The role of oral and pharyngeal motor exercises in post-stroke recovery: A scoping review

The association of odds ratio product with respiratory and arousal measures in post-stroke patients

STUDY OBJECTIVES

Obstructive Sleep Apnea (OSA) affects up to 70 % of post-stroke patients, complicating recovery and rehabilitation. This study aimed to evaluate the utility of the Odds Ratio Product (ORP), a continuous EEG-derived metric of sleep depth, in predicting conventional respiratory and arousal measures in stroke patients. We hypothesized that ORP metrics will predict conventional measures in patients with a history of stroke or Transient ischemic attack (TIA).

METHODS

A retrospective analysis was conducted on 113 stroke/TIA individuals who underwent in-laboratory polysomnography (PSG). ORP metrics, including ORPnrem, ORPrem, ORP9, and Wake Intrusion Indices (WIIs), were analyzed using multivariate linear regression models. Models were stratified by OSA status. Standardized coefficients were used to assess associations with the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and arousal indices.

RESULTS

ORP metrics demonstrated statistically significant associations with conventional respiratory and arousal measures, with varying predictive strength across models. Specifically, ORPnrem and WIIs exhibited strong predictive effects across all models. ORP9 significantly predicted respiratory and arousal measures in the overall sample and the OSA subgroup, but its predictive value diminished in the non-OSA subgroup. ORPrem was statistically significantly associated with respiratory and arousal measures; however, its associations with arousal measures were weaker in participants with OSA compared to those without OSA.

CONCLUSION

ORP metrics have the potential to refine OSA diagnoses and improve therapeutic strategies in post-stroke/TIA populations. Their integration into sleep assessments could facilitate early intervention and potentially optimize stroke recovery outcomes, addressing gaps in current evaluation methods.

A Scoping Review on the Effects of Kinesio Taping on Oropharyngeal Function Related to Swallowing and Feeding

Following the expansion of interdisciplinary communication among rehabilitative service providers, new techniques have been introduced for treating swallowing disorders. Kinesio taping (KT) is one of the recently noticed techniques in the rehabilitation of swallowing and feeding disorders. Given the novelty of this technique in research and practice, the present scoping review aimed to summarize the available evidence on the effects of KT on the oropharyngeal function related to swallowing, and to identify current knowledge gaps to guide future studies. The initial comprehensive search was conducted in the six databases in November 2022 and then was updated in June 2023. Studies were independently reviewed by two authors to exclude all types of reviews and study protocols, studies published only in an abstract form and also studies that used KT for improving voice and dysarthria symptoms. The methodology of the included studies was also critically appraised using Joanna Briggs Institute (JBI) standard tools by two authors. The results of the studies were categorized and reported based on their overall objectives. In final analysis, 21 articles were described. Study designs ranged from randomized control trials (RCTs) to the case reports. The effects of KT had been investigated on drooling, oral feeding skills of infants, immediate activation of swallowing muscles, and management of dysphagia in patients with stroke or cerebral palsy (CP). Although innovative approaches to use KT as a therapeutic method in swallowing disorders have been investigated in the studies, there are many methodological limitations that affected validity of the results. In general, it seems there is not enough evidence to add KT to the usual management of feeding and swallowing disorders yet. Further studies, therefore, are required to achieve more accurate conclusions in each of the objectives summarized in this study.

Human-AI collaboration improves adults' oral biomechanical functions: A multi-centre, self-controlled clinical trial

OBJECTIVES

Maintenance of oral muscle functions is important for survival and communication. Utilizing Artificial Intelligence (AI) as a self-health-management material has shown promise. Here we developed a functional and AI-enabled smartphone e-Oral APP that provided real-time feedback features to let humans collaborate with AI, targeting to improve oral biomechanical and speech functions of adults.

METHODS

A total of 113 neurologically healthy Hong Kong citizens over 50 years old were recruited in this study from June to October 2022. A set of 12 exercises of the tongue, lips, and jaw were conducted with guidance provided in the self-developed e-Oral APP, in which visual-audio demonstrations and immediate feedback on facial movements by an open-source AI-pretrained 68-point Ensemble of Regression Tree (ERT) face landmark detector was given to the users. After 8-week exercises, assessments after 1-week and 4-week post-training were conducted. Primary outcomes were measured on oral functions, including occlusal force, masticatory efficiency, tongue strength, along with dry mouth condition, and oral health-related quality of life (OHQoL), while secondary outcomes were comprised of oral diadochokinesis (DDK) and swallowing ability. The usability of the APP was evaluated by a self-written questionnaire.

RESULTS

After exercising a set of 12 exercises on the tongue, lips, and jaw for 8 weeks, 70 out of 113 participants (average age of 67.70±4.93 y.o., 52 female and 18 male) had a significant improvement in the occlusal force (p < 0.001), while masticatory efficiency (p = 0.002), tongue pressure (p < 0.001) and endurance (p = 0.004) were also improved. 80.3 % of respondents rated the APP with an overall rating of 3 out of 5 points, and 68.6 % would recommend the APP to others.

CONCLUSIONS

AI-based APP can be an effective approach to help healthy adults improve their occlusal force, masticatory efficiency, tongue functions, and oral diadochokinesis after 8-week home oral exercises. Furthermore, these improvements can be sustained for at least four weeks.

CLINICAL SIGNIFICANCE

This is the first AI-assisted APP developed for oral muscle training. Our findings demonstrated that a self-administrated human-AI collaboration APP can improve clinically oral muscle biomechanics and functions for healthy adults. AI technology in smartphone gadgets provides a cost-effective, convenient, and reliable means for oral muscles training for adults.

Stroke rehabilitation: from diagnosis to therapy

Stroke remains a significant global health burden, necessitating comprehensive and innovative approaches in rehabilitation to optimize recovery outcomes. This paper provides a thorough exploration of rehabilitation strategies in stroke management, focusing on diagnostic methods, acute management, and diverse modalities encompassing physical, occupational, speech, and cognitive therapies. Emphasizing the importance of early identification of rehabilitation needs and leveraging technological advancements, including neurostimulation techniques and assistive technologies, this manuscript highlights the challenges and opportunities in stroke rehabilitation. Additionally, it discusses future directions, such as personalized rehabilitation approaches, neuroplasticity concepts, and advancements in assistive technologies, which hold promise in reshaping the landscape of stroke rehabilitation. By delineating these multifaceted aspects, this manuscript aims to provide insights and directions for optimizing stroke rehabilitation practices and enhancing the quality of life for stroke survivors.

Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial

This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.

The effect of behavioral therapy on dysphagia of acute ischemic stroke patients feeding with a nasogastric tube

This prospective observational study aimed to assess the impact of behavioral therapy on dysphagia in patients with acute ischemic stroke undergoing nasogastric tube feeding. The study was conducted between June 2020 and May 2022 at the Neurological Center of Bach Mai Hospital, Vietnam, with a sample size of 230 patients divided into two groups: a normal and a behavioral therapy group. The normal therapy group received routine care and treatment based on standard protocols, while the behavioral therapy group underwent daily swallowing exercises for approximately 60 minutes. The Gugging Swallowing Screen (GUSS) was utilized to screen individuals with dysphagia, and the difference-in-differences (DID) method was adopted to estimate the effect of behavioral therapy on dysphagia patients. The study concluded that behavioral therapy improved dysphagia in patients with acute ischemic stroke undergoing nasogastric tube feeding. This study highlights the potential of behavioral therapy as an effective intervention for dysphagia rehabilitation in stroke patients.

The role of the tongue in post-stroke dysphagia and obstructive sleep apnea: Correlation with sonography measurement

OBJECTIVE

Obstructive sleep apnea (OSA) is a common risk factor for stroke, and dysphagia and pneumonia are both well-known complications of stroke. The development of these conditions is related to the oropharyngeal structures. We investigated whether specific structural features of the tongue may lead to the development of these complications.

METHODS

Patients with ischemic stroke who required admission and community-dwelling elderly controls were enrolled. The participants underwent tongue measurements by received hand-held ultrasound, and received questionnaires to evaluate sleep quality and daytime sleepiness. The patient group also underwent objective sleep measurement by actigraphy and the 3-Step Swallowing Test (3-SSS). Sleep parameters and outcomes were analyzed.

RESULTS

Patient with ischemic stroke had significantly thicker tongue than controls (6.53 cm v. 6.05 cm, p = 0.002). Multiple logistic regression analysis revealed that the anatomical parameters of the tongue in patients with stroke were significantly correlated with parameters of OSA, and the thickness of the tongue was positively correlated with the development of OSA (p = 0.024) and pneumonia (p = 0.048).

CONCLUSIONS

A thicker-than average tongue may be a risk factor for OSA and pneumonia in patient with stroke. Hand-held ultrasound can be used to identify these anatomical features. Further studies are warranted to clarify the role of the tongue in these post-stroke complications.

A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals

Stroke is the fourth leading cause of mortality and is estimated to be one of the major reasons for long-lasting disability worldwide. There are limited studies that describe the application of physical therapy interventions to prevent disabilities in stroke survivors and promote recovery after a stroke. In this review, we have described a wide range of interventions based on impairments, activity limitations, and goals in recovery during different stages of a stroke. This article mainly focuses on stroke rehabilitation tactics, including those for sensory function impairments, motor learning programs, hemianopia and unilateral neglect, flexibility and joint integrity, strength training, hypertonicity, postural control, and gait training. We conclude that, aside from medicine, stroke rehabilitation must address specific functional limitations to allow for group activities and superior use of a hemiparetic extremity. Medical doctors are often surprised by the variety of physiotherapeutic techniques available; they are unfamiliar with the approaches of researchers such as Bobath, Coulter, and Brunnstrom, among others, as well as the scientific reasoning behind these techniques.