Kyung Won Jang, Sook Joung Lee , Sang Beom Kim, Kyeong Woo Lee, Jong Hwa Lee, Jin Gee Park
Physical Medicine and Rehabilitation, Dong-A University Hospital, KR-49201 Busan, Korea.
DOI: 10.2340/16501977-2506

Objective: To investigate the therapeutic effects of mechanical inspiration and expiration exercise using mechanical cough assist on velopharyngeal incompetence in patients with subacute stroke.
Design: Pilot, randomized controlled study.
Setting: University-based rehabilitation centre.
Subjects: Thirty-six patients with subacute stroke diagnosed with velopharyngeal incompetence by videofluoroscopic swallowing study.
Methods: Subjects were randomly assigned to 2 groups. The study group received conventional dysphagia therapy and additional mechanical inspiration and expiration exercise. The control
group received conventional dysphagia therapy only. Swallowing function was evaluated according to the American Speech-Language-Hearing association scale, functional dysphagia score, and the penetration aspiration scale, based on the videofluoroscopic swallowing study. Coughing function was measured using peak cough flow.
Results: Eighteen patients in each group completed the protocol and were analysed. After treatment, the study group showed significant improvement in functional dysphagia score with regard to nasal penetration degree. Comparing the treatment effect between the 2 groups, nasal penetration degree and peak cough flow showed greater improvement in the study group.
Conclusion: Mechanical inspiration and expiration exercise had a therapeutic effect on velopharyngeal incompetence in subacute stroke patients with dysphagia. This therapy is easy to provide clinically and could be a useful therapeutic strategy for velo-pharyngeal incompetence with dysphagia in patients with stroke.

Dysfunctional swallowing and coughing are common after stroke. These functions are closely related as they both use the same expiration-related muscles. Velopharyngeal incompetence (VPI) is one of the symptoms of swallowing and coughing dysfunction. However, there have been few studies regarding treatment of VPI. This study investigated the therapeutic effects of mechanical inspiration and expiration (MIE) exercise, using mechanical cough assist, on VPI in subacute stroke patients with dysphagia. The degree of nasal penetration and peak cough flow were improved to a greater extent in patients in the MIE exercise group. MIE exercise was effective on both swallowing and coughing function. This therapy is easy to apply in the clinical setting. Thus, MIE exercise may be a useful therapeutic strategy for VPI with dysphagia in patients with stroke.