Clinical Characteristics and Rehabilitation Strategies for the Stomatognathic System Disturbances in Patients with Stroke: A Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Registration and Protocol
2.2. Search Strategy
2.3. Selection Strategy
2.4. Study Quality Assessment
3. Results
3.1. Structural Changes in the Stomatognathic System in Patients with Stroke
3.2. Stomatognathic System Dysfunctions in Patients with Stroke
3.3. Rehabilitation Strategies for Stomatognathic System Disturbances
3.4. Methodological Quality
4. Discussions
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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First Author, Year, Reference | Inclusion Criteria | Exclusion Criteria | Sample (Total Sample, Number of Groups) | Mean Age (Per Group) ± SD (Total and Per Group) | Gender (% Women Per Group) | Time Since Stroke (Mean ± SD; Mean, Range) | Setting |
---|---|---|---|---|---|---|---|
kim, 2005 [19] |
|
| Total: n = 20 2 groups: EG (n = 10) CG (n = 10) | 64.6 y (50, 82) | EG: 50 CG: 50 | 9.8 w (2, 24 w) | Department of Rehabilitation Medicine, Clinical Research Institute, National University Hospital, Seoul, Korea |
Kawasaka, 2010 [21] |
|
| Total: n = 60 2 groups: EG (n = 30) CG (n = 30) | EG = 61.4 ± 2.3 y CG = 63.4 ± 3.1 y | EG: 53.33 CG: 63.33 | 8.3 ± 2.1 mo | Kirishima Rehabilitation Center of Kagoshima, University Hospital, Japan |
Schimmel, 2010 [3] |
|
| Total: n = 55 2 groups: EG (n = 31) CG (n = 24) | EG = 69.0 ± 12.7 y CG = 68.8 ± 10.8 y | EG: 41.9 CG: 45.8 | 42.3 ± 14.4 d (18, 85) | Division of Neuro-rehabilitation at the Department for Clinical Neurosciences of the University Hospitals of Geneva |
Schimmel, 2011a [20] |
|
| Total: n = 55 2 groups: EG (n = 31) CG (n = 24) | EG = 69.0 ± 12.7 y CG = 68.8 ± 10.8 y | EG: 41.9 CG: 45.8 | 42.3 ± 14.4 d | Division of Neuro-rehabilitation at the Department for Clinical Neurosciences of the University Hospitals of Geneva |
Schimmel, 2011b [22] |
|
| Total: n = 55 2 groups: EG (n = 31) CG (n = 24) | EG = 69.0 ± 12.7 y CG = 68.8 ± 10.8 y | EG: 41.9 CG: 45.8 | 42.3 ± 14.4 d | Division of Neurorehabilitation of the Department of Clinical Neurosciences of the University Hospitals of Geneva, Switzerland |
Schimmel, 2011c [23] |
|
| Total: n = 49 2 groups: EG (n = 27) CG (n = 22) | EG = 68.7 ± 12.9 y CG = 69.0 ± 11.2 y | EG: 44.45 CG:45.45 | 43.8 ± 14.2 d | Division of Neurorehabilitation of the Department of Clinical Neurosciences of the University Hospitals of Geneva, Switzerland |
Schimmel, 2013 [24] |
|
| Total: n = 20 2 groups: EG (n = 10) CG (n = 10) | EG: n = 64.1 ± 17.4 y CG: n = 64.4 ± 18.6 y | EG: 40 CG: 40 | >6 mo | Division of Neurorehabilitation of the Department of Clinical Neurosciences of the University Hospitals of Geneva, Switzerland |
Oh, 2013 [13] |
|
| Total: n = 14 2 groups: EG (n = 7) CG (n = 7) | EG = 53.71 ± 12.46 y CG = 56.14 ± 12.31 y | EG: 28.57 CG: 28.57 | EG: 43.00 ± 27.90 mo CG: 13.57 ± 16.53 mo | Wonkwang University Hospital, Republic of Korea |
Steele, 2016 [25] |
|
| Total: n = 14 2 groups: TPPT (n = 7) TPSAT (n = 7) | TPPT: 74.85 TPSAT: 67.14 | Male: 64.3 Female: 35.7 | 70 d (range 18–150) | Three stroke rehabilitation centers in Ontario, Canada |
Schimmel, 2017 [26] |
|
| Total: n = 54 2 groups: EG (n = 27 CG (n = 27) | EG = 64.3 ± 14.1 y CG = 60.8 ± 14.3 y | EG: 70.37 CG: 62.96 | EG: 31.00 ± 54.00 d | Division of Neurorehabilitation of the Department of Clinical Neurosciences of the University Hospitals of Geneva, Switzerland |
Dursun, 2018 [7] |
|
| Total: n = 100 2 groups: EG (n = 50) CG (n = 50) | EG = 62.16 ± 11.41 y CG = 59.7 ± 9.62 y | NR | NR | Bolu Izzet Baysal Physical Therapy and Rehabilitation Education and Research Hospital. Bolu and Düzce cities. |
Altvater Ramos, 2019 [27] |
|
| n = 11 1 group | 55–70 y | NR | >3 mo | Physical therapy and rehabilitation center from Universidade Estadual do Norte do Paraná (UENP), Jacarezinho, Paraná |
Umay, 2019 [12] |
|
| Total: n = 102 2 groups: EG (n = 51) CG (n = 51) | EG = 63.68 ± 9.13 y CG = 65.41 ± 8.47 y | EG: 41.2 CG: 35.3 | 20–60 d | Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara Turkey |
Yilzman, 2020 [4] |
|
| n = 30 1 group | 68.73 ± 4.79 y | 26.7 | 8.00 ± 2.22 mo | Physical Medicine and Rehabilitation Clinic and Rehabilitation Center Hospital, Kastamonu, Turkey |
Choi, 2020 [28] |
|
| Total: n = 21 2 groups: JOE group (n = 11) HLE group (n = 10) | JOE group: n = 63.47 ± 7.65 y HLE group: n = 61.24 ± 9.73 y | 57.14 | 1 to 5 m | Two hospitals in South Korea |
Song, 2021 [29] |
|
| n = 20 1 group | 47.65 ± 9.16 y | 50 | <1 y | Luoyang Orthopaedic Hospital of Henan Province, China |
First Author, Year, Reference | Design | Intervention/Control | Frequency (Min Per Sesion/Sessions Per w)/Intervention Duration (w) | Structures of the Stomatognathic System Assessed | Outcome Measures (Device, Tool) | Main Results |
---|---|---|---|---|---|---|
kim, 2005 [19] | Non-randomized study | Saliva, masticatory performance | Spitting and weight measure of salivary flow for 30 min. Total chew duration oral phase from the time of the test food. | Saliva flow rate was significantly lower in stroke patients. Stroke patients chewed for a longer time. | ||
Kawasaka, 2010 [21] | Non-randomized study | Teeth | Modified cotton swab method for salivary secretion. Oclusal force. | Salivary secretion was reduced in cerebral stroke patients. Lower oclusal force in hemi-plegic side with normal denture. | ||
Schimmel, 2010 [3] | Quantitative descriptive study | Masseter muscle | Masseter thickness. | In EG, the masseter muscle in the affected side was thinner than the non-affected side. | ||
Schimmel, 2011a [20] | Non-randomized study | Masticatory efficiency, lip | Two color mixing test. Lip force. OHIP. | Significant difference in chewing efficiency between EG and CG. Maximum lip force was significantly lower in CG. OHRQoL was significantly reduced in stroke patients. | ||
Schimmel, 2011b [22] | Non-randomized study | Teeth, lips | Two color-gum mixing-test. Maximum voluntary bit force. Lip force. Lip seal. | Masticatory efficiency and maximum lip force were significantly reduced in EG. Maximum bite force was not significantly different between both sides and between EG and EC. | ||
Schimmel, 2011c [23] | Non-randomized study | Facial muscles (frontalis, lower facial and orbicularis oris muscles) | Quantitative assessment of facial muscle function. House–Brackmann scale. | Lower facial muscles were more affected than the upper ones, showing muscular weakness in the EG and reduced tonus of the affected orbicularis muscle. | ||
Schimmel, 2013 [24] | Non-randomized study | Teeth, lips, masseter muscle | DMFT. Color-mixing ability test. Maximum restraining lip force. Maximum voluntary bite force. Masseter muscle thickness. | Chewing efficiency: significatly less efficient in stroke patients. Maximum restraining lip force: significantly lower in stroke patients. Maximum voluntary bite force: difference in the cortical control of the jaw closing muscles and those of the upper limb. Masseter muscle thickness: significant difference between contra- and ipsilesional sides, but not between stroke and control groups. | ||
Oh, 2013 [13] | Randomized controlled trial | EG and CG: functional training in their routine rehabilitation EG group: stomatognathic alignment exercise, active ROM exercises for the neck and TMJ | 60/3/4 | Neck muscles, TMJ | Range of mouth opening. Neck mobility. CMI. MASA. | Significant changes on the opening, CMI, and MASA scores between the EG and CG. Neck mobility: EG showed significant differences between pre- and post-test values in all measures. |
Steele, 2016 [25] | A randomized trial | TPSAT: strength targets and accuracy targets TPPT: real saliva swallows | -/2–3/8–12 | Tongue | Tongue strength: VFFS. | A significant treatment effect was found in both outcomes. No significant differences between both treatments. |
Schimmel, 2017 [26] | Non-randomized study | Lips, tongue, cheeks | Maximum voluntary bite force. Maximum restraining lip force. TDT and 2PD. Color-mixing ability test. | Bite and lip force: no significant difference between both groups. Lower lip force in the stroke group. TDT and 2PD were significantly higher on the affected side in stroke patients. Significantly lower chewing efficiency in stroke patients. | ||
Dursun, 2018 [7] | Non-randomized study | TMJ, masticatory muscles | TMJ ROM. Fonseca questionnaire. Facial asymmetry. PPT of masticatory muscles. | TMJ ROM loss, facial asymmetry, and TMJD were more prevalent in stroke patients. PPT: middle part of the left temporalis muscle was more sensitive to pressure pain in stroke. | ||
Altvater Ramos, 2019 [27] | Quantitative descriptive study | TMJ, temporal, sternocleidomastoid, masseter, and upper trapezius | Mandibular movement. TMJ, facial, and neck muscle PPT ROM cervical region. | 81.8% of the patients presented signs and symptoms related to TMD and most of them had a diagnosis of reduced disc displacement. Significant difference in the TMJ and masseter muscle PPT. Cervical ROM: decreased amplitude. | ||
Umay, 2019 [12] | A prospective randomized controlled study | Intermittent galvanic stimulation to masseter muscles and cognitive, sensorimotor and respiratory rehabilitation + Standard dysphagia rehabilitation | 60–90/5/4 | Tongue, masseter, and orbicularis muscles | Sweep speed and sensitivity of the tongue, masseter, and orbicularis muscles. Electrical activity of submental muscles. | Tongue, masseter, and orbicularis muscles: lower muscle action potential amplitudes. EG presented longer swallowing intervals compared to the healthy control group. Significant improvement in muscle dynamic activity. |
Yilzman, 2020 [4] | Quantitative non-randomized study | Active and active assisted ROM exercises for neck and TMJ, chin tuck, breathing and relaxing, and postural exercises + stroke rehabilitation program | 5/10/4 | TMJ and neck muscles | CMI. Cervical mobility. | All parameters were significantly improved both in 1st and 6th month evaluation. |
Choi, 2020 [28] | Open-label, parallel-group, comparative study randomized trial | JOE group: JOE exercises using a resistance bar + traditional dysphagia treatment HLE group: HLE exercises + traditional dysphagia treatment | 30/5/6 | Digastric and mylohyoid muscles Hyoid bone | Digastric and mylohyoid muscle thickness. Kinematic movement of the hyoid bone. | Both groups showed a statistically significant increase in the thickness of the digastric and mylohyoid muscles and on the anterior and superior movement of the hyoid bone. |
Song, 2021 [29] | Non-randomized study | Masseter muscle, masticatory performance | Masseter muscle stiffness and hardness. Masticatory performance. | Masseter muscle hardness and masticatory performance were significantly greater on the unaffected side. A statistically negative moderate correlation between the masseter muscle stiffness of the affected side and the masticatory performance was found. |
Quantitative randomized controlled trials | 2.1. Randomization appropriately performed? | 2.2. Groups comparable at baseline? | 2.3. Complete outcome data? | 2.4. Outcome assessors blinded to the intervention provided? | 2.5. Participants adhere to the assigned intervention? | % Total |
---|---|---|---|---|---|---|
Oh, 2013 [13] | Yes | No | Yes | Yes | No | 60% |
Steele, 2016 [25] | Yes | Yes | No | Yes | Yes | 80% |
Umay, 2019 [12] | No | Yes | Yes | Yes | Yes | 80% |
Choi, 2020 [28] | Yes | Yes | No | No | No | 40% |
Quantitative non-randomized | 3.1. Participants representative of the target population? | 3.2. Measurements appropriate regarding both the outcome and intervention (or exposure)? | 3.3. Complete outcome data? | 3.4. Confounders accounted for in the design and analysis? | 3.5. Intervention administered (or exposure occurred) as intended? | % Total |
kim, 2005 [19] | Yes | Yes | Yes | Yes | Yes | 100% |
Kawasaka, 2010 [21] | Yes | Yes | Yes | Yes | Yes | 100% |
Schimmel, 2010 [3] | Yes | Yes | Yes | Yes | Yes | 100% |
Schimmel, 2011a [20] | Yes | Yes | Yes | Yes | Yes | 100% |
Schimmel, 2011b [22] | Yes | Yes | No | Yes | Yes | 80% |
Schimmel, 2011c [23] | Yes | Yes | Yes | Yes | Yes | 100% |
Schimmel, 2013 [24] | Yes | Yes | No | Yes | Yes | 80% |
Schimmel, 2017 [26] | Yes | Yes | Yes | Yes | Yes | 100% |
Dursun, 2018 [7] | Yes | Yes | Yes | Yes | Yes | 100% |
Yilzman, 2020 [4] | Yes | Yes | Yes | Yes | Yes | 100% |
Song, 2021 [29] | Yes | Yes | Yes | No | Yes | 80% |
Quantitative descriptive | 4.1. Sampling strategy relevant to address the research question? | 4.2. Sample representative of the target population? | 4.3. Measurements appropriate? | 4.4. Risk of non-response bias low? | 4.5. Statistical analysis appropriate to answer the research question? | % Total |
Altvater Ramos, 2019 [27] | No | No | Yes | Yes | Yes | 60% |
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Zapata-Soria, M.; Cabrera-Martos, I.; López-López, L.; Ortiz-Rubio, A.; Granados-Santiago, M.; Ríos-Asín, I.; Valenza, M.C. Clinical Characteristics and Rehabilitation Strategies for the Stomatognathic System Disturbances in Patients with Stroke: A Systematic Review. Int. J. Environ. Res. Public Health 2023, 20, 657. https://doi.org/10.3390/ijerph20010657
Zapata-Soria M, Cabrera-Martos I, López-López L, Ortiz-Rubio A, Granados-Santiago M, Ríos-Asín I, Valenza MC. Clinical Characteristics and Rehabilitation Strategies for the Stomatognathic System Disturbances in Patients with Stroke: A Systematic Review. International Journal of Environmental Research and Public Health. 2023; 20(1):657. https://doi.org/10.3390/ijerph20010657
Chicago/Turabian StyleZapata-Soria, Mónica, Irene Cabrera-Martos, Laura López-López, Araceli Ortiz-Rubio, María Granados-Santiago, Izarbe Ríos-Asín, and Marie Carmen Valenza. 2023. "Clinical Characteristics and Rehabilitation Strategies for the Stomatognathic System Disturbances in Patients with Stroke: A Systematic Review" International Journal of Environmental Research and Public Health 20, no. 1: 657. https://doi.org/10.3390/ijerph20010657