Effciency of a rehabilitation training method by means of special infant formulas in patients with ischemic stroke and neurogenic dysphagia as part of combined therapy

Objective: to evaluate the efficiency of a training method using special infant formulas as part of combined rehabilitation for patients with ischemic stroke and neurogenic dysphagia.

Patients and methods. The investigation enrolled 55 patients (30 men and 25 women) aged 45–80 years with dysphagia during the acute period of ischemic stroke. Thirty patients used special astringent formulas as part of combined therapy and 25 patients did not. The investigators studied the time of course of changes in the restoration of swallowing function, by using the Penetration-Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from probe feeding to independent one.

Results and discussion. The best restoration of swallowing function was shown to be achieved through training using formulas with different astringency. Stronger astringent formulas, like solid foods, stimulate better the pharyngeal receptor apparatus; the most active restoration of a dynamic swallowing stereotype occurs. The gradual transition to a milder astringent formula allows restoration of the skill to swallow thinner liquid foods. It takes 10 days to achieve a significant clinical effect in most patients, mainly in those with pseudobulbar disorders. Training may be prolonged to 2 weeks or more in severe cases, in bulbar dysfunctions.

Conclusion. The training rehabilitation method using special infant formulas in combination with electrical stimulation in patients with ischemic stroke and neurogenic dysphagia allows achieving the significantly better indicators of restoration of swallowing function in accordance with the PAS scale. The application of the method contributes to the significantly better transition from probe feeding to independent one.

1. Skvortsova VI. Reducing the incidence, mortality and disability from stroke in the Russian Federation. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2007;Special Issue:25-9. (In Russ.)

2. Schepp SK, Tirschwell DL, Miller RM, Longstreth WT. Swallowing screens after acute stroke: a systematic review. Stroke. 2012 Mar; 43(3):869-71. doi: 10.1161/STROKEAHA.111.638254. Epub 2011 Dec 8.

3. de Larminat V, Dureuil B, Montravers P, Desmonts JM. Impairment of deglutition reflex after prolonged intubation. Ann Fr Anesth Reanim. 1992;11(1):17-21.

4. Brodsky MB, Huang M, Shanholtz C, et al. Recovery of Dysphagia Symptoms after Oral Endotracheal Intubation in ARDS Survivors: A 5Year Longitudinal Study. Ann Am Thorac Soc. 2017 Mar;14(3):376-383. doi: 10.1513/AnnalsATS.201606-455OC.

5. Hammond CAS, Goldstein LB. Cough and Aspiration of Food and Liquids Cough and Aspiration of Food and Liquids Due to OralPharyngeal. Chest. 2006 Jan;129(1 Suppl): 154S-168S. doi: 10.1378/chest.129.1_suppl.154S.

6. Skvortsova VI, Stachovskaya LV, Кlochihina ОА. The stroke epidemiology in different regions of Russia by method of territorially populational register in 2009-2010 years. The 21th European Stroke Conference. Lisbon; 2012. P. 564.

7. Saldina IYu, Shprakh VV, Klochikhina OA, Stakhovskaya LV. Epidemiology of stroke in Irkutsk according to the territorial population register. Zhurnal nevrologii i psikhiatrii im S.S. Korsakova. 2015;115(9):15-9. (In Russ.).

8. Logopedicheskaya diagnostika i reabilitatsiya patsientov s povrezhdeniyami golovnogo mozga v ostrom periode: klinicheskie rekomendatsii [Speech therapy diagnosis and rehabilitation of patients with brain damage in the acute period: clinical recommendations]. Moscow: Natsional'naya assotsiatsiya po bor'be s insul'tom; 2014.

9. Diagnostika i lechenie disfagii pri zabolevaniyakh tsentral'noi nervnoi sistemy: klinicheskie rekomendatsii [Diagnosis and treatment of dysphagia in diseases of the Central nervous system: clinical guidelines]. Moscow: Natsional'naya assotsiatsiya po bor'be s insul'tom; 2013.

10. Belkin AA, Ershov VI, Ivanova GE. Impaired swallowing in case of emergency – postextubation dysphagia. Anestiziologiya i reanimatologiya. 2018;(4):76–82. (In Russ.).

11. Parfenov VA. Ishemicheskii insul't [Ischemic stroke]. Moscow: MIA; 2012. 298 p.

12. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1; 344(9):665-71.

13. Pancorbo-Hidalgo PL, Garcia-Fernandez FР, Ramirez-Perez С. Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs. 2001 Jul; 10(4):482-90.

14. Therapeutic guidelines for the treatment of laryngeal paresis, aphasia, dysphagia and dysarthria with VocaStim http://www.satellitegroupvrn.ru/upload/content/12.pdf

15. Likholetova NV, Gorbachev VI. Analysis of the outcomes of the disease in patients with acute cerebrovascular disease during respiratory therapy. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2018;118(6):37-42. (In Russ.).

16. Shaker R, Geenen JE. Management of Dysphagia in Stroke Patients. Gastroenterol Hepatol (N Y). 2011 May;7(5):308-32.

17. Broniatowski M, Grundfest-Broniatowski S, Tyler DJ, et al. Dynamic laryngotracheal closure for aspiration: a preliminary report. Laryngoscope. 2001 Nov;111(11 Pt 1):2032-40.

18. Gorbachev VI, Lokhov AV, Gorbacheva SM. To the question of respiratory support of patients with severe stroke at the prehospital stage. Skoraya meditsinskaya pomoshch'. 2018;19(3):69-74. (In Russ.).

19. Blackford MG, Glover ML, Reed MD. Lower respiratory tract infections. In: Pharmacotherapy: A Pathophysiologic Approach. 2002. Р. 1849-67.

20. Shnaider NA, Kozulina EA, Dmitrenko DV. Clinical and genetic heterogeneity of dystrophic myotonia (literature review). Mezhdunarodnyi nevrologicheskii zhurnal. 2007;3(13):119-30. (In Russ.).

21. Strel'nikova IA. Dynamics of recovery of swallowing function in patients with stroke on the background of complex treatment with neuromuscular electrical stimulation. Aspirantskii vestnik Povolzh'ya. 2013;(1-2):64-8. (In Russ.).

22. Belkina YuB. A variant of a complex speech therapy manual in neurorehabilitation after stroke. Spetsial'noe obrazovanie. 2010;(2):12-8. (In Russ.).

23. Temirova AR, Syzdykov MB, Kaparov ShF, et al. Early rehabilitation of patients with acute cerebrovascular disturbance. Nauka i zdravookhranenie. 2014;(2):103-5. (In Russ.).

24. Kamaeva OV, Monro P, Burakova ZF, et al. Mul'tidistsiplinarnyi podkhod v vedenii i rannei reabilitatsii nevrologicheskikh bol'nykh: Metodicheskoe posobie. Chast' 1 [Multidisciplinary approach in the management and early rehabilitation of neurological patients: Handbook. Part 1. Organization Of The Stroke Unit]. Organizatsiya Insul'tnogo Bloka. SaintPetersburg; 2003.

25. Avdyunina IA. Neurogenic dysphagia management: use of liquid and food thickener (analysis of two clinical cases). Lechashchii vrach. 2015;(1): 70-4. (In Russ.).