The use of biofeedback in the treatment of chronic dysphagia in stroke patients.

OBJECTIVE To evaluate the efficacy of the use of surface electromyographic feedback in the treatment of stroke patients with chronic dysphagia. PATIENTS AND METHODS Data of 11 consecutive patients with chronic dysphagia after stroke were analyzed. Our patients were treated for dysphagia with surface electromyography as biofeedback as adjunct to normal exercises. All patients suffered from dysphagia after stroke. The average time after onset was 31.1 months. All patients had been previously treated by speech therapists without success. Functional swallowing was estimated using the Functional Oral Intake Scale (FOIS). At the start of the treatment 8 patients were tube dependent (FOIS < or = 4). Three patients were on an oral diet, but with restrictions (FOIS > or = 5). RESULTS The patients were treated on average seven 7 times. The time between the first and last treatment session was on average 76.1 days (SD +/- 44.0; range = 29-168). Before treatment the average FOIS was 2.6 (SD +/-2.3) and after treatment 5.6 (SD +/-1.6). The median scores improved from 1 to 6, showing a significant and clinically relevant improvement (z = -2.820: p < 0.01) in swallowing function. In 6 of initially 8 patients with percutaneous enteral gastrostomy tubes, the feeding tube could be removed after treatment. CONCLUSION Our data suggest that the use of surface electromyography as biofeedback in the treatment of chronic dysphagia after stroke could be an effective adjunct to standard therapy for swallowing disorders in 11 patients.