K. W. Jang et al.
100
Fig. 3. Flow diagram of the study.
Table II. Baseline demographic characteristics
Characteristics
Sex (Male/Female), n (%)
Stroke type, n (%)
Haemorrhage
Infarction
Age, years, mean (SD)
Days from stroke onset, mean (SD)
Study group
(n = 18) Control group
(n = 18)
10/8 (56/44) 9/9 (50/50)
8 (44)
10 (56)
67.28 (9.48)
20.48 (13.56) 6 (33)
12 (67)
71.15 (8.61)
18.34 (12.45)
SD: standard deviation; ASHA-NOMS: American Speech-Language-Hearing
Association-National Outcome Measurement System Swallowing scale; FDS:
functional dysphagia Scale; PAS: Penetration-Aspiration Scale; PCF: peak
cough flow.
discharge, recurrent stroke, or deterioration of their
medical conditions and were thus excluded from the
study. A final total of 36 patients (18 in the study group
and 18 in the control group) completed the study, in-
cluding follow-up evaluations (Fig. 3).
Baseline demographic characteristics and initial
evaluations are presented in Table II. No significant
differences were observed in baseline characteristics
between the study group and the control group. Initial
evaluation of swallowing and cough function between
the 2 groups showed no significant difference (Table II).
After 2 weeks of rehabilitation, the study group sho-
wed significant improvements in the swallowing score
of the ASHA-NOMS, FDS and PAS, and
cough function for the PCF (Table III).
In the control group, significant impro-
vements were also observed in the swal-
lowing score of the ASHA-NOMS, FDS
and PAS. By contrast, no statistically
significant differences were observed in
the sub-scores of FDS for the oral phase,
for the degree of nasal penetration, and
the PCF in the control group (Table III).
When the therapeutic effect was
compared between the 2 groups, the
study group showed more significant
improvement in the sub-scores of FDS
for the degree of nasal penetration and
PCF than the control group. However, no
statistically significant differences were
observed in the swallowing scores of the
ASHA-NOMS and in the FDS in total, for the oral
phase, the pharyngeal phase, and the PAS (Table IV).
DISCUSSION
This study aimed to investigate the therapeutic effects of
MIE exercise using mechanical cough assist on VPI in
patients with subacute stroke. The results indicated that
patients in the study group who received additional MIE
exercise showed greater improvements in the degree of
VPI and PCF than did the patients in the control group.
Table IV. Comparison of the exercise effect between 2 groups
Δ
Δ
Δ
Δ
Δ
Δ
Δ
ASHA-NOMS
FDS (Total)
FDS (Oral phase)
FDS (Pharyngeal phase)
FDS (Nasal penetration degree)*
PAS
PCF (l/min)*
Study group
(n = 18)
Mean (SD) Control group
(n = 18)
Mean (SD)
p-value
1.26 (1.05)
–8.31 (5.64)
–1.46 (1.73)
–6.85 (4.44)
–3.23 (2.14)
–0.86 (1.24)
28.76 (18.47) 0.86 (1.21)
–6.22 (4.25)
–1.26 (1.18)
–4.96 (3.83)
–1.34 (1.88)*
–0.76 (0.97)
14.63 (9.48)*
0.482
0.347
0.886
0.173
0.04
0.778
0.03
*p < 0.05 by Mann–Whitney U test.
ASHA-NOMS: American Speech-Language-Hearing Association-National
Outcome Measurement System Swallowing scale; FDS: Functional Dysphagia
Scale; PAS: Penetration-Aspiration Scale; PCF: peak cough flow.
Table III. Changes of measurements before and after exercise in each group, within-group comparison
Study group (n = 18)
ASHA-NOMS
FDS (Total)
FDS (Oral phase)
FDS (Pharyngeal phase)
FDS (Nasal penetration degree)
PAS
PCF (l/min)
Control group (n = 18)
Pre
Mean (SD) Post
Mean (SD) p-value Pre
Mean (SD) Post
Mean (SD) p-value
2.38 (1.25)
45.68 (12.46)
3.32 (3.24)
42.36 (10.82)
4.86 (1.48)
7.62 (0.39)
175.41 (56.62) 3.64 (1.64)
37.37 (10.35)
1.96 (1.77)
35.51 (9.35)
1.60 (0.82)
6.76 (0.41)
204.17 (42.24) 0.036*
0.022*
0.384
0.015*
0.024*
0.032*
0.036* 2.73 (1.54)
44.92 (13.64)
3.87 (3.66)
41.05 (9.15)
4.98 (1.64)
7.81 (0.70)
165.41 (62.36) 3.59 (1.47)
38.70 (9.48)
2.61 (1.81)
36.09 (10.24)
3.64 (0.98)
7.05 (0.53)
180.04 (37.65) 0.043*
0.046*
0.452
0.034*
0.072
0.039*
0.076
*p < 0.05 by Wilcoxon signed-rank test. ASHA-NOMS: American Speech-Language-Hearing Association-National Outcome Measurement System Swallowing scale;
FDS: Functional Dysphagia Scale; PAS: Penetration-Aspiration Scale; PCF: peak cough flow.
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