Early Feasibility of a Novel Skill-based Swallowing Training Program for Post-stroke Patients with Dysphagia

Research Objectives: To develop an intensive skill-based swallowing program and determine its feasibility and early efficacy in post-stroke patients with dysphagia (swallowing disorders).

Design: Within-subject feasibility with pre-and post-treatment measurements.

Setting: Rehabilitation hospital.

Participants: Fifteen swallowing clinicians and seven researchers with background in speech-language pathology answered a survey about the program’s acceptability, appropriateness, and feasibility. Two participants (56-year-old female and a 33-year-old male) with moderate-severe dysphagia secondary to post-stroke (33- and 21-days post-stroke, respectively) received the swallowing intervention during inpatient rehabilitation.

Interventions: The training program, EAT-STARS (Effort, Accuracy, Timing- Skill Training Applied to Rehabilitation in Swallowing), is a systematic and progressive skill-based swallowing program focused on increasing accuracy of swallowing effort and timing. Visual feedback of muscle contraction during swallowing is provided by submental surface electromyography. Patients participated in one-hour sessions for 2 weeks (up to 8 sessions).

Main Outcome Measures: Feasibility was assessed using the (i) Acceptability of Intervention Measure (AIM), (ii) Intervention Appropriateness Measure (IAM), and (iii) Feasibility of Intervention Measure (FIM) to provide feedback on the EAT-STARS program. Effects of the program on swallowing included (i) clinical and functional changes in swallowing performance (Mann Assessment of Swallowing Ability-MASA and Modified Barium Swallowing Impairment Profile-MBSImP) and (ii) patient-reported outcome measures (visual analog scale-VAS and Eating Assessment Tool-EAT10).

Results: The program met measurement targets for acceptability (90%), appropriateness (87.5%), and feasibility (83%). Clinical (MASA) and functional swallowing abilities (MBSImP) improved after the intervention program in both participants. Moreover, both participants reported positive changes in swallowing (VAS and EAT-10).

Conclusions: The EAT-STARS program showed preliminary positive effects in improving swallowing outcomes in post-stroke survivors with dysphagia. Further early-phase testing is underway and includes more participants.

Author(s) Disclosures: The authors declare no conflict of interest.