7. Effects on facial dysfunction and swallowing capacity of intraoral stimulation early and late after stroke.

Hägg MK., Tibbling LI. NeuroRehabilitation. 2015;36 (1):101–6.

Abstract as published

Background Most patients with post-stroke dysphagia are also affected by facial dysfunction in all four facial quadrants. Intraoral stimulation can successfully treat post-stroke dysphagia, but its effect on post-stroke facial dysfunction remains unknown. Objective This study aimed to investigate whether intraoral stimulation after stroke has simultaneous effects on facial dysfunction in the contralateral lower facial quadrant and in the other three facial quadrants, on lip force, and on dysphagia. Methods Thirty-one stroke patients were treated with intraoral stimulation and assessed with a facial activity test, lip force test, and swallowing capacity test at three time-points: before treatment, at the end of treatment, and at late follow-up (over one year after the end of treatment). Results Facial activity, lip force, and swallowing capacity scores were all improved between baseline and the end of treatment (P < 0.001 for each), with these improvements remaining at late follow-up. Baseline and treatment data did not significantly differ between patients treated short and late after stroke. Conclusions Treatment with intraoral stimulation significantly improved post-stroke dysfunction in all four facial quadrants, swallowing capacity, and lip force even in cases of long-standing post-stroke dysfunction. Furthermore, such improvement remained for over one year after the end of treatment.

Relevance to conditions

Dysphagia: Proof of effect of IQoro on swallowing, facial paresis in stroke patients.

Study type

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

Aim

This study aimed to investigate whether intraoral stimulation after stroke has simultaneous effects on facial dysfunction in the contralateral lower facial quadrant and in the other three facial quadrants, on lip force, and on dysphagia.

Patients

42 patients with stroke, divided between:

  • Group 1 (n=31), median age 79 years, with a recent stroke (0–5 weeks),
  • Group 2 (n=20) median age 62 years, who had suffered stroke longer ago – median 57 weeks (range 6 weeks to 8.8 years).

Methods

Patients were treated with intraoral stimulation with either IQoro (90 seconds per day) or a Palatal Plate (90 minutes per day) and assessed for facial activity, pharyngeal sling force, and swallowing ability at three time-points: before treatment, at the end of treatment, and at late follow-up (>1 year after the end of treatment).

Outcome measurements

  • Facial Activity Test (FAT),
  • Pharyngeal sling force (using Lip Force meter) – lower normal value ≥ 15 N,
  • Swallowing ability (using Timed Water Swallow Test – TWST) – lower normal value for swallowing rate ≥ 10 ml / sec.

Results

FAT, LF, and TWST scores were all improved from baseline to end-of-treatment (p < 0.001 for each), with these improvements remaining at late follow-up. Baseline and treatment data did not significantly differ between patients treated shortly and late after stroke.

Statistical significance of result

(p < 0.001) pharyngeal sling force (LF)
(p < 0.001) swallowing ability (TWST)
(p < 0.001) orofacial sensory and motor test (FAT)

Conclusion

IQoro is effective in improving swallowing ability and facial activity in all four facial quadrants in patients after stroke irrespective of time from stroke debut to start of treatment. Improvements were still present at long-term follow-up. It is very unlikely that the improvements seen were due to spontaneous remission.