Hägg, M. & Larsson, B. (2004). Dysphagia 19:219–230
Abstract as published
Dysphagia is a common poststroke symptom with negative effects on recovery and rehabilitation. However, the orofacial regulation therapy, developed by Castillo Morales, comprising body regulation and orofacial regulation in combination with a palatal plate application has shown promising results in stroke patients. This therapy is based not only on muscle exercises but also on an improvement of the entire sensory-motor reflex arc involved in normal deglutition, and on the knowledge that the function of face and oropharynx at deglutition is closely interrelated with the entire body posture as well as with appropriate breathing. The treatment concept is relatively unknown to caregivers, partly due to lack of scientific evaluation of treatment results. The present investigation aimed to assess the effect of motor and sensory stimulation in stroke patients with dysphagia persisting for more than six months. Seven patients were evaluated with respect to orofacial and pharyngeal motility and sensory function before and two weeks after a five-week treatment period. The evaluation comprised a swallowing capacity test, a meal observation test, clinical examination of oral motor and sensory function, a velopharyngeal closure test, and videofluoroscopy. In addition, the symptoms were scored by the patients. An overall single-blind estimation showed objective and self-assessed swallowing improvement in all seven patients. Kappa coefficients are calculated on all reliability data, both inter- and intra-rater reliabilities. Sensory and motor stimulation seems to be a promising therapy in stroke patients with long-lasting and persistent oropharyngeal dysphagia.
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Relevance to conditions
Dysphagia: Stroke and rehab.
Snoring and sleep apnoea: VCT. Velum closure is linked to snoring and OSA.
Peer reviewed, Cohort pre- and post- study.
The present investigation aimed to assess the effect of motor and sensory stimulation using manual muscle therapy and palatal plate according to Morales in stroke patients with dysphagia persisting for more than 6 months.
7 patients, F=1, M=6. Adult, median age 72 (range 48 – 84 years). All with oropharyngeal dysphagia of duration median 1½ years (range 6 months – 4 years)
Body regulation, manual orofacial regulation, palatal plate application, and velopharyngeal closure training. Duration: once per week for 5 weeks in a clinical setting, and home exercises three times per day.
- Swallowing ability (using Timed Water Swallow Test – TWST) – lower normal value for swallowing rate ≥ 10 ml / sec
- Meal Observation Test (MOT)
- Clinical examination of orofacial sensory and motor function
- Velum Closure Test (VCT) – lower normal value ≥ 10 sec
- Videofluoroscopy (VF).
Descriptive statement of improvement in swallowing, orofacial sensory function, orofacial motor function and velum closure ability in all patients. The Orofacial Motor Tests (OFMT) were validated and Kappa coefficients were calculated for both intra- and inter-rater reliability with a result of = 0.90.
Orofacial regulation therapy according Castillo Morales can improve long-lasting oropharyngeal dysphagia in stroke patients. The Orofacial Motor Tests (OFMT) were shown to have a high Kappa coefficient of reliability.