Pneumonia is one of the leading causes of death in elderly people in Japan.1 Nakajoh et al.2 reported that the latency time in swallowing reflex (LTSR), which was defined as the time from injection of water to the onset of swallowing, was delayed in most elderly people with a history of pneumonia. Therefore, improving the swallowing reflex may be an efficacious strategy for preventing aspiration pneumonia. Studies on acupuncture targeting patients after stroke with a high risk of aspiration pneumonia revealed a significant shortening of LTSR3 and reductions in pharyngeal retention and aspiration,4 but only doctors and acupuncturists are allowed to perform acupuncture in Japan, so it is difficult to employ as a daily treatment at hospitals and nursing care facilities.
Transcutaneous electrical stimulation (TES) using surface electrodes is a physical therapy technique that is applied for pain relief and facilitation of motor function. TES was performed with surface electrodes placed over acupoints, and its effect on LTSR was investigated. The ethical committee of Tohoku University Graduate School of Medicine approved this study.
Twelve patients who had a stroke (mean age±standard deviation 78.2±6.5; 7 women, 5 men) in the chronic stage who had episodes of choking while eating or drinking were selected randomly and assigned to a TES group and a control group of six patients each. There was no significant difference in age, sex, or initial LTSR value between the two groups. TES was performed with a hand-held battery-powered electrical stimulator (Pulsecure-Pro KR-7, OG Giken, Okayama, Japan), which delivered 300-μs-long square-wave pulses. Surface electrodes with adhesive pads (40 mm by 35 mm) were attached at two acupoints, ST36 and K3,3 on each lower leg. TES was applied for 15 minutes per treatment, with a stimulus frequency of 15 Hz, in cycles of 5 seconds on and 2 seconds off. Stimulus intensity was just below the pain threshold. Swallowing was induced by a bolus injection of 1 mL of distilled water into the pharynx through a nasal catheter, and LTSR was measured.5 Plasma substance P (SP) levels of the TES group were also measured. Peripheral blood was collected into an ethylenediaminetetraacetic acid tube and centrifuged immediately. Plasma was stored at −80°C until analysis, and plasma SP levels were quantified using radioimmunoassay according to the manufacturer's instructions. The study was performed as follows. On Day 1, blood samples of the TES group were taken in the morning. After measurement of initial LTSR, TES was applied for 15 minutes. As soon as possible thereafter, LTSR was measured again. TES was performed three times a week for 4 weeks. Blood sampling and LTSR measurement were also conducted on the last day. In the control group, LTSR was measured on Day 1 and after 4 weeks. To measure LTSR, distilled water was injected into the pharynx five times for each condition. Three of five LTSRs were averaged, excluding the maximum and minimum values. The Wilcoxon signed-rank test was used to compare LTSR before and after TES.
There was a significant shortening of LTSR (12.1±8.2 vs 3.1±1.2 seconds, P<.05) after TES, as shown in Figure 1, indicating improvement of the swallowing reflex. No significant change was observed in LTSR of the control group between Day 1 and 4 weeks (10.2±2.4 vs 10.4±3.4 seconds). Although plasma SP levels were higher in four of six subjects in the TES group (18.3±5.7 vs 20.7±4.7 pg/mL), no significant difference was found. There was also no significant change in LTSR on Day 1 before and immediately after TES (12.1±8.2 vs 10.4±5.9 seconds). These findings suggest that TES applied on these acupoints may not have the same immediate effect as acupuncture but that TES three times a week for 4 weeks can improve swallowing reflex. LTSR was shortened to less than 5 seconds in four of the subjects (Figure 1). Patients with an LTSR longer than 5 seconds are at high risk for pneumonia,2 so TES may have the effect of preventing pneumonia. Because it is easy for family members and the nursing staff to perform TES, this finding may be of benefit. This study was a pilot study, so the number of subjects was too small to indicate a relationship between LTSR and plasma SP levels. In future studies, more subjects should be included.
J Am Geriatr Soc. 2009 Oct;57(10):1959-60.
Improvement of swallowing reflex after electrical stimulation to lower leg acupoints in patients after stroke.
Akamatsu C, Ebihara T, Ishizuka S, Fujii M, Seki K, Arai H, Handa Y, Seki T.
Integr Cancer Ther. 2010 Sep;9(3):284-90. Epub 2010 Aug 16.
Acupuncture for dysphagia after chemoradiation therapy in head and neck cancer: a case series report.
Weidong Lu, Posner MR, Wayne P, Rosenthal DS, Haddad RI.
Source
Dana-Farber Cancer Institute, Harvard Medical School, 44 Binney Street, Boston, MA 02115, USA. weidong_lu@dfci.harvard.edu
Abstract
BACKGROUND:
Dysphagia is a common side effect following chemoradiation therapy (CRT) in patients with head and neck cancer (HNC).
METHODS:
In this retrospective case series, 10 patients with HNC were treated with acupuncture for radiation-induced dysphagia and xerostomia. All patients were diagnosed with stage III/IV squamous cell carcinoma. In all, 7 of 10 patients were percutaneous endoscopic gastrostomy (PEG) tube dependent when they began acupuncture. Manual acupuncture and electroacupuncture were used once a week.
RESULTS:
A total of 9 of 10 patients reported various degrees of subjective improvement in swallowing functions, xerostomia, pain, and fatigue levels. Overall, 6 (86%) of 7 PEG tube-dependent patients had their feeding tubes removed after acupuncture, with a median duration of 114 days (range 49 to 368 days) post CRT. One typical case is described in detail.
CONCLUSIONS:
A relatively short PEG tube duration and reduced symptom severity following CRT were observed in these patients. Formal clinical trials are required to determine the causality of the observatioConsider using this space to introduce your page. Just click to add your own content.
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