Conditions when training with IQoro is not appropriate
In IQoro clinical experience, there are three contra-indications that we have come across that directly preclude the use of IQoro in adults. Please contact us before ordering IQoro if you suffer from one of the following conditions:
- Trigeminal neuralgia
- Paraesophageal hernia
- Achalasia Cardiae
Conditions when training with IQoro should be started carefully
And these two conditions require extra thought and care:
- Peripheral facial palsy
The difficulties in using IQoro when these conditions exist are described more fully later in this document.
IQoro training in overview
All the scientific studies that we know of show no negative side-effects, nor does the company’s Quality Management System (QMS) record any serious adverse events.
In the beginning, training of under-used muscles can cause some soreness in the oral cavity, the neck, and deeper in the swallowing system – just like the first session in the gym for a long time, or the first day of the season on the ski slopes causes muscle aches. This soreness soon disappears.
General advice for healthcare professionals
IQoro can be used widely in a hospital or care setting by different categories of healthcare professionals as a neuromuscular training device to treat swallowing difficulties (dysphagia), hiatal hernia, GORD, snoring, sleep apnoea and related swallowing or respiratory difficulties. This includes patients with significant respiratory problems, possibly in ICU, or with a nasal oxygen feed, or those with cardiac problems.
Common inclusion symptoms include:
- Diagnosed with dysphagia, including those who are nil by mouth
- Facial paralysis
- Indistinct speech sounds
- Drooling and post-nasal drip
- Impaired postural control
- Hiatal hernia
- Hoarse voice and excessive throat clearing
- Snoring and sleep apnoea
IQoro after stroke
In Sweden, IQoro would normally not be used during the first week after stroke when the patient is disorientated, and when the risk of a new stroke or mortality is at its highest. After the first week, when a ‘steady state’ has often been achieved, IQoro would be deployed on those displaying symptoms of dysphagia.
IQoro and degenerative conditions
There are no studies of patients with degenerative conditions, who may often have swallowing problems as a result of their diseases, although the extensive research on patients with stroke – another type of neurological condition – have shown very good results.
IQoro will not treat the underlying condition, however It may be expected to improve swallowing ability, and to maintain swallowing ability longer than otherwise may have been expected. Clinical experience supports this. It is still likely that, long-term, swallowing ability will continue to worsen.
Degenerative conditions can include:
- Parkinson’s Disease
- Multiple Sclerosis
- Amyotrophic Lateral Sclerosis
IQoro and other conditions
Some patients are possibly not clinically fit or able enough to undertake IQoro training. As with all rehab interventions, patients should be considered individually before being treated with IQoro. The patient’s condition may mean that they are not well enough to tolerate rehab, or they may have some other disallowing factor that makes this treatment inappropriate. Such factors may include:
- An ongoing unwillingness or inability to cooperate.
- A severe receptive dysphasia, affecting ability to understand and participate.
- Particularly high muscle tone, which after discussion with the MDT, appears to contra-indicate the use of IQoro. Where they can be trained, a normal improvement would be expected, usually this would require training assistance by a helper. The IQoro feasibility kit can be used to assess contra-indication.
As mentioned in the opening paragraph, the following co-conditions usually preclude the use of IQoro:
- Trigeminal neuralgia
- Paraesophageal hernia
- Achalasia Cardiae
Short and intensive attacks of acute pain. This disease often begins in patients around 50 years old and is more common in women than in men. It affects around 6 people in every 100 000.
The condition is classified as either classic- or symptomatic-trigeminal neuralgia. The former is probably caused by the mechanical effect of a trapped blood vessel pressing on the trigeminus nerve-ending or has no detectable cause at all. Symptomatic trigeminal neuralgia can have its origin in either a tumour or a neurological condition. It is not uncommon that the intense pain is wrongly ascribed as coming from the teeth or sinuses. In both types of this condition the right side of the face is twice as likely to be affected as the left.
Since even brushing the teeth can trigger an attack, training with IQoro is not usually recommended in such cases.
Also known as ‘rolling hiatal hernia’ (as opposed to ‘sliding hiatal hernia’). In this rare variant of hiatal hernia, a part of the stomach intrudes through the diaphragm into the chest cavity on the left-hand side, under the heart. Crucially, this intrusion is not of the mouth of the stomach (which remains in the stomach cavity) as in a sliding hiatus hernia, but another part of the stomach wall. The herniated part of the stomach can be strangulated in the chest cavity and surgical intervention is often recommended.
Training with IQoro is not usually recommended in such cases.
Achalasia is a rare type of esophageal dysphagia, but in some cases can be reminiscent of the symptoms of a hiatus hernia, which is much more common. Unfortunately, it’s not uncommon that achalasia and hiatus hernia are confused with each other, which can lead to an incorrect diagnosis when the doctor examines.
Misunderstandings between the doctor and patient can also occur when, for example, the doctor describes a blockage in the upper stomach mouth – esophageal sphincter – using the Latin word ”achalasia” which means ”blockage” or bottleneck. Hiatus hernia can also be perceived as a feeling of a blockage in the chest, which the doctor can correctly report as ”achalasia in the rib cage”. This must not be confused with the diagnosis ”achalasia cardiae”.
Cases where extra care should be exercised
People with this condition can sometimes experience an altered hearing sensation after training with IQoro, probably because one of the nerves stimulated by IQoro emanates from the middle ear. In some cases, this change in perceived ‘noise’ is a positive one, in others it is perceived as a worsening.
IQoro treatment is recommended, but a gradual introduction and build-up to the full 3×10 second sessions, three times per day is to be preferred. Be prepared to stop increasing your training, or even to drop back a level if you experience significant discomfort. Call us if you wish to discuss.
Peripheral facial palsy
Peripheral facial palsy differs from central facial palsy. If a person with peripheral facial paralysis is asked to raise his eyebrows, close his eyes, and smile at the same time it can be seen in the paralysed half that the facial expressiveness is depressed and that the person can have difficulty in:
- Closing one eye – the lower eyelid hangs down and reveals the white of the eye
- The eyebrow on the affected side does not lift
- The corner of the mouth on the affected side does not raise
IQoro treatment is recommended, but a gradual introduction and build-up to the full 3×10 second sessions three times per day is to be preferred. Be prepared to stop increasing your training, or even to drop back a level if you experience significant discomfort. Call us if you wish to discuss.
Training is best done in front of a mirror to check for balance and symmetry in the pulling action.