In Patients with Brainstem Strokes, Does Dysphagia Rehabilitation Improve Health Related Outcomes Compared to Usual care? A Systematic Review and Meta-analysis
Tracks
4
Acute care – adult
Adult
Dysphagia
Neuromuscular Electrical Stimulation (NMES)
Research
Stroke
Swallowing
| Sunday, June 15, 2025 |
| 10:55 AM - 11:05 AM |
Overview
Julia Gorton
Details
⏫ Research insights
⏲️ 10.55am - 11.15am
⌛20-minutes
📚 Assumed knowledge of attendees: Intermediate (Some previous learning/working knowledge of topic e.g. treated a few cases)
⏲️ 10.55am - 11.15am
⌛20-minutes
📚 Assumed knowledge of attendees: Intermediate (Some previous learning/working knowledge of topic e.g. treated a few cases)
Presenter
Ms Julia Gorton
Royal Melbourne Hospital
In Patients with Brainstem Strokes, Does Dysphagia Rehabilitation Improve Health Related Outcomes Compared to Usual care? A Systematic Review and Meta-analysis
10:55 AM - 11:05 AMPresentation summary
Introduction: Dysphagia rehabilitation is used to improve swallowing function in patients with brainstem strokes. However, there is variety in types of rehabilitation exercises and delivery protocols. The aim of this systematic review was to explore and synthesise the effectiveness of dysphagia rehabilitation on swallow function in inpatients with brainstem stroke.
Methods: Five electronic databases were searched using a pre-specified criteria in November 2023. Independent screening, data extraction and quality ratings (via the Mixed Methods Appraisal Tool) were completed. Narrative synthesis was used to describe study characteristics, intervention details and study outcomes. Meta-analyses were completed when three or more randomised control trials on one intervention were available.
Results: In the 11 studies included, there were 437 participants with 250 (57.2%) males with an age range of 32 to 95 years. The most common intervention was strengthening/oromotor exercises (5 studies), however most of these were lower quality studies. There were two studies using Neuromuscular Electrical Stimulation (NMES) and one study with Transcranial Direct Current Stimulation (tDCS) as the main intervention. In three studies, with 75 participants, stroke patients who received Repetitive Transcranial Magnetic Stimulation (rTMS) had large improvements in swallow function post intervention compared to controls (SMD 1.52, 95% CI,0.77 to 2.26, I2 42%).
Conclusion: rTMS improved swallow function for brainstem strokes. Further research is required in this area to further determine the optimal protocol and dosage of rTMS as well as effectiveness and dosage of non-transcranial stimulation interventions given their common use in Australian inpatient settings.
Relevance to clinical practice or patient experience: This study highlights the effectiveness of rTMS in brainstem stroke dysphagia rehabilitation
Methods: Five electronic databases were searched using a pre-specified criteria in November 2023. Independent screening, data extraction and quality ratings (via the Mixed Methods Appraisal Tool) were completed. Narrative synthesis was used to describe study characteristics, intervention details and study outcomes. Meta-analyses were completed when three or more randomised control trials on one intervention were available.
Results: In the 11 studies included, there were 437 participants with 250 (57.2%) males with an age range of 32 to 95 years. The most common intervention was strengthening/oromotor exercises (5 studies), however most of these were lower quality studies. There were two studies using Neuromuscular Electrical Stimulation (NMES) and one study with Transcranial Direct Current Stimulation (tDCS) as the main intervention. In three studies, with 75 participants, stroke patients who received Repetitive Transcranial Magnetic Stimulation (rTMS) had large improvements in swallow function post intervention compared to controls (SMD 1.52, 95% CI,0.77 to 2.26, I2 42%).
Conclusion: rTMS improved swallow function for brainstem strokes. Further research is required in this area to further determine the optimal protocol and dosage of rTMS as well as effectiveness and dosage of non-transcranial stimulation interventions given their common use in Australian inpatient settings.
Relevance to clinical practice or patient experience: This study highlights the effectiveness of rTMS in brainstem stroke dysphagia rehabilitation
Refrences
Chua, K. S., & Kong, K. H. (1996). Functional outcome in brain stem stroke patients after rehabilitation. Archives of Physical Medicine and Rehabilitation, 77(2), 194–197.
Chun, M. H., Kim, D., & Chang, M. C. (2017). Comparison of dysphagia outcomes between rostral and caudal lateral medullary infarct patients. The International Journal of Neuroscience, 127(11), 965–970.
Dong, L.-H., Pan, X., Wang, Y., Bai, G., Han, C., Wang, Q., & Meng, P. (2022). High-Frequency Cerebellar rTMS Improves the Swallowing Function of Patients with Dysphagia after Brainstem Stroke. Neural Plasticity, 2022(c94, 100883417), 6259693.
Huang, Y.-C., Hsu, T.-W., Leong, C.-P., Hsieh, H.-C., & Lin, W.-C. (2018). Clinical Effects and Differences in Neural Function Connectivity Revealed by MRI in Subacute Hemispheric and Brainstem Infarction Patients With Dysphagia After Swallowing Therapy. Frontiers in Neuroscience, 12(101478481), 488.
Khedr, E. M., & Abo-Elfetoh, N. (2010). Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction. Journal of Neurology, Neurosurgery, and Psychiatry, 81(5), 495–499.
Kim, H., Lee, H. J., & Park, J.-W. (2018). Clinical course and outcome in patients with severe dysphagia after lateral medullary syndrome. Therapeutic Advances in Neurological Disorders, 11(101480242), 1756286418759864.
Maeshima, S., Osawa, A., Miyazaki, Y., Takeda, H., & Tanahashi, N. (2012). Functional outcome in patients with pontine infarction after acute rehabilitation. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 33(4), 759–764.
Mao, H., Lyu, Y., Li, Y., Gan, L., Ni, J., Liu, L., & Xiao, Z. (2022). Clinical study on swallowing function of brainstem stroke by tDCS. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 43(1), 477–484.
Prosiegel, M., Holing, R., Heintze, M., Wagner-Sonntag, E., & Wiseman, K. (2005). Swallowing therapy—A prospective study on patients with neurogenic dysphagia due to unilateral paresis of the vagal nerve, Avellis’ syndrome, Wallenberg’s syndrome, posterior fossa tumours and cerebellar hemorrhage. Acta Neurochirurgica. Supplement, 93(100962752), 35–37.
Tageldin E., Khalil M., Bahnasy W., & Fouda B. (2017). Evaluation of possible role of repetitive transcranial magnetic stimulation for dysphagic patients with brain stem infarction. Neurology, 88(16 Supplement 1).
Zhang, M., Tao, T., Zhang, Z.-B., Zhu, X., Fan, W.-G., Pu, L.-J., Chu, L., & Yue, S.-W. (2016). Effectiveness of Neuromuscular Electrical Stimulation on Patients With Dysphagia With Medullary Infarction. Archives of Physical Medicine and Rehabilitation, 97(3), 355–362.
Norrving B, Cronqvist S. Lateral medullary infarction: prognosis in an unselected series. Neurology. 1991;41:244–8.
Kruger E, Teasell R, Salter K, Foley N, Hellings C. The rehabilitation of patients recovering from brainstem strokes: case studies and clinical considerations. Topics in Stroke Rehabilitation. 2007;14(5):56–64.
Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP. Wallenberg’s lateral medullary syndrome. Arch Neurol. 1993;50:609–14.
Meng NH, Wang TG, Lien IN. Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil. 2000;79(2):170–5.
Kim HJ, Lee HJ, Park JW. Clinical course and outcome in patients with severe dysphagia after lateral medullary syndrome. Ther Adv Neurol Disord. 2018;11:1–6.
Benjamin, E, Roddy, L, & Giuliano, K. Management of patient tubes and lines during early mobility in the intensive care unit. Human Factors in Healthcare. 2022;2.
Lucendo, Alfredo J., et al. "Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis." Rev Esp Enferm Dig 107.3 (2015): 128-136.
Schrag, Sherwin P., et al. "Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review." Journal of Gastrointestinal and Liver Diseases 16.4 (2007): 407.
Stoykov ME, Stojakovich M, Stevens JA. Beneficial effects of postural intervention on prehensile action for an individual with ataxia resulting from brainstem stroke. NeuroRehabilitation. 2005;20(2): 85–89.
Teasell RW, Foley N, McRae M, Finestone H. Use of percutaneous gastrojejunostomy feeding tubes in the rehabilitation of stroke patients. Arch Phys Med Rehabil. 2001;82:1412–1415. C
Chun, M. H., Kim, D., & Chang, M. C. (2017). Comparison of dysphagia outcomes between rostral and caudal lateral medullary infarct patients. The International Journal of Neuroscience, 127(11), 965–970.
Dong, L.-H., Pan, X., Wang, Y., Bai, G., Han, C., Wang, Q., & Meng, P. (2022). High-Frequency Cerebellar rTMS Improves the Swallowing Function of Patients with Dysphagia after Brainstem Stroke. Neural Plasticity, 2022(c94, 100883417), 6259693.
Huang, Y.-C., Hsu, T.-W., Leong, C.-P., Hsieh, H.-C., & Lin, W.-C. (2018). Clinical Effects and Differences in Neural Function Connectivity Revealed by MRI in Subacute Hemispheric and Brainstem Infarction Patients With Dysphagia After Swallowing Therapy. Frontiers in Neuroscience, 12(101478481), 488.
Khedr, E. M., & Abo-Elfetoh, N. (2010). Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction. Journal of Neurology, Neurosurgery, and Psychiatry, 81(5), 495–499.
Kim, H., Lee, H. J., & Park, J.-W. (2018). Clinical course and outcome in patients with severe dysphagia after lateral medullary syndrome. Therapeutic Advances in Neurological Disorders, 11(101480242), 1756286418759864.
Maeshima, S., Osawa, A., Miyazaki, Y., Takeda, H., & Tanahashi, N. (2012). Functional outcome in patients with pontine infarction after acute rehabilitation. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 33(4), 759–764.
Mao, H., Lyu, Y., Li, Y., Gan, L., Ni, J., Liu, L., & Xiao, Z. (2022). Clinical study on swallowing function of brainstem stroke by tDCS. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 43(1), 477–484.
Prosiegel, M., Holing, R., Heintze, M., Wagner-Sonntag, E., & Wiseman, K. (2005). Swallowing therapy—A prospective study on patients with neurogenic dysphagia due to unilateral paresis of the vagal nerve, Avellis’ syndrome, Wallenberg’s syndrome, posterior fossa tumours and cerebellar hemorrhage. Acta Neurochirurgica. Supplement, 93(100962752), 35–37.
Tageldin E., Khalil M., Bahnasy W., & Fouda B. (2017). Evaluation of possible role of repetitive transcranial magnetic stimulation for dysphagic patients with brain stem infarction. Neurology, 88(16 Supplement 1).
Zhang, M., Tao, T., Zhang, Z.-B., Zhu, X., Fan, W.-G., Pu, L.-J., Chu, L., & Yue, S.-W. (2016). Effectiveness of Neuromuscular Electrical Stimulation on Patients With Dysphagia With Medullary Infarction. Archives of Physical Medicine and Rehabilitation, 97(3), 355–362.
Norrving B, Cronqvist S. Lateral medullary infarction: prognosis in an unselected series. Neurology. 1991;41:244–8.
Kruger E, Teasell R, Salter K, Foley N, Hellings C. The rehabilitation of patients recovering from brainstem strokes: case studies and clinical considerations. Topics in Stroke Rehabilitation. 2007;14(5):56–64.
Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP. Wallenberg’s lateral medullary syndrome. Arch Neurol. 1993;50:609–14.
Meng NH, Wang TG, Lien IN. Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil. 2000;79(2):170–5.
Kim HJ, Lee HJ, Park JW. Clinical course and outcome in patients with severe dysphagia after lateral medullary syndrome. Ther Adv Neurol Disord. 2018;11:1–6.
Benjamin, E, Roddy, L, & Giuliano, K. Management of patient tubes and lines during early mobility in the intensive care unit. Human Factors in Healthcare. 2022;2.
Lucendo, Alfredo J., et al. "Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG) tube insertion under antiplatelet therapy: a systematic review with a meta-analysis." Rev Esp Enferm Dig 107.3 (2015): 128-136.
Schrag, Sherwin P., et al. "Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review." Journal of Gastrointestinal and Liver Diseases 16.4 (2007): 407.
Stoykov ME, Stojakovich M, Stevens JA. Beneficial effects of postural intervention on prehensile action for an individual with ataxia resulting from brainstem stroke. NeuroRehabilitation. 2005;20(2): 85–89.
Teasell RW, Foley N, McRae M, Finestone H. Use of percutaneous gastrojejunostomy feeding tubes in the rehabilitation of stroke patients. Arch Phys Med Rehabil. 2001;82:1412–1415. C
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Julia Gorton is a Grade 2 Speech Pathologist at the Royal Melbourne Hospital. Julia has previously completed a Certificate III in Pathology Collection, a Bachelor of Science (Honours) in stroke research, and her Masters in Speech Pathology. Julia recently completed the Stepping into Research program at the Royal Melbourne Hospital looking at dysphagia rehabilitation in brainstem strokes. Julia's clinical interest areas are in stroke, neurology and dysphagia management, and she is a secretary of Dysphagia Interest Group Victoria. Outside of Speech Pathology, Julia is a keen ceramic potter.
Dr Julia Dray
University Of Technology Sydney
No presentation (1)
10:55 AM - 11:15 AM**********
Dr Julia Dray, aka Dr Dray, is Senior Research fellow within the Graduate School of Health at UTS. In her current role Julia is working closely with Prof Bronwyn Hemsley in the final stages of an ARC Discovery project on 3D Printed Food for People with Swallowing Disability, and leading a small scale study into views of family members and health professionals on use of GenAI to support youth mental health. Dr Dray’s prior postdoctoral roles focussed on child and adolescent resilience and mental health, lived experience research in mental health and evaluations of complex implementation science-based approaches to improve prevalence and care, for mental health problems, the reduction of modifiable health risk behaviours and associated chronic disease.
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