Journal of Rehabilitation Medicine 51-10 | Page 33

Effects of game-based exercise for dysphagia after stroke
753
Table III. Changes in parameters before and after treatment
Experimental group
Pre-
Post-
Mean (SD) Mean (SD)
Videofluoroscopic dysphagia scale
Oral phase
Pharyngeal phase
Total score
Penetration-aspiration scale
Functional oral intake scale
Control group
Within-group
p-value
11.35 (1.96) 9.52 (1.84) < 0.001*
40.45 (2.77) 32.22 (4.35) < 0.001*
51.80 (3.40) 41.75 (4.71) < 0.001*
4.60 (0.88) 3.30 (0.73) < 0.001*
3.45 (0.82) 4.70 (1.21) < 0.001*
Pre-
Mean (SD)
Post-
Mean (SD)
Within-group Comparison between
p-value
groups after intervention
10.75 (1.89) 9.15 (1.12) < 0.001*
38.57 (3.41) 30.75 (5.15) < 0.001*
49.32 (4.10) 39.90 (5.44) < 0.001*
4.85 (0.93) 3.85 (1.08) < 0.001*
3.25 (0.78) 4.10 (1.33) < 0.001*
0.443
0.335
0.258
0.069
0.403
*p  < 0.05 by paired t-test.
SD: standard deviation.
tion, but there was no significant difference between
the 2 groups. This suggests that gbCTAR exercise and
Experimental group Control group
HLE have similar effects in patients with dysphagia.
Mean (SD)
Mean (SD)
p-value
The goal of submental muscle strengthening in patients
Videofluoroscopic dysphagia scale
with dysphagia is the same in both gbCTAR exercise and
Oral phase
–1.82 (1.35)
–1.60 (1.51)
0.624
Pharyngeal phase
–8.22 (2.90)
–7.82 (3.34)
0.689
HLE, although they differ in terms of performance. These
Total score
–10.05 (2.76)
–9.42 (3.80)
0.556
2 exercise methods, through strengthening of the submen-
Penetration-aspiration scale –1.30 (0.73)
–1.05 (0.99)
0.403
tal muscles, are known to induce physiological changes
Functional oral intake scale
1.25 (0.91)
0.85 (0.98)
0.191
in the muscle, such as muscle thickness or strength.
SD: standard deviation.
Physiological changes in the submental muscles through
resistance exercise (e.g. CTAR or HLE) produce sufficient
Numerical rating self-report scale
muscle contractility during swallowing, which directly
The experimental group had higher scores in the mo-
contributes to kinematic effects, such as increased move-
tivation and interest/enjoyment items than the control
ment of the hyolaryngeal complex. This, in turn, affects
group (p < 0.001), but the scores in the physical effort
airway protection through effective epiglottis tilting and
needed and muscle fatigue items were significantly
swallowing function effects, such as increased opening
lower (p < 0.001) (Fig. 4).
of the upper esophageal sphincter. Previous studies have
reported improvements in swallowing performance in the
pharyngeal phase with decreasing aspiration in patients
DISCUSSION
with dysphagia after stroke for both CTAR and HLE (4,
This study compared the effects of gbCTAR exercise
9, 10), which is consistent with the results of the current
and HLE on swallowing function and compliance in
study. Both exercises are therapeutic methods for impro-
patients with dysphagia after stroke. Both methods re-
ving the swallowing function of patients with dysphagia,
sulted in significant improvement in swallowing func­
and their therapeutic effects are the same.
The greatest advantage of incorporating
games into rehabilitation is to encourage
participation by inducing enjoyment and
excitement for patients (18). In particular,
it is important to induce more active parti-
cipation by motivating patients and piquing
their interest in resistance training, which
requires a lot of physical effort. Li et al.
(12) reported that task-oriented repetition
and patient motivation play an important
role in stroke rehabilitation, and that inte-
rest, challenge, reward and competition,
especially through games, can increase
motivation to participate in rehabilitation.
Therefore, this study assessed the effects
of the 2 exercises in terms of motivation,
enjoyment/interest, physical effort needed,
Fig. 4. Numerical rating self-report scale (motivation, enjoyment/interest, physical
and pain/fatigue during rehabilitation
effort needed, and muscle fatigue).
training using the 0–10 numerical rating
† p < 0.001.
Table IV Comparison of the differences after the 4-week treatment
in the 2 groups
J Rehabil Med 51, 2019