Abstract：
OBJECTIVE: Dysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients.
METHODS: A single-blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65 years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40 min/session, 1 session/day, and 5 days/week for 4 weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4 weeks of intervention for both groups.
RESULTS: Before treatment, all patients were susceptible to pneumonia after two and 4 weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p < 0.05) and a statistically significant increase in incidence of SAP after 2 weeks of intervention only in the control group (p < 0.05). The results also showed a significant negative correlation between GUSS score and SAP (r = - 0.3662, p = 0.0018) IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.
METHODS: A single-blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65 years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40 min/session, 1 session/day, and 5 days/week for 4 weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4 weeks of intervention for both groups.
RESULTS: Before treatment, all patients were susceptible to pneumonia after two and 4 weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p < 0.05) and a statistically significant increase in incidence of SAP after 2 weeks of intervention only in the control group (p < 0.05). The results also showed a significant negative correlation between GUSS score and SAP (r = - 0.3662, p = 0.0018) IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.
摘要：
目的：吞咽困难是中风后常见的并发症。它对应于肺炎的发展，这总是与不良预后有关，住院时间更长，死亡率增加。该研究的目的是评估吞咽困难的物理治疗干预对预防急性中风患者肺炎的影响。
方法：对70例缺血性脑卒中伴口咽吞咽困难患者进行了一项单盲随机对照试验，年龄49~65岁.他们被随机分为两组（对照组和研究组），数量相等。对照组患者接受口腔护理和鼻胃管喂养,而研究组患者除了设计好的物理治疗方案（运动和神经肌肉电刺激）外，还接受了相同的方案。干预计划应用40分钟/次，1次/天，和5天/周4周。狼吞虎咽的屏幕（GUSS），卒中相关性肺炎（SAP）控制和预防标准用于评估基线时吞咽困难和肺炎发生率，两组均在干预2周和4周后。
结果：治疗前，干预2周和4周后,所有患者均易患肺炎;两组患者的GUSS评分均显著升高,且改善更有利于研究组(p<0.05),仅对照组干预2周后SAP发生率显著升高(p<0.05).结果还显示，GUSS评分与SAP之间存在显着负相关（r=-0.3662，p=0.0018）对物理治疗方法的影响：在口腔护理和鼻胃管喂养中增加物理疗法（运动疗法和神经肌肉电刺激）可以有效改善急性缺血性中风患者的口咽部吞咽困难并降低吸入性肺炎的发生率。
方法：对70例缺血性脑卒中伴口咽吞咽困难患者进行了一项单盲随机对照试验，年龄49~65岁.他们被随机分为两组（对照组和研究组），数量相等。对照组患者接受口腔护理和鼻胃管喂养,而研究组患者除了设计好的物理治疗方案（运动和神经肌肉电刺激）外，还接受了相同的方案。干预计划应用40分钟/次，1次/天，和5天/周4周。狼吞虎咽的屏幕（GUSS），卒中相关性肺炎（SAP）控制和预防标准用于评估基线时吞咽困难和肺炎发生率，两组均在干预2周和4周后。
结果：治疗前，干预2周和4周后,所有患者均易患肺炎;两组患者的GUSS评分均显著升高,且改善更有利于研究组(p<0.05),仅对照组干预2周后SAP发生率显著升高(p<0.05).结果还显示，GUSS评分与SAP之间存在显着负相关（r=-0.3662，p=0.0018）对物理治疗方法的影响：在口腔护理和鼻胃管喂养中增加物理疗法（运动疗法和神经肌肉电刺激）可以有效改善急性缺血性中风患者的口咽部吞咽困难并降低吸入性肺炎的发生率。
