Efficacy of Game-Based EMG-Biofeedback Therapy in Post-Stroke Dysphagia: A Randomized Controlled Trial.

Abstract

The aim of the present study was to investigate the effects of game-based electromyography (EMG)-biofeedback therapy on swallowing functions and quality of life in patients with post-stroke dysphagia. The prospective, double-blind, randomized controlled trial included 33 patients with post-stroke dysphagia. The study group performed the Mendelsohn maneuver and effortful swallow using game-based EMG-biofeedback, while the control group performed the Mendelsohn maneuver and effortful swallow using only verbal feedback for 30 min in 15 sessions in total. Before and during the trial, patients were evaluated using clinical swallowing assessments such as the Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale (PAS), Dysphagia Outcome and Severity Scale (DOSS), and Dysphagia Handicap Index (DHI). Statistically significant improvement was found in FOIS scores (p = 0.038), PAS-Liquid scores (p = 0.026), and DOSS scores (p = 0.003) in the study group, while there was no statistically significant change in the control group. While PAS-Semisolid scores improved in both groups (study group, p = 0.002; control group, p = 0.023), post-treatment scores were statistically significantly higher in the study group than in the control group (p = 0.031). Although statistically significant improvement was found in DHI total, physical, emotional, and functional scores in both groups at the end of treatment (p < 0.05 for all), the post-treatment DHI scores were statistically significantly higher in the study group compared to those in the control group (p < 0.05 for all). The addition of game-based EMG-biofeedback to conventional treatment improved clinical and radiological assessments demonstrated by FOIS, PAS-Liquid, and DOSS scores and resulted in a statistically significant improvement in PAS-Semisolid and DHI scores. In conclusion, we believe that the inclusion of game-based EMG-biofeedback therapy in swallowing rehabilitation programs may have a positive impact on treatment outcomes.