniels SK, Pathak S, Mukhi SV, et al. The relationship between lesion localization and dysphagia in acute stroke. Dysphagia 2017;32:777-84.
    連結：
26. Kim SY, Kim TU, Hyun JK, et al. Differences in videofluoroscopic swallowing study (VFSS) findings amlording to the vascular territory involved in stroke. Dysphagia 2014;29:444-9.
    連結：
27. Moon HI, Nam JS, Leem MJ, et al. Periventricular white matter lesions as a prognostic factor of swallowing function in older patients with mild stroke. Dysphagia 2017;32:480-6.
    連結：
28. Moon HI, Kim GS, Lee E. Is the location of white matter lesions important in the swallowing function of older patients with mild stroke?. Dysphagia 2019;34:407-14.
    連結：
29. Wilmskoetter J, Bonilha L, Martin-Harris B, et al. Mapping acute lesion locations to physiological swallow impairments after stroke. Neuroimage Clin 2019;22:101685
    連結：
30. Li S, Luo C, Yu B, et al. Functional magnetic resonance imaging study on dysphagia after unilateral hemispheric stroke: a preliminary study. J Neurol Neurosurg Psychiatry 2009; 80:1320-9.
    連結：
31. Teismann IK, Suntrup S, Warnecke T, et al. Cortical swallowing processing in early subacute stroke. BMC Neurol 2011;11:34.
    連結：
32. Barritt A, Smithard D. Role of cerebral cortex plasticity in the recovery of swallowing function following dysphagic stroke. Dysphagia 2009;24:83-90.
    連結：
33. Hinchey JA,  Shephard T, Furie K, et al. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005;36:1972-6.
    連結：
34. Al-Khaled M, Matthis C, Binder A, et al. Dysphagia in patients with acute ischemic stroke: Early dysphagia screening may reduce stroke-related pneumonia and improve stroke outcomes. Cerebrovasc Dis 2016;42:81-9.
    連結：
35. Bray BD, Smith CJ, Cloud GC, et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry 2017;88:25-30.
    連結：
36. Palli C, Fandler S, Doppelhofer K, et al. Early dysphagia screening by trained nurses reduces pneumonia rate in stroke patients: a clinical intervention study. Stroke 2017;48:2583-5.
    連結：
37. Joundi RA, Martino R, Saposnik G, et al. Predictors and outcomes of dysphagia screening after acute ischemic stroke. Stroke 2017;48:900-6.
    連結：
38. Garand KL, Mmlullough G, Crary M, , et al. Assessment across the life span: the clinical swallow evaluation. Am J Speech-Lang Pathol 2020;29:919-33.
    連結：
39. Turner-Lawrence DE, Peebles M, Price MF, et al. A feasibility study of the sensitivity of emergency physician dysphagia screening in acute stroke patients. Ann Emerg Med 2009;54:344-8.
    連結：
40. Ellis AL, Hannibal RR. Nursing swallow screens: why is testing water only not enough? J Neurosci Nurs 2013;45:244-53.
    連結：
41. Brodsky MB, Suiter DM, González-Fernández M. et al. Screening amluracy for aspiration using bedside water swallow tests: a systematic review and meta-analysis. Chest 2016;150:148-63.
    連結：
42. DePippo KL, Holas MA, Reding MJ. Validation of the 3-oz waterswallow test for aspiration following stroke. Arch Neurol 1992;49:1259-61.
    連結：
43. Suiter DM, Leder SB. Clinical utility of the 3-ounce water swallow test. Dysphagia 2008;23:244-50.
    連結：
44. Wu MC, Chang YC, Wang TG, et al. Evaluating swallowing dysfunction using a 100-ml water swallowing test. Dysphagia 2004;19:43-7.
    連結：
45. Osawa A, Maeshima S, Tanahashi N. Water-swallowing test: screening for aspiration in stroke patients. Cerebrovasc Dis 2013;35:276-81.
    連結：
46. Watanabe S, Oh-Shige H, Oh-Iwa I, et al. Reconsideration of three screening tests for dysphagia in patients with cerebrovascular disease performed by non-expert examiners. Odontology 2020;108:117-23.
    連結：
47. Perry L. Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial evaluation of a screening tool for use by nurses. J Clin Nurs 2001;10:463-73.
    連結：
48. Clavé P, Arreola V, Romea M, et al. Amluracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nutr 2008;27:806-15.
    連結：
49. Rofes L, Arreola V, Mukherjee R, et al. Sensitivity and specificity of the eating assessment tool and the volume‐viscosity swallow test for clinical evaluation of oropharyngeal dysphagia. Neurogastroent Motil 2014;26:1256-65.
    連結：
50. Benfield JK, Everton LF, Bath PM, et al. Amluracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: a systematic review and meta-analysis. J Clin Nurs 2020;29:1527-38.
    連結：
51. Mulheren RW, González-Fernández M. Swallow screen associated with airway protection and dysphagia after acute stroke. Arch Phys Med Rehabil 2019;100:1289-93.
    連結：
52. Daniels SK, Anderson JA, Willson PC. Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke 2012;43;892-7.
    連結：
53. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2019;50:e344-418.
    連結：
54. Martino R, Silver F, Teasell R, et al. The Toronto Bedside SwallowingScreening Test (TOR-BSST): development and validation of a dysphagia screening tool for patients with stroke. Stroke 2009;40:555-61.
    連結：
55. Donovan NJ, Daniels SK, Edmiaston J, et al. American Heart Association Council on Cardiovascular Nursing and Stroke Council. Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium. Stroke 2013;44:e24-31
    連結：
56. Casaubon LK, Boulanger J-M, Glasser E, et al. Canadian Stroke Best Practice Recommendations: Acute Inpatient Stroke Care Guidelines, Update 2015. International Journal of Stroke 2016;11:239-52.
    連結：
57. Crary MA, Carnaby GD, Sia I, et al. Spontaneous swallowing frequency has potential to identify dysphagia in acute stroke. Stroke 2013; 44:3452-7.
    連結：
58. Niimi M, Hashimoto G, Hara T, et al. Relationship between frequency of spontaneous swallowing and salivary substance P level in patients with acute stroke Dysphagia 2018;33:414-8.
    連結：
59. Carnaby G,  Sia I, Crary MA. Associations between spontaneous swallowing frequency at admission, dysphagia, and stroke-related outcomes in acute care. Arch Phys Med Rehabil 2019;100:1283-8.
    連結：
60. Persson E, Wårdh I, Östberg P. Repetitive saliva swallowing test: norms, clinical relevance and the impact of saliva secretion. Dysphagia 2019;34:271-8.
    連結：
61. Niimi M, Hashimoto G, Hara T, et al. The 2-minute spontaneous swallowing screening predicts independence on enteral feeding in patients with acute stroke. Journal of Stroke and Cerebrovascular Diseases 2020;29:104508.
    連結：
62. Garuti G, Reverberi C, Briganti A, et al. Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols. Multidiscip Respir Med 2014;9:36.
    連結：
63. Bechet S, Hill F, Gillheaney O, et al. Diagnostic amluracy of the modified Evan’s blue dye test in detecting aspiration in patients with tracheostomy: a systematic review of the evidence. Dysphagia 2016;31:721-9.
    連結：
64. Knigge MA, Thibeault S, Mmlulloch TM. Implementation of high-resolution manometry in the clinical practice of speech language pathology. Dysphagia 2014;29:2-16.
    連結：
65. Costa MMB. Videofluoroscopy: the gold standard exam for studying swallowing and its dysfunction. Arq Gastroenterol 2010;47:327-8.
    連結：
66. Kim SB, Lee SJ, Lee KW, et al. Usefulness of early videofluoroscopic swallowing study in acute stroke patients with dysphagia. Ann Rehabil Med 2018;42:42-51.
    連結：
67. Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia1988;2:216-9.
    連結：
68. Leder SB. Serial fiberoptic endoscopic swallowing evaluations in the management of patients with dysphagia. Arch Phys Med Rehabil 1998;79:1264-9.
    連結：
69. Aviv JE, Kaplan ST, Thomson JE, et al. The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations. Dysphagia 2000;15:39-44.
    連結：
70. Bax L, McFarlane M, Green E, et al. Speech-language pathologist-led fiberoptic endoscopic evaluation of swallowing: functional outcomes for patients after stroke. J Stroke Cerebrovasc Dis 2014;23:e195-200.
    連結：
71. Bours GJJW, Speyer R, Lemmens J, et al. Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: Systematic review. Journal of Advanced Nursing 2008;65:477-93.
    連結：
72. Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, et al. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope 2017;127:2002-10.
    連結：
73. Mmlulloch TM, Hoffman MR, Ciumli MR. High resolution manometry of pharyngeal swallow pressure events associated with head turn and chin tuck. Ann Otol Rhinol Laryngol 2010;119:369-76.
    連結：
74. Hori K, Tamine K, Barbezat C, et al. Influence of chin-down posture on tongue pressure during dry swallow and bolus swallows in healthy subjects. Dysphagia 2011;26:238-45.
    連結：
75. Shanahan TK, Logemann JA, Rademaker AW, et al. Chin-down posture effect on aspiration in dysphagic patients. Arch Phys Med Rehabil 1993;74:736-9.
    連結：
76. Logemann JA, Gensler G, Robbins J, et al. A randomized study of three interventions for aspiration of thin liquids in patients with dementia and Parkinson’s disease. J Speech Lang Hear Res 2008;51:173-83.
    連結：
77. Kim CK, Ryu JS, Song SH, et al. Effects of head rotation and head tilt on pharyngeal pressure events using high resolution manometry. Ann Rehabil Med 2015;39:425.
    連結：
78. Rasley A, Logemann JA, Kahrilas PJ, et al. Prevention of barium aspiration during videofluoroscopic swallowing studies: value of change in posture. AJR Am J Roentgenol 1993;160:1005-9.
    連結：
79. Drake W, O'Donoghue S, Bartram C, et al. Eating in side-lying facilitates rehabilitation in neurogenic dysphagia. Brain Inj 1997;11:137-42.
    連結：
80. Matsui T, Yamaya M, Ohrui T, et al. Sitting position to prevent aspiration in bed-bound patients. Gerontology 2002;48:194-5.
    連結：
81. Dantas RO, Kern MK, Massey BT, et al. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol 1990;258:G675-81.
    連結：
82. Matta Z, Chambers IVE, Garcia JM, et al. Sensory characteristics of beverages prepared with commercial thickeners used for dysphagia diets. J Am Diet Assoc 2006;106:1049-54.
    連結：
83. CM. Steele, AM Namasivayam, Brittany T. et al. Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. Arch Phys Med Rehabil 2018;99:934-4.
    連結：
84. Daniels SK, Schroeder MF, DeGeorge PC, et al. Effects of verbal cue on bolus flow during swallowing. Am J Speech Lang Pathol 2007;16:140-7.
    連結：
85. Adams V, Mathisen B, Baines S, et al. : Reliability of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument with elderly adults. Disabil Rehabil 2015,37:389-95.
    連結：
86. Robbins J, Kays SA, Gangnon RE, et al. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil 2007;88:150-8.
    連結：
87. Shaker R, Kern M, Bardan E, et al. Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physoil 1997;272:G1518-22.
    連結：
88. Easterling C, Grande B, Kern M, et al. Attaining and maintaining isometric and isokinetic goals of the shaker exercise. Dysphagia 2005;20:133-8.
    連結：
89. Wada S, Tohara H, Iida T, et al. Jaw opening exercise for insufficient opening of upper esophageal sphincter. Arch Phys Med Rehabil 2012;93:1995-9.
    連結：
90. Yoon WL, Khoo JKP, Liow SJR. Chin tuck against resistance (CTAR): new method for enhancing suprahyoid muscle activity using a Shaker-type exercise.Dysphagia 2014;29:243-8.
    連結：
91. Park JS, An DH, Oh DH, et al. Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: a randomized pilot study. NeuroRehabilitation 2018;42:191-7.
    連結：
92. Sze WP, Yoon WL, Escoffier N, et al. Evaluating the training effects of two swallowing rehabilitation therapies using surface electromyography—chin tuck against resistance (CTAR) exercise and the shaker exercise. Dysphagia 2016;31:195-205.
    連結：
93. Hegland KW, Davenport PW, Brandimore AE, et al. Rehabilitation of swallowing and cough functions following stroke: an expiratory muscle strength training trial. Arch Phys Med Rehabil 2016;97:1345-51.
    連結：
94. Troche MS, Okun MS, Rosenbek JC, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology 2010;7:1912-9.
    連結：
95. Wang Z, Wang Z, Fang Q,et al. Effect of Expiratory Muscle Strength Training on Swallowing and Cough Functions in Patients With Neurological Diseases: A Meta-analysis. Am J Phys Med Rehabil 2019;98:1060-6.
    連結：
96. Fujiu-Kurachi M, Fujiwara S, Tamine K, et al. Tongue pressure generation during tongue-hold swallows in young healthy adults measured with different tongue positions. Dysphagia 2014;29:17-24.
    連結：
97. Fujiu M, Logemann JA. Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition. Am J Speech Lang Pathol 1996;5:23-30
    連結：
98. Mmlullough GH, Kamarunas, E, Mann GC, et al. Effects of Mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil 2012;19:234-43.
    連結：
99. Mendelsohn MS, Martin RE. Airway protection during breath-holding. Ann Otol Rhinol Laryngol 1993;102:941-4.
    連結：
100. Chaudhuri G, Hildner CD, Brady S, et al. Cardiovascular effects of the supraglottic and supersupraglottic swallowing maneuvers in stroke patients with dysphagia. Dysphagia 2002;17:19-23.
     連結：
101. Huckabee ML, Steele CM. An analysis of lingual contribution to submental surface electromyographic measures and pharyngeal pressures during effortful swallow. Arch Phys Med Rehabil 2006;87:1067-72.
     連結：
102. Jang HJ, Leigh JH, Seo HG, et al. Effortful swallow enhances vertical hyolaryngeal movement and prolongs duration after maximal excursion. J Oral Rehabil 2015;42:765-73.
     連結：
103. Connor NP, Ota F, Nagai H, et al. Differences in age-related alterations in muscle contraction properties in rat tongue and hindlimb. J Speech Lang Hear Res 2008;51:818-27.
     連結：
104. Michou E, Mastan A, Ahmed S, et al. Examining the role of carbonation and temperature on water swallowing performance: a swallowing reaction-time study. Chem Senses 2012;37:799-807.
     連結：
105. Sdravou K, Walshe M. Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia. Dysphagia 2012;27:240-50.
     連結：
106. Palmer PM, Mmlulloch TM, Jaffe D, et al. Effects of a sour bolus on the intramuscular electromyographic (EMG) activity of muscles in the submental region. Dysphagia 2005;20:210-7.
     連結：
107. Pelletier CA, Dhanaraj GE. The effect of taste and palpability on lingual swallowing pressure. Dysphagia 2006;21:121-8.
     連結：
108. Rosenbek JC, Roecker EB, Wood JL, et al. Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia 1996;11:225-33.
     連結：
109. Teismann IK, Steinsträter O, Warnecke T.et al. Tactile thermal oral stimulation increases the cortical representation of swallowing. BMC Neurosci 2009;10:71.
     連結：
110. Shin S, Shutoh N, Tonai M, et al. The effect of capsaicin-containing food on the swallowing response. Dysphagia 2016;31:146-53.
     連結：
111. Wang Z, Wu L, Fang Q, et al. Effects of capsaicin on swallowing function in stroke patients with dysphagia: A randomized controlled trial. J Stroke Cerebrovasc Dis 2019;28:1744-51.
     連結：
112. Cabib C, Nascimento W, Rofes L, et al. Short-term neurophysiological effects of sensory pathway neurorehabilitation strategies on chronic poststroke oropharyngeal dysphagia. Neurogastroenterol Motil 2020;32:e13887.
     連結：
113. Rofes L, Arreola V, Martin A. et al. Effect of oral piperine on the swallow response of patients with oropharyngeal dysphagia. J Gastroenterol 2014; 49:1517-23.
     連結：
114. Alvarez-Berdugo D, Rofes L, Farré R, et al. Localization and expression of TRPV1 and TRPA1 in the human oropharynx and larynx. Neurogastroenterol Motil 2016;28:91-100.
     連結：
115. Chen YW, Chang KH, Chen HC, et al. The effects of surface neuromuscular electrical stimulation on poststroke dysphagia: a systemic review and meta-analysis. Clin Rehabil 2016;30:24-35.
     連結：
116. Bergquist AJ, Clair JM, Lagerquist O, et al. Neuromuscular electrical stimulation: implications of the electrically evoked sensory volley. European Journal of Applied Physiology 2011;111:2409-26.
     連結：
117. Oh BM, Kim DY, Paik NJ. Recovery of swallowing function is amlompanied by the expansion of the cortical map. Int J Neurosci 2007;117:1215-27.
     連結：
118. Benfield JK, Everton LF, Bath PM, et al. Does therapy with biofeedback improve swallowing in adults with dysphagia? A systematic review and meta-analysis. Arch Phys Med Rehabil 2019;100:551-61.
     連結：
119. Vasant DH, Michou E, O’Leary N, et al. Pharyngeal electrical stimulation in dysphagia poststroke: a prospective, randomized single-blinded interventional study. Neurorehabil Neural Repair 2016;30:866-75.
     連結：
120. Suntrup S, Marian T, Schröder JB, et al. Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial. Intensive Care Med 2015;41:1629-37.
     連結：
121. Muhle P, Suntrup-Krueger S, Bittner S, et al. Increase of substance P concentration in saliva after pharyngeal electrical stimulation in severely dysphagic stroke patients - an indicator of decannulation sumless? Neurosignals 2017;25:74-87.
     連結：
122. Dziewas R, Stellato R, van der Tweel I, et al. Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol 2018;17:849-59.
     連結：
123. Bath PM, Scutt P, Love J, et al. Pharyngeal electrical stimulation for treatment of dysphagia in subacute stroke: a randomized controlled trial. Stroke 2016;47:1562-70.
     連結：
124. Pisegna JM, Kaneoka A, Pearson WG, et al. Effects of non-invasive brain stimulation on post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials. Clin Neurophysiol 2016;127:956-68.
     連結：
125. Liao X, Xing G, Guo Z, et al. Repetitive transcranial magnetic stimulation as an alternative therapy for dysphagia after stroke: a systematic review and meta-analysis. Clin Rehabil 2017;31:289-98.
     連結：
126. Ahn YH, Sohn HJ, Park JS, et al. Effect of bihemispheric anodal transcranial direct current stimulation for dysphagia in chronic stroke patients: a randomized clinical trial. J Rehabil Med 2017;49:30-5.
     連結：
127. Li Y, Feng H, Li J, et al. The effect of transcranial direct current stimulation of pharyngeal motor cortex on swallowing function in patients with chronic dysphagia after stroke: a retrospective cohort study. Medicine (Baltimore) 2020;99:e19121
     連結：
128. Pingue V, Priori A, Malovini A, et al. Dual transcranial direct current stimulation for Poststroke dysphagia: a randomized controlled trial. Neurorehabil Neural Repair 2018;32:635-44.
     連結：
129. Rossi S, Hallett M, Rossini PM, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009;120:2008-39.
     連結：
130. Stefan K, Kunesch E, Cohen LG, et al. Induction of plasticity in the human motor cortex by paired associative stimulation. Brain 2000;123 Pt 3:572-84.
     連結：
131. Michou E, Mistry S, Jefferson S,, et al. Targeting unlesioned pharyngeal motor cortex improves swallowing in healthy individuals and after dysphagic stroke. Gastroenterology 2012;142:29-38.
     連結：
132. Singh S, Mistry S, Jefferson S, et al. A magnetic resonance spectroscopy study of brain glutamate in a model of plasticity in human pharyngeal motor cortex. Gastroenterology 2009;136:417-24.
     連結：
133. Sun SF, Hsu CW, Lin HS, et al. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia. Dysphagia 2013;28:557-66.
     連結：
134. Park JS, Hwang NK, Kim HH, et al. Effect of neuromuscular electrical stimulation combined with effortful swallowing using electromyographic biofeedback on oropharyngeal swallowing function in stroke patients with dysphagia: a pilot study. Medicine 2019;98:e17702.
     連結：
135. Carnaby GD, LaGorio L, Silliman S, et al. Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: A double-blind placebo-controlled trial. J Oral Rehabil 2020;47:501-10.
     連結：
136. Cui F, Yin Q, Wu C, et al. Capsaicin combined with ice stimulation improves swallowing function in patients with dysphagia after stroke: A randomised controlled trial. J Oral Rehabil 2020;47:1297-303.
     連結：
137. Zhang C, Zheng X, Lu R, et al. Repetitive transcranial magnetic stimulation in combination with neuromuscular electrical stimulation for treatment of post-stroke dysphagia. J Int Med Res 2019;47:662-72.
     連結：
138. Smith JC, Kishore KA, Vail A, et al. Diagnosis of stroke associated pneumonia: recommendations from the pneumonia in stroke consensus group. Stroke 2015;46:2335-40
     連結：
139. Hoffmann S, Harms H, Ulm L, et al. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - the PREDICT study. J Cereb Blood Flow Metab 2017;37:3671-82.
     連結：
140. Gomes G, Pisani J, Macedo E, et al. The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia. Curr Opin Clin Nutr Metabol Care 2003;6:327-33.
     連結：
141. Brady M, Furlanetto D, Hunter R, et al. Staff-led interventions for improving oral hygiene in patients following stroke. Cochrane Database Syst Rev 2006;4:CD003864.
     連結：
142. Eltringham SA, Kilner K, Gee M. et al. Factors associated with risk of stroke-associated pneumonia in patients with dysphagia: a systematic review. Dysphagia 2020;35:735-44.
     連結：
143. Kulnik ST, Birring SS, Hodsoll J, Moxham J, Rafferty GF, Kalra L. Higher cough flow is associated with lower risk of pneumonia in acute stroke. Thorax 2016;71:474-5.
     連結：
144. Hasani A, Pavia D, Agnew JE, et al. Regional lung clearance during cough and forced expiration technique (FET): effects of flow and viscoelasticity. Thorax 1994;49:557-61.
     連結：
145. Kalra L, Irshad S, Hodsoll J, et al. Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial. Lancet 2015;386:1835-44.
     連結：
146. Arai N, Nakamura A, Tabuse M, et al. Histamine H2-blocker and proton pump inhibitor use and the risk of pneumonia in acute stroke: a retrospective analysis on susceptible patients. PLoS ONE 2017;12:e0169300.
     連結：
147. Marchina S, Doros G, Modak J, et al. Acid-suppressive medications and risk of pneumonia in acute stroke patients: A systematic review and meta-analysis. J Neurol Sci. 2019;400:122-8.
     連結：
148. Warusevitane A, Karuntilake D, Lally F, et al. The safety and effect of metoclopramide to prevent pneumonia in stroke patients fed via nastrogastric tubes (MAPS trial). Stroke 2015;46:454-60.
     連結：
149. Liu C, Shau W, Wu C, Lai M. Angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers and pneumonia risk among stroke patients. J Hypertension 2012;30:2223-9.
     連結：
150. Shinohara Y. Antiplatelet cilostazol is effective in the prevention of pneumonia in ischemic stroke patients in the chronic stage. Cerebrovasc Dis 2006;22:57-60.
     連結：
151. Kobayashi H, Nakagawa T, Sekizawa K, et al. Levodopa and swallowing reflex. Lancet 1996;348:1320e1.
     連結：
152. Arai T, Sekizawa K, Yoshimi N, et al. Cabergoline and silent aspiration in elderly patients with stroke. J Am Geriatr Soc 2003;51:1815e6
     連結：
153. Nakagawa T, Wada H, Sekizawa K, et al. Amantadine and pneumonia. Lancet 1999;353(9159):1157.
     連結：
154. Aoki S, Hosomi N, Hirayama J, et al. The multidisciplinary swallowing team approach decreases pneumonia onset in acute stroke patients. PLoS One 2016;11:e0154608.
     連結：
155. Bath PM, Lee HS, Everton LF. Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database Syst Rev 2018;10:Cd000323.
     連結：
156. Steele CM, Molfenter S, Bailey GL, et al. Exploration of the utility ofa brief swallow screening protocol with comparison to concurrent videofluoroscopy. Canadian J Speech-Language Pathology Audiology 2011;35:228-42.
157. Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.
158. Intercollegiate Stroke Working Party. National Clinical Guideline for Stroke. Fifth Edition. 2016. London, Royal College of Physicians. https://www.strokeaudit.org/Guideline/Full-Guideline.aspx (June 27, 2017).
159. Watkins J: Clinical Guidelines for Stroke Management 2017. Melbourne Australia, National Manager Clinical Services, stroke foundation, 2017.
160. Crary M and Baron J. Endoscopic and fluroscopic evaluations of swallowing: comparison of observed and inferred findings. Dysphagia 1997;2:108.
161. Welch MW, Logemann JA, Rademaker AW, et al. Changes in pharyngeal dimensions effected by chin tuck. Arch Phys Med Rehabil 1993;74:178-81.
162. Nagaya M, Kachi T, Yamada T, et al. Videofluorographic observations on swallowing in patients with dysphagia due to neurodegenerative diseases. Nagoya J Med Sci 2004;67:17-23.
163. Logemann JA, Kahrilas PJ, Kobara M, et al. The benefit of head rotation on pharyngoesophageal dysphagia. Arch Phys Med Rehabil 1989;70:767-71.
164. Butler SG, Pelletier CA, Steele CM. Compensatory strategies and techniques. In: Shaker R, Easterling C, Belafsky PC, Postma GN, editors. Manual of diagnostic and therapeutic techniques for disorders of deglutition. New York: Springer. 2013;299-316.
165. Freed ML, Freed L, Chatburn RL, et al. Electrical stimulation for swallowing disorders caused by stroke. Respiratory Care 2001;46:466-74.
166. Li LX, Deng K. Acupuncture combined with swallowing training for poststroke dysphagia: a meta-analysis of randomised controlled trials. Acupunct Med 2019;37:81-90.