Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial

Dziewas, Rainer; Stellato, Rebecca K.; Tweel, Ingeborg van der; Walther, Ernst; Werner, Cornelius J.; Braun, Tobias; Citerio, Giuseppe; Jandl, Mitja; Friedrichs, Michael; Nötzel, Katja; Voško, Milan R.; Mistry, Satish; Hamdy, Shaheen; McGowan, Sue; Warnecke, Tobias; Zwittag, Paul; Bath, Philip M

doi:10.1016/s1474-4422(18)30255-2

Cited by 119 publications

(124 citation statements)

References 32 publications

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“…However, it is encouraging to see the growth in positive trial results from new interventional, pharmaceutical and device-based interventions in stroke [18][19][20] .…”

Section: Learning From Stroke Researchmentioning

confidence: 99%

UK consensus on pre-clinical vascular cognitive impairment functional outcomes assessment: Questionnaire and workshop proceedings

McFall

Hietamies

Bernard

et al. 2020

J Cereb Blood Flow Metab

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Assessment of outcome in preclinical studies of vascular cognitive impairment (VCI) is heterogenous. Through an ARUK Scottish Network supported questionnaire and workshop (mostly UK-based researchers), we aimed to determine underlying variability and what could be implemented to overcome identified challenges. Twelve UK VCI research centres were identified and invited to complete a questionnaire and attend a one-day workshop. Questionnaire responses demonstrated agreement that outcome assessments in VCI preclinical research vary by group and even those common across groups, may be performed differently. From the workshop, six themes were discussed: issues with preclinical models, reasons for choosing functional assessments, issues in interpretation of functional assessments, describing and reporting functional outcome assessments, sharing resources and expertise, and standardization of outcomes. Eight consensus points emerged demonstrating broadly that the chosen assessment should reflect the deficit being measured, and therefore that one assessment does not suit all models; guidance/standardisation on recording VCI outcome reporting is needed and that uniformity would be aided by a platform to share expertise, material, protocols and procedures thus reducing heterogeneity and so increasing potential for collaboration, comparison and replication. As a result of the workshop, UK wide consensus statements were agreed and future priorities for preclinical research identified.

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“…However, it is encouraging to see the growth in positive trial results from new interventional, pharmaceutical and device-based interventions in stroke [18][19][20] .…”

Section: Learning From Stroke Researchmentioning

confidence: 99%

UK consensus on pre-clinical vascular cognitive impairment functional outcomes assessment: Questionnaire and workshop proceedings

McFall

Hietamies

Bernard

et al. 2020

J Cereb Blood Flow Metab

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“…[12][13][14] IPES has been found specifically valuable to treat severely affected tracheostomized PS-OD patients by increasing the proportion of patients who were ready for decannulation. 15 Capsaicinoids have shown immediate biomechanical improvements using a high single dose while lower multiple doses have also shown sensory conduction improvements. [16][17][18] However, no central sensory strategy in this direction has been developed as far as we know.…”

Section: Introductionmentioning

confidence: 99%

Short‐term neurophysiological effects of sensory pathway neurorehabilitation strategies on chronic poststroke oropharyngeal dysphagia

Cabib

Nascimento

Rofes

et al. 2020

Neurogastroenterology Motil

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Background Neurorehabilitation strategies for chronic poststroke (PS) oropharyngeal dysphagia (OD) have been mainly focused on the neurostimulation of the pharyngeal motor cortex with only marginal effects. In contrast, treatments targeting the PS oropharyngeal sensory pathway dysfunction offer very promising results, but there is little knowledge on the underlying mechanisms. We aimed to explore the neurophysiological mechanisms behind the effect of three sensory neurostimulation strategies. Methods We carried out a randomized two‐blinded parallel group's crossover sham‐controlled clinical trial in 36 patients with unilateral stroke and chronic unsafe swallow to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) of the primary sensory cortex (A), oral capsaicin (B) and intra‐pharyngeal electrical stimulation (IPES; C). The effect was evaluated immediately after the interventions with videofluoroscopy (VFS) and motor/sensory evoked potentials (MEP/SEP). Key Results Interventions induced no changes in the biomechanics of the swallow response during VFS. However, an enhancement of motor cortex excitability (latency shortening and increased size of thenar MEP) was found with active interventions (A + B + C, and B/C alone; P < .05 for all) but not with sham. Active but not sham interventions shortened pharyngeal SEP latency in the ipsilesional hemisphere (A + B + C: P2‐peak, P = .039; A: N2‐peak, P = .034) and antagonized the physiological habituation in pharyngeal MEP (A + B + C and A alone, P < .05 for both). Conclusions and Inferences Sensory pathway neurostimulation strategies caused immediate enhancement of motor cortex excitability with peripheral strategies (capsaicin and IPES) and of pharyngeal sensory conduction with rTMS. These changes support the use of sensory neurorehabilitation strategies in promoting swallow recovery in chronic PS‐OD.

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“…Increased resting swallowing rates in tube-fed stroke patients with dysphagia have been shown in these patients [12]. Moreover, pharyngeal electrical stimulation favorably influenced the decannulation rate in tracheotomized ischemic stroke patients [11]. These novel approaches may be of special interest in SAH patients, as prolonged mechanical ventilation is common in poor admission grade patients rendering an early time window for these interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the novel understanding of neuronal plasticity of brain regions involved in the swallowing process has led to new treatment approaches, such as electrical pharyngeal stimulation, which can be applied already early after ictus. This intervention was recently found to be associated with an improved decannulation rate in tracheotomized stroke patients [11]. In addition, oropharyngeal air-pulse application was associated with increased resting swallowing rates in tube-fed patients with hemispheric stroke [12].…”

Section: Introductionmentioning

confidence: 97%

Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage

et al. 2019

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Background: Despite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome. Methods: This is a retrospective analysis of an ongoing prospective cohort study. Swallowing ability was assessed in consecutive non-traumatic SAH patients admitted to our neurological intensive care unit using the Bogenhausen Dysphagia Score (BODS). A BODS > 2 points indicated dysphagia. Functional outcome was assessed 3 months after the SAH using the modified Rankin Scale with a score > 2 defined as poor functional outcome. Results: Two-hundred and fifty consecutive SAH patients comprising all clinical severity grades with a median age of 57 years (interquartile range 47-67) were eligible for analysis. Dysphagia was diagnosed in 86 patients (34.4%). Factors independently associated with the development of dysphagia were poor clinical grade on admission (Hunt & Hess grades 4-5), SAH-associated parenchymal hematoma, hydrocephalus, detection of an aneurysm, and prolonged mechanical ventilation (> 48 h). Dysphagia was independently associated with a higher rate of pneumonia (OR = 4.32, 95% CI = 2.35-7.93), blood stream infection (OR = 4.3, 95% CI = 2.0-9.4), longer ICU stay [14 (8-21) days versus 29.5 (23-45) days, p < 0.001], and poor functional outcome after 3 months (OR = 3.10, 95% CI = 1.49-6.39). Conclusions: Dysphagia is a frequent complication of non-traumatic SAH and associated with poor functional outcome, infectious complications, and prolonged stay in the intensive care unit. Early identification of high-risk patients is needed to timely stratify individual patients for dysphagia treatment.

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Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial

Abstract: Phagenesis Ltd.

Cited by 119 publications

References 32 publications

UK consensus on pre-clinical vascular cognitive impairment functional outcomes assessment: Questionnaire and workshop proceedings

UK consensus on pre-clinical vascular cognitive impairment functional outcomes assessment: Questionnaire and workshop proceedings

Short‐term neurophysiological effects of sensory pathway neurorehabilitation strategies on chronic poststroke oropharyngeal dysphagia

Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage

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