11. Effect of IQoro training on impaired postural control and oropharyngeal motor function in patients with dysphagia after stroke.

Hägg M., Tibbling L. Acta Otolaryngol 2016; 136 (7):742–748.

Abstract as published

Conclusion All patients with dysphagia after stroke have impaired postural control. IQoro screen (IQS) training gives a significant and lasting improvement of postural control running parallel with significant improvement of oropharyngeal motor dysfunction (OPMD). Objectives The present investigation aimed at studying the frequency of impaired postural control in patients with stroke-related dysphagia and if IQS training has any effect on impaired postural control in parallel with effect on OPMD. Method A prospective clinical study was carried out with 26 adult patients with stroke-related dysphagia. The training effect was compared between patients consecutively investigated at two different time periods, the first period with 15 patients included in the study more than half a year after stroke, the second period with 11 patients included within 1 month after stroke. Postural control tests and different oropharyngeal motor tests were performed before and after 3 months of oropharyngeal sensorimotor training with an IQS, and at a late follow-up (median 59 weeks after end of training). Result All patients had impaired postural control at baseline. Significant improvement in postural control and OPMD was observed after the completion of IQS training in both intervention groups. The improvements were still present at the late follow-up.

Relevance to conditions

Dysphagia: Proof of effect of IQoro on OPMD and IPC in stroke patients.
Snoring and sleep apnoea: Velum Closure competence is linked to snoring and OSA.

Study type

Peer reviewed, Prospective, Cohort pre- and post-study.

Aim

To study the frequency of Impaired Postural Control (IPC) in patients with stroke-related dysphagia or Oropharyngeal Motility Disorder (OPMD) and whether IQoro Neuromuscular Training (IQNT) has any effect on IPC in parallel with its effect on OPMD.

Patients

26 adult patients with stroke with pathological levels for both OPMD and IPC (F=11, M=15), median age 68 years (range 49–82).

The patients were divided between

  • Group 1 (n=15)
    • had suffered stroke more than 1 year before
    • median age 67 years.
    • 100 % had pathological lip and tongue motor function.
    • 10 had a pathological jaw function.
    • 12 had a pathological velum function.
    • 6 had a pathological velopharyngeal closure ability.
    • 14 exhibited misdirected swallowing.
    • 4 patients in this group were fed via PEG.
  • Group 2 (n=11)
    • had suffered stroke within 1 month before starting IQoro treatment.
    • median age 69 years.
    • 100 % had pathological lip and tongue motor function.
    • 10 had a pathological jaw function.
    • 12 had a pathological velum closure ability.
    • 8 had a pathological velopharyngeal closure ability.
    • 100 % exhibited misdirected swallowing.
    • 1 patient in this group was fed via PEG. 

108 patients were originally screened for inclusion in Group 2, but many were excluded before recruitment due to the following criteria: deceased (67), second stroke (26), unable to cooperate (15).

Methods

IQoro training 3 x 10 seconds, three times per day for a duration of 13 weeks.

Outcome measurements were made at three time points: before training, at end of training, and at a late follow-up (median 59 weeks after end of training).

Outcome measurements

The following measurements were used at all three timepoints:

  • Postural Control according to Castillo Morales (PCCM),
  • Postural Assessment Scale for Stroke patients (PASS),
  • Oropharyngeal motor function (OPM) – function of the lips, jaw, tongue and velum,
  • Swallowing ability (measured using Timed Water Swallow Test – TWST) – lower normal value for swallowing rate ≥ 10 ml / sec
  • Pharyngeal sling force (measured using Lip Force meter) – lower normal value ≥ 15 N
  • Velopharyngeal Closure Test (VCT) – lower normal value ≥ 10 sec

Results

  • 2 patients in Group 1 showed no improvement in either swallowing ability or postural control.
  • 24 patients (92 %) showed significant improvement in all outcome measures in both Group 1 and Group 2 after 3 months’ IQoro neuromuscular training including:
    • Postural Control according to Castillo Morales (PCCM),
    • Postural Assessment Scale for Stroke patients (PASS),
    • Oropharyngeal motor function (OPM) – function of the lips, jaw, tongue and velum,
    • Swallowing ability (measured using Timed Water Swallow Test – TWST) – lower normal value for swallowing rate ≥ 10 ml / sec
    • Pharyngeal sling force (measured using Lip Force meter)
    • Velopharyngeal Closure Test
  • The PEG was removed from the 1 patient in the short-term intervention group.
  • The PEGs were removed from all 4 patients in the long-term intervention group.
  • The improvements were still present at late follow-up (median 59 weeks after end-of-training.

Statistical significance of result

  • Postural control

(p < 0.004) improvement in PCCM, Group 1
(p < 0.002) improvement in PCCM, Group 2
(p < 0.016) improvement in PASS, Group 1
(p < 0.031) improvement in PASS, Group 2

  • Orofacial motor function

(p < 0.005) improvement in lip function, Group 1
(p < 0.008) improvement in lip function, Group 2
(p < 0.008) improvement in jaw function, Group 1
(p < 0.016) improvement in jaw function, Group 2
(p < 0.001) improvement in tongue function, Group 1
(p < 0.008) improvement in tongue function, Group 2

  • Velum function

(p < 0.001) improvement in soft palate function, Group 1
(p < 0.004) improvement in soft palate function Group 2
(p < 0.001) improvement in velopharyngeal closure ability, Group 1
(p < 0.039) improvement in velopharyngeal closure ability, Group 2

  • Pharyngeal sling force

(p < 0.002) improvement in pharyngeal sling force, Group 1
(p < 0.008) improvement in pharyngeal sling force, Group 2

  • Swallowing ability

(p < 0.001) improvement in swallowing ability, Group 1
(p < 0.002) improvement in swallowing ability, Group 2

  • Long standing effect

(p < NS) no significant difference in any of the measured values between end of treatment and late follow up.

Conclusion

  • IQoro successfully treats impaired postural control and oropharyngeal motor function in patients with dysphagia after stroke.
  • PEGs can be removed after several years use, after 13 weeks’ IQoro treatment.
  • Velum function is significantly improved by IQoro training.
  • Improvements made are still present at long-term follow up.
  • The similarity of results in the two intervention groups further supports the contention that improvement is not due to spontaneous remission.
  • Effectiveness of IQoro treatment is not affected by time from stroke to start of treatment, nor age or gender of patient.
  • The positive effect on muscle groups not directly accessed by IQoro neuromuscular training supports the contention that the improvements are triggered by neurological rehabilitation.