Efeito da eletroestimulação funcional em pacientes com disfagia orofaríngea após acidente vascular cerebral isquêmico agudo: um ensaio clínico randomizado

Abstract

Stroke is considered the main cause of oropharyngeal neurogenic dysphagia, present in 45% of all cases. The swallowing functions management is a unique aspect for the rehabilitation of a patient after stroke, reducing the risk of aspiration pneumonia. Since the 1980s, electrostimulation has been used for therapeutic purposes in Brazil. Since the 1990s, it has been used as a relevant therapeutic tool in cases of oropharyngeal dysphagia. As there is no substantial evidence for these interventions, it is necessary to carry out more studies on their use. Objective: To evaluate the effect of functional electrostimulation as a complement to conventional speech therapy in dysphagic patients after ischemic stroke. Methodology: We performed an experimental, randomized and controlled study. 33 patients with dysphagia after stroke participated. Patients were randomized and divided into two groups and submitted to clinical evaluation using the Functional Oral Ingestion Scale (FOIS), Dysphagia Risk Assessment Protocol (PARD) and swallowing videoendoscopy exam (VED). Both groups undergone systematic speech therapy and in the Intervention Group (IG) functional electrotherapy was added. Results: The sample was composed mostly of men, around 60%, from 51 to 60 years old. Among the risk factors, the most incident was sedentary lifestyle, present in 72.7% of the patients. Although no significant difference was found between the groups with regard to the VED results, after 5 intervention days the number of patients with functional swallowing increased from 1 (6.25%) to 3 (17, 64%) in the IG. Initially, 1 IG patient received a mixed diet and all patients in the Placebo Group (PG) received exclusive enteral diet. At the end of five therapy sessions, 8 patients from the IG (50%) and 6 patients (35.3%) from the GP changed to an oral diet. There was a significant difference in relation to the improvement in the FOIS level of patients both in the IG (p = 0.001) and in the PG (p = 0.01). Regarding the intergroup comparison, no significant differences were observed before and after the intervention (p = 1.00 and 0.72 respectively). Conclusion: Speech therapy intervention performed with conventional exercises added or not with electrotherapy, can be an important tool to be used in the rehabilitation process of dysphagic patients affected by stroke and in use of an enteral diet.