頸部表面電刺激應用於腦中風患者吞嚥障礙之療效研究

The Effectiveness of Surface Electric Stimulation on the Treatment of Dysphagia in Stroke Patients

10.6143/JSLHAT.2017.12.03

張綺芬(Chi-Fen Chang)；盧璐(Lu Lu)；吳璦如(Ai-Ru Wu)

表面肌肉電刺激治療 ； 腦中風 ； 吞嚥障礙 ； 吞嚥治療 ； VitalStim ； Dysphagia ； Swallowing therapy

台灣聽力語言學會雜誌

37期（2017 / 12 / 01）

41 - 58

繁體中文

本研究目的在於進行本土化臨床實證，驗證頸部表面肌肉電刺激治療法對於改善腦中風導致吞嚥障礙的嚴重度成效影響，是否優於傳統吞嚥障礙治療。本研究共蒐集轉介到本院語言治療組接受吞嚥治療之腦中風病患40位，分成單純接受電刺激治療、同時接受電刺激與傳統吞嚥治療，以及單純接受傳統吞嚥治療共三組。記錄每位個案治療前測量值和治療後之測量值，每位病人接受每週兩次各30分鐘治療，至病人可安全由口進食，或最多30次的療程後結束治療，最後有35位個案完成本研究。研究結果發現，三組個案之吞嚥功能皆有顯著進步，但無組間差異。若比較接受合併治療與單純接受傳統吞嚥治療兩組個案間的進步差異時，亦無顯著差異。如將三組個案依其治療前口咽及吞嚥功能評估分數高低等比例分成四群，進行各群組間比較分析後，發現原始嚴重度高低與治療效果也沒有一定的關係。但本研究因個案數少，個案個別差異大，所以目前研究結果並無法完全排除電刺激對部分吞嚥障礙患者之療效。

This study investigates the effectiveness of surface electric stimulation therapy in stroke patients with dysphagia. Stroke patients referred to swallowing therapy were recruited with the inclusion criteria of dysphagia with nasogastic tube feeding as the main nutritional supply, and no significant medical problems. A total of 32 subjects finished the study. 20 subjects in the experimental group received simultaneous surface electric stimulation and traditional swallowing therapies. The 12 subjects in control group received traditional swallowing therapy only. Each patient received 30 minutes of therapy twice a week till they could eat per oral safely or till 30 treatment sessions. Outcome were analyzed by the changes in dysphagia severity scale, oral and pharyngeal motor function scale, oral and pharyngeal swallowing function scale, and rate of successful oral feeding. There were significant improvement （p ＜ 0.05） in all outcome measures in both groups of patients. However, no significant difference was noted in any outcome measures between these two groups. Further analysis by correlating the pretreatment severity with the treatment outcome also showed no group differences. Our study results did not support additional treatment effect of superficial electric stimulation on stroke dysphagic patients. However, since most of the subjects were in acute stage, further studies using chronic cases are necessary before exclusion of its treatment effectiveness.

1. Blumenfeld, L.,Hahn, Y.,Lepage, A.,Leonard, R.,Belafsky, P. C.(2006).Transcutaneous electrical stimulation versus traditional dysphagia therapy: A nonconcurrent cohort study.Otolaryngology-Head and Neck Surgery,135,754-757.
2. Bülow, M.,Speyer, R.,Baijens, L.,Woisard, V.,Ekberg, O.(2008).Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction.Dysphagia,23,302-309.
3. Freed, M. L.,Freed, L.,Chatburn, R. L.,Christian, M.(2001).Electrical stimulation for swallowing disorder caused by stroke.Respiration Care,46,466-474.
4. Freed, M. L.,Wijting, Y(2003).Training manual for patient assessment and treatment using VitalStim electrical stimulation.Hixson, TN:Chattanooga Group.
5. Fujiu, M.,Logemann, J. A.(1996).Effect of a tongue-holding maneuver on posterior pharyngeal wall movement during deglutition.American Journal of Speech-Language Pathology,5,23-30.
6. Homer, J.,Massey, E. W.,Riski, J. E.,Lathrop, D. L.,Chase, K. N.(1988).Aspiration following stroke, clinical correlates and outcome.Neurology,38,1359-1362.
7. Kiger, M.,Brown, C. S.,Watkins, L.(2006).Dysphagia management: An analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy.Dysphagia,21,243-253.
8. Li, L.,Li, Y.,Huang, R.,Yin, J.,Shen, Y.,Shi, J.(2015).The value of adding transcutaneous neuromuscular electrical stimulation (VitalStim) to traditional therapy for post-stroke dysphagia: A randomized controlled trial.European Journal of Physical and Rehabilitation Medicine,51,71-78.
9. Lim, K. B.,Lee, H. J.,Lim, S. S.,Choi, Y. I.(2009).Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: A randomized controlled trial.Journal of Rehabilitation Medicine,41,174-178.
10. Logemann, J. A.(2007).The effects of VitalStim on clinical and research thinking in dysphagia.Dysphagia,22,11-12.
11. Logemann, J. A.(1998).Evaluation and treatment of swallowing disorders.Austin, TX:pro-ed.
12. Ludlow, C. L.,Humbert, I.,Saxon, K.,Poletto, C.,Sonies, B.,Crujido, L.(2007).Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia.Dysphagia,22,1-10.
13. Permsirivanich, W.,Tipchatyotin, S.,Wongchai, M.,Leelamanit, V.,Setthawatcharawanich, S.,Sathirapanya, P.,Boonmeeprakob, A.(2009).Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: A randomized controlled study.Journal of the Medical Association of Thailand,92,259-265.
14. Shaker, R.,Easterling, C.,Kern, M.,Nitschke, T.,Massey, B.,Daniels, S.,Dikeman, K.(2002).Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening.Gastroenterology,122,1314-1321.
15. Shaw, G. Y.,Sechtem, P. R.,Searl, J.,Keller, K.,Rawi, T. A.,Dowdy, E.(2007).Transcutaneous neuromuscular electrical stimulation (vitalstim) curative therapy for severe dysphagia: Myth or reality?.Annals of Otology, Rhinology & Laryngology,116,36-44.
16. Skeat, J.,Perry, A.(2005).Outcome measurement in dysphagia: Not so hard to swallow.Dysphagia,20,113-122.
17. 王雪珮、陳襄貞、張綺芬(2008)。電刺激療法運用於吞嚥障礙之語言復健。中華民國聽力語言學會電子學報，15
18. 曾進興編(1999)。語言病理學基礎。台北市:心理。
19. 廖文炫、張梅蘭、蔡美文、王淑芬(2001)。物理因子治療學：電磁療學。台北市:合記。
20. 劉波兒校閱(1999)。復健護理。台北市:啟英。