Clinical Characteristics and Rehabilitation Strategies for the Stomatognathic System Disturbances in Patients with Stroke: A Systematic Review

Abstract

Background: Understanding the stomatognathic system disturbances is key to diagnosing them early and implementing rehabilitation approaches to promote functional recovery. The objective of this study was to systematically review all published data that examined the assessment and rehabilitation strategies for the stomatognathic system disturbances in patients with stroke. Methods: Five databases (i.e., PubMed/MEDLINE, Scopus, Science Direct, Web of Science, and PEDro), were screened for manuscripts that included the assessment and rehabilitation strategies for stomatognathic system disturbances. The methodological quality was evaluated using the Mixed Methods Appraisal Tool. Results: Sixteen articles were included in this systematic review. The most frequently reported symptoms in patients with stroke included stiffness and thickness of the masseter muscle on the affected side and suprahyoid muscles; facial muscles’ asymmetry and weakness; temporomandibular disorders; and a reduced maximum lip force, tongue pressure, and saliva flow rate. The rehabilitation strategies more frequently reported included exercises directed to the jaw, temporomandibular joint, tongue, and neck. The mean score for methodological quality was 85%. Conclusion: The stomatognathic system disturbances are frequently reported among patients with stroke, leading to dysfunction in masticatory performance or swallowing. More studies on interventions for stomatognathic system disturbances are required before conclusions may be drawn. Key Practitioner Message: This systematic review has clinical implications for rehabilitation practices, given that the results may help to develop early assessment and rehabilitation strategies for stomatognathic disturbances in patients with stroke.

It Is Time for a Multidisciplinary Rehabilitation Approach: A Scoping Review on Stomatognathic Diseases in Neurological Disorders

“…As far as we know, this is one of the few reviews [11,60] that deal with SD and TMD and their rehabilitative approach in patients affected by neurological disorders. In fact, this issue is often overlooked by clinicians and therapists when it would need more attention, especially for the possible improvements in the most important functions of life: speech, eating and breathing, besides the postural alignment.…”

“…In fact, this issue is often overlooked by clinicians and therapists when it would need more attention, especially for the possible improvements in the most important functions of life: speech, eating and breathing, besides the postural alignment. It is noteworthy that evidence highlighted the correlation and the relationship between the neurological disorder and the onset of SD or TMD [14,22,[36][37][38], while the literature about CTS-R intervention remains poor or limited to physical exercises for the post-stroke population [25][26][27]60] (see Table 2). Indeed, we have focused not only on the pathophysiological mechanism but also on the diagnostic work-up and treatment, pointing out the importance of a multidisciplinary and personalized approach.…”

“…Additionally, MT and/or OMT could induce muscle release and restore pain thanks to the discharge of endogenous opioids due to therapeutic touch [9,65]; -Muscle weakness and reduced TMJ functions were found in post-stroke survivors as a result of the acute onset of the brain damage [25][26][27][28]. In this clinical condition, authors [26,27,60] suggested the administration of specific isometric and isotonic exercises to improve jaw muscle strength and postural programs [61,84], including exercises to increase TMJ and neck mobility. To restore oral muscle strength, some evidence supported the administration of specific exercises for labial, intrinsic tongue and masticatory muscles, which can be helpful in managing dysphagic symptoms [28].…”

“…Conservative and rehabilitative management should aim to decrease orofacial pain and muscle contractures/spasms, improving TMJ function, despite the variety of TMD and SD types that clinicians could find in the population of neurological patients. Notably, Zapata-Soria et al [60] identified some CTS-R interventions in post-stroke patients, including therapeutic jaw exercises. It seems that both jaw opening and head lift exercises can improve digastric and mylohyoid muscle thickness as well as hyoid bone movements.…”

Analysis of the Effect of Exams on Perceived Stress and Temporomandibular Joint Status in Physiotherapy Students: A Pilot Study

“…These include biological, environmental, social, behavioral, and emotional factors, which continue to be a topic of discussion among different authors [ 3 , 4 , 5 ]. Skeletal malocclusion is described a factor that can influence the limitation of mandibular opening, producing TMJ noises [ 1 , 2 , 6 ], shown mostly in skeletal retrognathia, although the quality of the available literature does not seem high enough to provide strong scientific evidence on the subject [ 7 ]. Another factor associated with TMDs is stress, which causes muscle tension and/or psychosomatic reactions [ 8 ].…”