Effect of Oral Neuromuscular Training on Tracheostomy Decannulation and Swallowing Function in Patients with Severe Acquired Brain Injury: A Pilot Randomized Controlled Trial.

Abstract

There is a lack of evidence on training modalities for improving swallowing function in tracheostomized patients. The objective was to investigate the effect of oral neuromuscular training on decannulation and swallowing function in tracheostomized patients with acquired brain injury. A pilot randomized controlled trial with 22 patients, 11 in the intervention group and 11 in the usual care group. Inclusion criteria were: ≥ 18 years, cuffed tracheostomy tube at admission for rehabilitation, and Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) ≥ 4 at admission. Primary outcome was days from baseline until decannulation. Secondary outcomes were swallowing function assessed with FEDSS, Penetration Aspiration Scale (PAS), and the Yale pharyngeal residue scale (Yale scale) at baseline and following 4 weeks intervention. Participants in the two groups were comparable at baseline with regards to demographics and functional level. Difference in time until decannulation in the two groups was expressed with a hazard ratio of 1.40 (95%CI: 0.57; 3.43) in favour of the IQoro group. Swallowing function improved statistically significant in the usual care group on both PAS and Yale scale, whereas improvements in the IQoro group was only observed in FEDSS. Investigating between group differences, there was a statistically significant difference in pharyngeal residue assessed with the Yale Scale-pyriform sinus in favour of usual care (p = 0.018). Training with IQoro did not facilitate improvements in early decannulation or swallowing function compared to usual care. On the contrary, results showed less improvements in pharyngeal residue in the IQoro group compared with the usual care group.