Uma revisão das terapias de reabilitação para disfagia em pacientes com acidente vascular cerebral

Authors' contributions:

KCM, VFO, PLCO, PBN: study conception and design and data collection; KCM, VFO, PBN: analysis and interpretation of results; KCM, VFO: drafting of the manuscript. All authors reviewed the results and approved the final version of the manuscript.

References	Country	Patients	Diagnosis	Study design	Outcomes	Intervention	Intervention time	Results	Follow-up
Terré,R.; Mearin, F., 201499. Terré R, Mearin F. A randomized controlled study of neuromuscular electrical stimulation in oropharyngeal dysphagia secondary to acquired brain injury. Eur J Neurol. 2015 Apr;22(4):687-e44. https://doi.org/10.1111/ene.12631 https://doi.org/10.1111/ene.12631...	Spain	20	STROKE and TBI	Randomized; controlled; prospective	VFSS; FOIS	GI- EE and TC GC - EE placebo eTC	20 sessions/60 min-5 times a week	FOIS increased 4.9 points (GI); 3.1 points (GC).	1, 3 months
Sun, S.F et al., 201377. Sun S-F, Hsu C-W, Lin H-S, Sun H-P, Chang P-H, Hsieh W-L, et al. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia. Dysphagia. 2013 Dec;28(4):557-66. https://doi.org/10.1007/s00455-013-9466-9 https://doi.org/10.1007/s00455-013-9466-...	Taiwan	29	STROKE	Clinic; prospective	FOIS; Dysphagia scale	EE e TC separately	NMES and TC 12 sessions/60 min - 3 times a week	FOIS and dysphagia scale improved after NMES, for 6 months and 2 years (p \ 0.001, each)	6 months, 2 years
Rofes, L. et al., 20131010. Rofes L, Arreola V, López I, Martin A, Sebastián M, Ciurana A, et al. Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction. Neurogastroenterol Motil. 2013 Nov;25(11):888-e701. https://doi.org/10.1111/nmo.12211 https://doi.org/10.1111/nmo.12211...	Spain	20	STROKE	Randomized; double-blind	VFSS (PAS)	Motor EE group Sensory EE group	10 sessions/ 30 min - 5 times a week	Sensory and motor EE reduced the insecure deglutition number in (p < 0.001), and (p = 0.002)	No follow-up
Park, J. S. et al., 20161313. Park J-S, Oh D-H, Hwang N-K, Lee J-H. Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial. J Oral Rehabil. 2016 Jun;43(6):426-34. https://doi.org/10.1111/joor.12390 https://doi.org/10.1111/joor.12390...	Korea	50	STROKE	Randomized; Controlled; Single-blind	VFSS (PAS e VDS)	GI - EE and forced swallowing exercise GC - EE placebo and forced swallowing exercise	30 sessions/30 min - 5 times a week	GI increased oral and pharyngeal phase in VDS (P < 0.00, P = 002 and P < 0.00), and PAS (P < 0.00).	No follow-up
Park, J. W. et al., 20121515. Park J-W, Kim Y, Oh J-C, Lee H-J. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia. 2012 Dec;27(4):521-7. https://doi.org/10.1007/s00455-012-9403-3 https://doi.org/10.1007/s00455-012-9403-...	Korea	20	STROKE	Randomized; Controlled; Double-blind	VFSS (PAS; UES)	GI - Motor EE and forced swallowing GC- Sensory EE and forced deglutition	12 sessions/20 min - 3 times a week	GI increased vertical larynx movement (p\0.05).	No follow-up
Konecny, P.; Elfmark, M., 20181111. Konecny P, Elfmark M. Electrical stimulation of hyoid muscles in post-stroke dysphagia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018 Mar;162(1):40-2. https://doi.org/10.5507/bp.2017.043 https://doi.org/10.5507/bp.2017.043...	Czech Republic	108	STROKE	Randomized; Controlled; Prospective	VFSS	GI - Motor EE and TC GC - TC	20 sessions/20 min - 5 times a week	The difference in the oral and pharynx transit time after therapy between the GI and the GC (P = 0.01 e P= 0.009)	No follow-up
Lim, K. B. et al., 20091414. Lim K-B, Lee H-J, Lim S-S, Choi Y-I. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a randomized controlled trial. J Rehabil Med. 2009 Feb;41(3):174-8. https://doi.org/10.2340/16501977-0317 https://doi.org/10.2340/16501977-0317...	Korea	28	STROKE	Randomized; Controlled	VFSS	GI - EE muscular and tactile-thermic stimulation GC - Tactile-thermic stimulation	20 sessions/60 min - 5 times a week	GI with higher scores in PAS; 2 in semi-solid (p < 0.05) and 2.5 in liquids (p < 0.05)	No follow-up
Meng, P. et al., 20171212. Meng P, Zhang S, Wang Q, Wang P, Han C, Gao J, et al. The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia. J Back Musculoskelet Rehabil. 2018 Mar 21;31(2):363-70. https://doi.org/10.3233/BMR-170788 https://doi.org/10.3233/BMR-170788...	China	30	STROKE	Randomized	VFSS; DOSS	GA - EE with electrodes along the suprahyoid and along with the superior and inferior thyroid parts and TC GB - EE with 1 pair of electrodes in the geniohyoid region and 1 pair in the mylohyoid region and TC GC - TC	10 sessions/30 min - 5 times a week	Improvement in DOSS in groups A and B (P<0.005) in relation to GC.	No follow-up
Xia, W. et al.,20111818. Xia W, Zheng C, Lei Q, Tang Z, Hua Q, Zhang Y, et al. Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training. J Huazhong Univ Sci Technol Med Sci. 2011 Feb;31(1):73-6. https://doi.org/10.1007/s11596-011-0153-5 https://doi.org/10.1007/s11596-011-0153-...	China	120	STROKE	Randomized; prospective	SSA; VFSS	G1 - Conventional therapy G2 - EE G3 - Conventional therapy and EE	40 sessions/30 min - 2 times a day, 5 times a week for 4 weeks	SSA, VFSS increased more in G3 than in G1 and G2 (P < 0.01).	No follow-up
LI, L et al., 20151717. Li L, Li Y, Wu X, Wang G, Yi X, Zhao Y, et al. The value of adding transcutaneous neuromuscular electrical stimulation (VitalStim) to traditional therapy for post-stroke dysphagia: a randomized controlled trial. Top Geriatr Rehabil. 2018 Jul-Sep;34(3):200-6. https://doi.org/10.1097/TGR.0000000000000195 https://doi.org/10.1097/TGR.000000000000...	China	135	STROKE	Randomized; controlled	SSA	G1 - EE G2 - TC G3 - EE and TC	20 sessions/60 min - 5 times per week for 4 weeks	SSA improved in G3 (P <0.01)	4 weeks
Ploumis, A. et al., 20184444. Ploumis A, Papadopoulou SL, Theodorou SJ, Exarchakos G, Givissis P, Beris A. Cervical isometric exercises improve dysphagia and cervical spine malalignment following stroke with hemiparesis: a randomized controlled trial. Eur J Phys Rehabil Med. 2018 Dec;54(6):845-52. https://doi.org/10.23736/S1973-9087.17.04952-8 https://doi.org/10.23736/S1973-9087.17.0...	Greece	70	STROKE	Randomized, controlled, prospective.	VFSS; PAS	GI - Cervical exercises and conventional therapy GC - Conventional therapy	30 min daily sessions/12 weeks	Improved swallowing (P < 0.05) and PAS (P < 0.001)	No follow-up
Umay, E. et al., 201788. Umay EK, Yaylaci A, Saylam G, Gundogdu I, Gurcay E, Akcapinar D, et al. The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: a randomized controlled study. Neurol India. 2017 Jul-Aug;65(4):734-42. https://doi.org/10.4103/neuroindia.NI_377_16 https://doi.org/10.4103/neuroindia.NI_37...	India	98	STROKE	Randomized; controlled	MASA; SSA	GI - Sensory EE and TC GC - Sensory EE placebo and TC	20 sessions/60 min - 5 times a week for 4 weeks	All parameters improved in G1 (P <0.025).	No follow-up
Park, S.J. et al., 20193434. Park J-S, Lee G, Jung Y-J. Effects of game-based chin tuck against resistance exercise vs head-lift exercise in patients with dysphagia after stroke: an assessor-blind, randomized controlled trial. J Rehabil Med. 2019 Oct 29;51(10):749-54. https://doi.org/10.2340/16501977-2603 https://doi.org/10.2340/16501977-2603...	Korea	10	STROKE	Clinical; prospective	VFS; PAS	NMES and EMG-BF	20 sessions/30 min - 5 times a week	Significant differences between oral (P = 0.015) and pharyngeal (P = 0.016) VFS. Improved PAS (P = 0.031).	No follow-up
Carnaby, G.D et al., 20202020. Carnaby GD, LaGorio L, Silliman S, Crary M. Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: a double-blind placebo-controlled trial. J Oral Rehabil. 2020 Apr;47(4):501-10. https://doi.org/10.1111/joor.12928 https://doi.org/10.1111/joor.12928...	USA	53	STROKE	Randomized; controlled; double-blind	FOIS, MASA	G1 - TC and EENM G2 - TC and EENM placebo G3 - TC	15 sessions/60 min - 3 weeks	MASA was different among groups different (p ≤ 0.0001) G2 had the best FOIS result (p≤0.0001).	3 months

Reference	Country	Patients	Diagnosis	Study design	Outcomes	Intervention	Intervention time	Results	Follow-up
Hyun, Y. et al., 20172929. Ahn YH, Sohn H-J, Park J-S, Ahn TG, Shin YB, Park M, et al. Effect of bihemispheric anodal transcranial direct current stimulation for dysphagia in chronic stroke patients: a randomized clinical trial. J Rehabil Med. 2017 Jan 19;49(1):30-5. https://doi.org/10.2340/16501977-2170 https://doi.org/10.2340/16501977-2170...	Korea	26	Stroke	Randomized; multicenter controlled; prospective; double-blind.	DOSS	GI - ETCC and TC. GC - Placebo ETCC and TC	10 sessions/20 min - 5 times a week	DOSS - Significant improvement (0.62 points on GI)	No follow-up
Cheng, I. K. Y. et al., 20172121. Cheng IKY, Chan KMK, Wong C-S, Li LSW, Chiu KMY, Cheung RTF, et al. Neuronavigated high-frequency repetitive transcranial magnetic stimulation for chronic post-stroke dysphagia: a randomized controlled study. J Rehabil Med. 2017 Jun 28;49(6):475-81. https://doi.org/10.2340/16501977-2235 https://doi.org/10.2340/16501977-2235...	China	15	Stroke	Randomized; controlled; double-blind.	VFSS; IOPI	GI - Active EMTr GC - Simulated EMTr	10 applications - 5 times a week	No significant results	2, 6 and 12 months
Cheng, I. K. Y. et al., 20142222. Cheng IKY, Chan KMK, Wong CS, Cheung RTF. Preliminary evidence of the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) on swallowing functions in post-stroke individuals with chronic dysphagia. Int J Lang Commun Disord. 2015 May-Jun;50(3):389-96. https://doi.org/10.1111/1460-6984.12144 https://doi.org/10.1111/1460-6984.12144...	China	4	Stroke	Randomized; controlled.	VFSS; IOPI	GI - Active EMTr/ Tongue motor cortex stimulation GC - Simulated EMTr	10 sessions/30 min - 5 times a week	No significant deglutition improvement on GI	1 week, 1 month
Du, J. et al., 20162323. Du J, Yang F, Liu L, Hu J, Cai B, Liu W, et al. Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: a randomized, double-blind clinical trial. Clin Neurophysiol. 2016 Mar;127(3):1970-13. https://doi.org/10.1016/j.clinph.2015.11.045 https://doi.org/10.1016/j.clinph.2015.11...	China	40	Ischemic stroke	Randomized; controlled; double-blind.	SSA	G1 - High-frequency EMTr (3Hz) G2 - Low-frequency EMTr (1Hz) G3 - Simulated EMTr	5 sessions	Better G1 and G2 dysphagia improvement after 5 days compared to the other group, remaining for 5 months.	1, 2 and 3 months
Park, J.W. et al., 20131515. Park J-W, Kim Y, Oh J-C, Lee H-J. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia. 2012 Dec;27(4):521-7. https://doi.org/10.1007/s00455-012-9403-3 https://doi.org/10.1007/s00455-012-9403-...	Korea	18	Stroke	Randomized; controlled; double-blind.	VFSS (PAS and VDS)	GI - Contralesional pharyngeal motor cortex EMTr 5Hz GC - Placebo (same conditions)	20 sessions/10 min	VDC and PAS improved significantly on the GI (P<0.005)	2 weeks
Shigematsu, T. et al., 20133030. Shigematsu T, Fujishima I, Ohno K. Transcranial direct current stimulation improves swallowing function in stroke patients. Neurorehabil Neural Repair. 2013 May 1;27(4):363-9. https://doi.org/10.1177/1545968312474116 https://doi.org/10.1177/1545968312474116...	Japan	20	Stroke	Prospective; double-blind.	DOSS	GI - TC and 1-mA ETCC (contralesional pharyngeal motor cortex) GC - Simulated ETCC and TC	10 sessions/20min - Once a day	1.4 points (P=0.006) improvement and after 1 month 2.8 points (P=0.004) improvement on the GI.	1 month
Krueger, S. S. et al., 20183131. Suntrup-Krueger S, Ringmaier C, Muhle P, Wollbrink A, Kemmling A, Hanning U, et al. Randomized trial of transcranial direct current stimulation for poststroke dysphagia. Ann Neurol. 2018 Feb;83(2):328-40. https://doi.org/10.1002/ana.25151 https://doi.org/10.1002/ana.25151...	Germany	59	Ischemic stroke	Randomized; double-blind.	FEDSS; SSA	Contralesional pharyngeal motor cortex ETCC group Placebo ETCC group	4 sessions/20min	Significant dysphagia improvement on the ETCC group when compared to the placebo group (P<0.0005)	No follow-up

References	Country	Patients (n)	Diagnosis	Study Design	Outcomes	Intervention	Intervention time	Results	Follow-up
Bath, P. M. et al., 20162424. Bath PM, Scutt P, Love J, Clavé P, Cohen D, Dziewas R, et al. Pharyngeal electrical stimulation for treatment of dysphagia in subacute stroke: a randomized controlled trial. Stroke. 2016 Jun;47(6):1562-70. https://doi.org/10.1161/STROKEAHA.115.012455 https://doi.org/10.1161/STROKEAHA.115.01...	United Kingdom	162	Stroke	Multicenter; Randomized; Controlled; Double-blind	VFSS (PAS)	GI - active PES GC - simulated PES	3 sessions/10 min	No GI improvements in relation to the GC	2,6 and 12 weeks
Vasant, D, H et al., 20162525. Vasant DH, Michou E, O’Leary N, Vail A, Mistry S, Hamdy S. Pharyngeal electrical stimulation in dysphagia poststroke: a prospective, randomized single-blinded interventional study. Neurorehabil Neural Repair. 2016 Oct 1;30(9):866-75. https://doi.org/10.1177/1545968316639129 https://doi.org/10.1177/1545968316639129...	United Kingdom	36	Stroke	Multicenter; Randomized; Controlled	DSR	GI - active PES GC - simulated PES	3sessions/10 min	In relation to the simulated group, a probability ratio (OR)> 1 indicated a favorable outcome for the active group in DSR punctuations.	2 weeks and 3 months
Essa, H., 20172626. Essa H, Vasant DH, Raginis-Zborowska A, Payton A, Michou E, Hamdy S. The BDNF polymorphism Val66Met may be predictive of swallowing improvement post pharyngeal electrical stimulation in dysphagic stroke patients. Neurogastroenterol Motil. 2017 Aug;29(8):e13062. https://doi.org/10.1111/nmo.13062 https://doi.org/10.1111/nmo.13062...	United Kingdom	38	Stroke	Randomized; Controlled; Double-blind	DRS	GI - active PES GC - simulated PES	3 sessions/10 min	In the GI, patients with the allele Met BDNF showed improvements in DERD after 3 months in relation to patients in the GC (P = 0.009)	2 weeks and 3 months
Moon, J. H et al., 20184141. Moon J-H, Hahm S-C, Won YS, Cho H-Y. The effects of tongue pressure strength and accuracy training on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia: a preliminary randomized clinical trial. Int J Rehabil Res. 2018 Sep;41(3):204-10. https://doi.org/10.1097/MRR.0000000000000282 https://doi.org/10.1097/MRR.000000000000...	Korea	16	Stroke	Randomized; Controlled	IOPI; MASA	GI - TPSAT in the morning and TC in the afternoon GC - TC	80 sessions/30 min - 2 times a day, 5 times a week for 8 weeks	Anterior (P = 0.001) and posterior (P = 0.001) PMI improvement in the GI in relation to the GC; GI and GC MASA improvement (P = 0.012)	No follow-up
Kim, H. D. et al., 20163535. Kim H-H, Park J-S. Efficacy of modified chin tuck against resistance exercise using hand-free device for dysphagia in stroke survivors: a randomised controlled trial. J Oral Rehabil. 2019 Nov;46(11):1042-6. https://doi.org/10.1111/joor.12837 https://doi.org/10.1111/joor.12837...	Korea	35	Stroke	Randomized; Controlled	IOPI; VFSS (VDS and PAS)	GI - TPRT and TC GC - TC	20 sessions - 5 times a week	GI tongue strength improvement (anterior and posterior, p = 0.009, 0.015) and oral and pharynx phases punctuations improvement in VDS (p = 0.029, 0.007), but not in PAS (p = 0.471) in relation to the control group.	No follow-up

Reference	Country	Patients	Diagnosis	Study design	Outcomes	Intervention	Intervention time	Results	Follow-up
Gao, J.; Zhang, H.J., 20173333. Gao J, Zhang H-J. Effects of chin tuck against resistance exercise versus Shaker exercise on dysphagia and psychological state after cerebral infarction. Eur J Phys Rehabil Med. 2017 Jun;53(3):426-32. https://doi.org/10.23736/S1973-9087.16.04346-X https://doi.org/10.23736/S1973-9087.16.0...	China	90	Ischemic stroke	Clinical; Random	VFSS (PAS)	GC - TC Shaker - TC and Shaker exercise CTAR - TC and CTAR	42 sessions - 3 times a day	A better swallowing improvement in the CTAR group when compared to the Shaker group	2, 4 and 6 weeks
Park, J. S. et al., 20183232. Park J-S, An D-H, Oh D-H, Chang M-Y. Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: a randomized pilot study. NeuroRehabilitation. 2018 Mar 12;42(2):191-7. https://doi.org/10.3233/NRE-172250 https://doi.org/10.3233/NRE-172250...	Korea	22	Stroke	Randomized; Controlled	VFSS (PAS; FDS)	GI - CTAR and TC GC - TC	20 sessions/30 min - 5 times a week	Significant improvement in the PAS and FDS in the GI when compared to the GC	No follow-up
Choi, J. B. et al., 20173737. Choi J-B, Shim S-H, Yang J-E, Kim H-D, Lee D-H, Park J-S. Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia. NeuroRehabilitation. 2017 Dec 15;41(4):753-7. https://doi.org/10.3233/NRE-172145 https://doi.org/10.3233/NRE-172145...	Korea	31	Stroke	Randomized; Controlled; Double-blind	VFSS (PAS); FOIS	GI - TC and Shaker exercise GC - TC	20 sessions/30 min - 5 times a week	PAS and FOIS significantly improved the GI in relation to the GC	No follow-up
Park, J. S et al., 2019 3434. Park J-S, Lee G, Jung Y-J. Effects of game-based chin tuck against resistance exercise vs head-lift exercise in patients with dysphagia after stroke: an assessor-blind, randomized controlled trial. J Rehabil Med. 2019 Oct 29;51(10):749-54. https://doi.org/10.2340/16501977-2603 https://doi.org/10.2340/16501977-2603...	Korea	37	Stroke	Randomized; Controlled	VFSS (PAS); FOIS	GI - Game-based CTAR GC - CTAR	20 sessions/30min - 5 times a week	There were no differences in improvement between groups	No follow-up
Kim, H. H.; Park, J. S, 20193535. Kim H-H, Park J-S. Efficacy of modified chin tuck against resistance exercise using hand-free device for dysphagia in stroke survivors: a randomised controlled trial. J Oral Rehabil. 2019 Nov;46(11):1042-6. https://doi.org/10.1111/joor.12837 https://doi.org/10.1111/joor.12837...	Korea	30	Stroke	Clinical; Randomized	PAS; FOIS	GI - CTAR and TC GC - TC	30 sessions/30 min - 5 times a week	GI had a significant improvement in PAS and FOIS (P <0.001, both)	No follow-up

Reference	Country	Patients	Diagnosis	Study design	Outcomes	Intervention	Intervention time	Results	Follow-up
McCullough, G.H. et al., 2012 2828. McCullough GH, Kamarunas E, Mann GC, Schmidley JW, Robbins JA, Crary MA. Effects of mendelsohn maneuver on measures of swallowing duration post stroke. Top Stroke Rehabil. 2012 May-Jun;19(3):234-43. https://doi.org/10.1310/tsr1903-234 https://doi.org/10.1310/tsr1903-234...	USA	18	Stroke	Randomized	VFSS (DOHME and DOHAME)	Group A - 2 weeks of treatment with the Mendelsohn maneuver and EMG with feedback and 2 weeks without treatment. Group B - 2 weeks without treatment and 2 weeks with treatment.	45 min sessions, 2 times a day	DOHME and DOHMAE significantly improved (P = 0.011 and 0.009) after treatment.	No follow-up
McCullough, G.H; Kim, Y., 2013 2727. McCullough GH, Kim Y. Effects of the Mendelsohn Maneuver on extent of hyoid movement and UES opening post-stroke. Dysphagia. 2013 Dec;28(4):511-9. https://doi.org/10.1007/s00455-013-9461-1 https://doi.org/10.1007/s00455-013-9461-...	USA	18	Stroke	Randomized	VFSS (HME, HMAE, UES)	Group A - 2 weeks of treatment with the Mendelsohn maneuver and EMG with feedback and 2 weeks without treatment. Group B - 2 weeks without treatment and 2 weeks with treatment.	45 min sessions, 2 times a day	No significant improvement after treatment	1 month, 1 year
Xia, W. et al., 20153838. Xia W, Zheng C, Zhu S, Tang Z. Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke? a randomized controlled trial. Clin Rehabil. 2016 Mar 1;30(3):237-46. https://doi.org/10.1177/0269215515578698 https://doi.org/10.1177/0269215515578698...	China	124	Stroke	Clinical; Randomized; Double blind	SSA; DOSS	GI- TC and acupuncture GC - TC	24 sessions/30 minutes - 6 times a week	SSA and DOSS GI improvement in relation to the GC (P<0.01)	No follow-up
Mao, L. et al., 2016 3939. Mao L-Y, Li L-L, Mao Z-N, Han Y-P, Zhang X-L, Yao J-X, et al. Therapeutic effect of acupuncture combining standard swallowing training for post-stroke dysphagia: a prospective cohort study. Chin J Integr Med. 2016 Jul;22(7):525-31. https://doi.org/10.1007/s11655-016-2457-6 https://doi.org/10.1007/s11655-016-2457-...	China	98	Stroke	Prospective	VFSS; SSA	GI - TC and acupuncture GC - TC	20 sessions/30 minutes - 5 times a week	VFSS and SSA GI improvement in relation to the GC (P=0.007 and P=0.007)	No follow-up
Chen, L. et al., 2016 4040. Chen L, Fang J, Ma R, Gu X, Chen L, Li J, et al. Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: A multicenter randomized controlled trial. BMC Complement Altern Med. 2016 Jul 18;16:226. https://doi.org/10.1186/s12906-016-1193-y https://doi.org/10.1186/s12906-016-1193-...	China	250	Stroke	Randomized; Double-blind; Controlled	NIHSS; VFSS; SSA	GI - TC and acupuncture GC - TC	18 sessions/30 minutes - 6 times a week	GI improvement in relation to the GC: NIHSS (p < 0.001), VFSS (p < 0.001) and SSA (p =0.037)	1, 3, 7 weeks

[1] Correspondence:
Klayne Cunha Matos; Email: klaynematos@hotmail.com.

Brasil

Brasil

Uma revisão das terapias de reabilitação para disfagia em pacientes com acidente vascular cerebral

RESUMO

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