2008 Faculty Researchers

Joseph E. Burris, MD

Dysphagia following CVA: Effect of rehabilitation interventions of formal, supervised meal group and vital stimulation on functional independence measures, discharge destination, and nutritition status

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Department

Physical Medicine and Rehabilitation

Office Location

Rusk Rehabilitation Center, 315 Business Loop 70 W

Phone #:

Office: (573) 882-3101
Fax: (573) 884-4540

Summary

Approximately 700,000 Americans suffer stroke yearly, representing the third leading cause of death and the leading cause of severe disabiity in the United States. Approximately 500,000 patients survive at least one month after stroke. Following stroke, approximately forty percent of stroke patients are left with moderate functional impairments, and 15-30 percent with severe disability. Approximately forty percent of stroke patients suffer from swallowing dysfunction, or dysphagia, and aspiration pneumonia represents a leading cause of death in the first month following stroke. Effective rehabilitation interventions may significantly reduce the severity of dysphagia, and therefore decrease a leading cause of morbidity and mortality after stroke.

The purpose of this project is to retrospectively evaluate the effectiveness of the addition of a supervised meal group, staffed with speech and occupational therapists, whose role was to focus on the treatment of dysphagia consistently during stroke rehabilitation in a local inpatient rehabilitation hospital. Additionally, a new treatment modality, named vital stimulation, a functional electrical stimulation intervention for muscles involved in the swallowing process, was introduced into the rehabilitation hospital. This project will review the effectiveness of this intervention in addition to the effect of the formal meal group, to improve the understanding of effective treatments in dysphagic stroke patients. Outcome measures, including functional independence measure, or FIM's, will be compared before and after the aforementioned interventions, in addition to evaluation for the development of pneumonia during the rehabilitation course. Nutritional measures, specifically prealbumin, will be retrospectively reviewed to evaluate the effectiveness of this laboratory measurement in predicting the medical complication rates, functional outcomes, discontinuation of enteral nutrition tubes, and discharge destinations in stroke rehabilitation patients. In preliminary investigation, prealbumin was strongly correlated with these measures and outcomes.

Student investigators will work directly with physicians, therapists, dieticians, and research and administrative personnel in this project. Intensive chart review of prior collected data will be assimilated, with critical statistical analysis of this data leading to conclusions regarding impact of rehabilitation interventions and effective rehabilitation interventions of dysphagic stroke patients.

At the completion of this summer project, student investigators should be able to:

1. Understand University policies for research such as Institutional Review Board process.
2. Understand the process of development of a clinically relevant research project in the field of rehabilitation medicine.
3. Evaluate the need for further investigation in stroke rehabilitation issues.
4. Be prepared to develop and submit a poster or paper presentation for a local or national conference.