Physiotherapy interventions for stroke-related dysphagia - a systematic review

Authors

  • Siddhika J. Sankhe Dr. APJ Abdul Kalam College of Physiotherapy (Deemed to be University), Loni, Maharashtra, India
  • Sambhaji B. Gunjal Dr. APJ Abdul Kalam College of Physiotherapy (Deemed to be University), Loni, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251315

Keywords:

Stroke, Dysphagia, Physiotherapy interventions, Respiratory muscle training

Abstract

Dysphagia, or difficulty in swallowing, affects over half of stroke survivors, leading to severe complications such as aspiration pneumonia, malnutrition, and dehydration. Physiotherapy interventions, including swallowing exercises, neuromuscular electrical stimulation (NMES), respiratory muscle training, and compensatory strategies, show potential in improving swallowing function. This systematic review consolidates the evidence on the effectiveness of physiotherapy interventions in stroke-related dysphagia. A systematic review was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Articles were retrieved from databases such as PubMed and Google Scholar. The review analyzed various physiotherapy interventions and their impact on swallowing function and aspiration risk. Results indicate that interventions such as chin tuck against resistance (CTAR), NMES, and respiratory muscle training significantly improve swallowing safety and function. A combination of multiple strategies yielded better results than single interventions. This study highlights the importance of individualized physiotherapy management in stroke-related dysphagia rehabilitation.

Metrics

Metrics Loading ...

References

Smithard DG, Smeeton NC, Wolfe CD. Long-term outcome after stroke: does dysphagia matter? Age Ageing. 2007;36(1):90-4. DOI: https://doi.org/10.1093/ageing/afl149

New York University School of Medicine. Swallowing Disorders - Symptoms of Dysphagia. Available at: https://www.nyp.org/digestive/ dysphagia. Accessed on 14 January 2025.

Broussard DL, Altschuler SM. Brainstem viscerotopic organization of afferents and efferents involved in the control of swallowing. Am J Med. 2000;108(4a):79S-86S. DOI: https://doi.org/10.1016/S0002-9343(99)00343-5

Jean A. Brainstem organization of the swallowing network. Brain Behav Evol. 1984;25(2-3):109-16. DOI: https://doi.org/10.1159/000118856

Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81(2):929-69. DOI: https://doi.org/10.1152/physrev.2001.81.2.929

Aydogdu I, Ertekin C, Tarlaci S, Turman B, Kiylioglu N, Secil Y. Dysphagia in lateral medullary infarction (Wallenberg’s syndrome): an acute disconnection syndrome in premotor neurons related to swallowing activity? Stroke. 2001;32(9):2081-7. DOI: https://doi.org/10.1161/hs0901.094278

Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's principles of internal medicine. 19th Edition. McGraw-Hill Education. 2009.

Spieker MR. Evaluating dysphagia. Am Fam Phys. 2000;61(12):3639-48.

Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke. 2013;15(3):128-34. DOI: https://doi.org/10.5853/jos.2013.15.3.128

Indian Council of Medical Research, Public Health Foundation of India, Institute for Health Metrics and Evaluation. India: Health if the Nation’s States- The India State- Level Disease Burden Initiative. 2017. Available at: https://www.healthdata.org/sites/ default/files/files/policy_report/2017/India_Health_of_the_Nation%27s_States_Report_2017. Accessed on 14 January 2025.

Perry A, Lee SH, Cotton S, Kennedy C. Therapeutic exercises for affecting post-treatment swallowing in people treated for advanced-stage head and neck cancers. Cochrane Database Syst Rev. 2016;2016(8):CD011112. DOI: https://doi.org/10.1002/14651858.CD011112.pub2

Logemann JA. Evaluation and treatment of swallowing disorders. Austin, Tex: Pro-Ed. 1998. DOI: https://doi.org/10.1097/00020840-199812000-00008

Alamer A, Melese H, Nigussie F. Effectiveness of Neuromuscular Electrical Stimulation on Post-Stroke Dysphagia: A Systematic Review of Randomized Controlled Trials. Clin Interv Aging. 2020;15:1521-31. DOI: https://doi.org/10.2147/CIA.S262596

Farpour S, Asadi-Shekaari M, Borhani Haghighi A, Farpour HR. Improving Swallowing Function and Ability in Post Stroke Dysphagia: A Randomized Clinical Trial. Dysphagia. 2023;38(1):330-9. DOI: https://doi.org/10.1007/s00455-022-10470-0

Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, Tafakhori A, Logemann J, Faghihzadeh S, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol. 2015;14(3):119-24.

Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of swallowing exercises in stroke rehabilitation: a systematic review. Eur Arch Otorhinolaryngol. 2023;280(3):1017-45. DOI: https://doi.org/10.1007/s00405-022-07735-7

Park JS, Hwang NK. Chin tuck against resistance exercise for dysphagia rehabilitation: A systematic review. J Oral Rehabil. 2021;48(8):968-77. DOI: https://doi.org/10.1111/joor.13181

Park JS, Oh DH, Chang MY, Kim KM. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. J Oral Rehabil. 2016;43(5):364-72. DOI: https://doi.org/10.1111/joor.12382

Liaw MY, Hsu CH, Leong CP, Liao CY, Wang LY, Lu CH, et al. Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial. Medicine (Baltimore). 2020;99(10):e19337. DOI: https://doi.org/10.1097/MD.0000000000019337

Sproson L, Pownall S, Enderby P, Freeman J. Combined electrical stimulation and exercise for swallow rehabilitation post-stroke: a pilot randomized control trial. Int J Lang Commun Disord. 2018;53(2):405-17. DOI: https://doi.org/10.1111/1460-6984.12359

Steele CM, Bayley MT, Peladeau-Pigeon M, Nagy A, Namasivayam AM, Stokely SL, et al. A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia. Dysphagia. 2016;31(3):452-61. DOI: https://doi.org/10.1007/s00455-016-9699-5

Ploumis A, Papadopoulou SL, Theodorou SJ, Exarchakos G, Givissis P, Beris A. Cervical isometric exercises improve dysphagia and cervical spine malalignment following stroke with hemiparesis: a randomized controlled trial. Eur J Phys Rehabil Med. 2018;54(6):845-52. DOI: https://doi.org/10.23736/S1973-9087.17.04952-8

Park HS, Oh DH, Yoon T, Park JS. Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial. Int J Lang Commun Disord. 2019;54(3):479-84. DOI: https://doi.org/10.1111/1460-6984.12453

Gómez-García N, Álvarez-Barrio L, Leirós-Rodríguez R, Soto-Rodríguez A, Andrade-Gómez E, Hernández-Lucas P. Transcranial direct current stimulation for post-stroke dysphagia: a meta-analysis. J Neuroeng Rehabil. 2023;20(1):165. DOI: https://doi.org/10.1186/s12984-023-01290-w

Park JS, Hwang NK, Oh DH, Chang MY. Effect of head lift exercise on kinematic motion of the hyolaryngeal complex and aspiration in patients with dysphagic stroke. J Oral Rehabil. 2017;44(5):385-91. DOI: https://doi.org/10.1111/joor.12492

Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. J Oral Rehabil. 2017;44(1):59-64. DOI: https://doi.org/10.1111/joor.12461

Kim HH, Park JS. Efficacy of modified chin tuck against resistance exercise using hand-free device for dysphagia in stroke survivors: A randomised controlled trial. J Oral Rehabil. 2019;46(11):1042-6. DOI: https://doi.org/10.1111/joor.12837

Zhang W, Pan H, Zong Y, Wang J, Xie Q. Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2022;103(6):1179-91. DOI: https://doi.org/10.1016/j.apmr.2021.10.020

Matos KC, de Oliveira VF, de Oliveira PLC, Carvalho FA, de Mesquita MRM, da Silva Queiroz CG, et al. Combined conventional speech therapy and functional electrical stimulation in acute stroke patients with dyphagia: a randomized controlled trial. BMC Neurol. 2022;22(1):231. DOI: https://doi.org/10.1186/s12883-022-02753-8

Guillén-Solà A, Messagi Sartor M, Bofill Soler N, Duarte E, Barrera MC, Marco E. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil. 2017;31(6):761-71. DOI: https://doi.org/10.1177/0269215516652446

Suntrup S, Marian T, Schröder JB, Suttrup I, Muhle P, Oelenberg S, et al. Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial. Intensive Care Med. 2015;41(9):1629-37. DOI: https://doi.org/10.1007/s00134-015-3897-8

Choi JB, Shim SH, Yang JE, Kim HD, Lee DH, Park JS. Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia. Neuro Rehab. 2017;41(4):753-7. DOI: https://doi.org/10.3233/NRE-172145

Umay EK, Yaylaci A, Saylam G, Gundogdu I, Gurcay E, Akcapinar D, et al. The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: A randomized controlled study. Neurol India. 2017;65(4):734-42. DOI: https://doi.org/10.4103/neuroindia.NI_377_16

Meng P, Zhang S, Wang Q, Wang P, Han C, Gao J, et al. The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia. J Back Musculoskelet Rehabil. 2018;31(2):363-70. DOI: https://doi.org/10.3233/BMR-170788

Park JS, Lee G, Jung YJ. Effects of game-based chin tuck against resistance exercise vs head-lift exercise in patients with dysphagia after stroke: An assessor-blind, randomized controlled trial. J Rehabil Med. 2019;51(10):749-54. DOI: https://doi.org/10.2340/16501977-2603

Downloads

Published

2025-04-29

How to Cite

Sankhe, S. J., & Gunjal, S. B. (2025). Physiotherapy interventions for stroke-related dysphagia - a systematic review. International Journal of Research in Medical Sciences, 13(5), 2088–2097. https://doi.org/10.18203/2320-6012.ijrms20251315

Issue

Section

Systematic Reviews