Journal of Rehabilitation Medicine 51-10 | Page 31

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Effects of game-based exercise for dysphagia after stroke
Fig. 1. Game-based Chin Tuck against Resistance exercise.
Outcome measures
This study used the videofluoroscopic dysphagia scale (VDS),
penetration-aspiration scale (PAS) and functional oral intake
scale (FOIS) based on VFSS to evaluate swallowing function
and oral diet. Aspiration or penetration only in liquid type was
evaluated in all study participants; thus, VFSS was evaluated
only in the liquid type using milk. In addition, the effects of
the 2 exercises were examined in terms of motivation, interest/
enjoyment, physical effort needed, and muscle fatigue, using
a 0-to-10 numerical rating self-report scale and drop-out ratio.
The VDS is a comprehensive swallowing assessment based
on the VFSS findings. The VDS is divided into the oral phase (7
items: lip closure, bolus formation, tongue-to-palate contact, mas-
tication, apraxia, premature bolus loss, and oral transit time) and
the pharyngeal phase (7 items: pharyngeal triggering, vallecular
residues, pyriform sinus residues, laryngeal elevation, pharyngeal
wall coating, pharyngeal transit time, and aspiration) (15).
The PAS is an 8-point observational scale used to measure
the severity of airway aspiration, with higher levels of airway
aspiration indicating higher aspiration severity. Penetration is
defined as the passage of material into the larynx, which does
not pass below the vocal folds, whereas aspiration refers to the
action of material penetrating into the larynx and entering into
the airway below the true vocal folds (16).
Table I. Protocol of 2 exercise programmes for dysphagia
rehabilitation
Exercise Game-based Chin Tuck against
type
Resistance exercise
Head-lift exercise
Isotonic
Patient performs 30 consecutive
repetitions by strongly pressing
against the resistance of the
device and releasing it again
Isometric Patient performs chin tuck
against device 3 times for 60 s
with no repetition.
In the same supine position
the patient performs 30
consecutive repetitions of head
raising, without sustaining the
lifted position.
In the supine position the
patient performs head raise up
3 times, and looks at their toes
for 60 s without lifting their
shoulder from the ground
Fig. 2. Head-lift exercise.
J Rehabil Med 51, 2019