Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury

Abstract

IntroductionDysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly compensatory strategies to the retraining of swallowing function using principles from neuroscience. However, there are no studies that map interventions available to retrain swallowing function in patients with moderate-to-severe ABI.ObjectiveTo systematically map the accessible research literature to answer the research question: Which non-surgical, non-pharmacological interventions are used in the treatment of dysphagia in patients with moderate and severe ABI in the acute and subacute phase?DesignScoping review based on the methodology of Arksey and O’Malley and methodological advancement by Levac et al.Data sourcesMEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, OTseeker, speechBITE and PEDro were searched up until 14 March 2021.Eligibility criteriaAll studies reporting rehabilitative interventions within 6 months of injury for patients with moderate-to-severe ABI and dysphagia were included.Data extraction and synthesisData was extracted by two independent reviewers and studies were categorised based on treatment modality.ResultsA total of 21 396 records were retrieved, and a final of 26 studies were included. Interventions were categorised into cortical or non-cortical stimulation of the swallowing network. Cortical stimulation interventions were repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. Non-cortical were complex swallowing interventions, neuromuscular electrical stimulation, pharyngeal electrical stimulation (PES), sensory stimulation, strengthening exercises and respiratory muscle training.ConclusionThis scoping review provides an overview of rehabilitative dysphagia interventions for patients with moderate and severe ABI, predominantly due to stroke, in the acute and subacute phase. Positive tendencies towards beneficial effects were found for rTMS, complex swallowing interventions, PES and cervical strengthening. Future studies could benefit from clear reporting of patient diagnosis and disease severity, the use of more standardised treatment protocols or algorithms and fewer but standardised outcome measures to enable comparison of effects across studies and interventions.

Focal vibration in dysphagia: A technological treatment for severe acquired brain injury rehabilitation

“…A recent review 24 analysed studies on non‐pharmacological or surgical types of treatment for dysphagia in patients with acquired brain injury. This showed that transcranial direct current stimulation, transcranial magnetic stimulation (rTMS), neuromuscular electrical stimulation and pharyngeal electrical stimulation were found to be the most commonly used innovative tools.…”

“…3 More recently, besides conventional approach, studies have been carried out on the use of innovative techniques. A recent review 24 analysed studies on non-pharmacological or surgical types of treatment for dysphagia in patients with acquired brain injury. This showed that transcranial direct current stimulation, TA B L E 1 Characteristics of patients at baseline.…”

Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem

“…The conventional treatment of dysphagia consists of exercises to increase oropharyngeal muscles strength as well as compensation strategies (including positioning, posture change and dietary modification to promote swallowing physiology and increase sensory input through thermal-tactile stimulation) [62]. However, as the aforementioned outcomes could be reached at different times by the different patients, personalized treatment has to be considered [58][59][60].…”

A Dual Synergetic Nanoreactor for Managing Parkinson's Disease by Regulating Inflammation and Mitigating Oxidative Damage

“…[3] In addition, surgical treatments have been linked to adverse effects, such as inflammation and brain trauma. [4][5][6] This calls for in-depth exploration of the pathogenesis of PD and the crucial need to develop comprehensive and noninvasive treatments for PD patients.…”