Efficacy of Game-Based EMG-Biofeedback Therapy in Post-Stroke Dysphagia: A Randomized Controlled Trial

Abstract The aim of this study was to investigate the effects of game-based electromyography (EMG)-biofeedback therapy on swallowing functions and quality of life in patients with post-stroke dysphagia. This prospective, assessor-blind, randomized controlled trial included 33 patients with post-stroke dysphagia. The study group performed the Mendelsohn maneuver and effortful swallow using game-based EMG-biofeedback, while the control group performed the same tasks with only verbal feedback for 30 min across a total of 15 sessions. In addition, both groups received oral motor exercises and thermal-tactile stimulation for equal durations. Patients were evaluated immediately before and after the treatment using clinical swallowing assessments, including the Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale (PAS), Dysphagia Outcome and Severity Scale (DOSS), and Dysphagia Handicap Index (DHI). Statistically significant improvements were observed in FOIS scores (p = 0.038), PAS-Liquid scores (p = 0.026), and DOSS scores (p = 0.003) in the study group, while no significant changes were noted in the control group. PAS-Semisolid scores improved in both groups (study group, p = 0.002; control group, p = 0.023); however, post-treatment scores were significantly higher in the study group compared to the control group (p = 0.031). Although significant improvements in DHI total, physical, emotional, and functional scores were observed in both groups at the end of treatment (all p < 0.05), post-treatment DHI scores were significantly higher in the study group compared to the control group (all p < 0.05). The addition of game-based EMG-biofeedback to conventional therapy improved clinical and radiological outcomes, as evidenced by improvements in FOIS, PAS-Liquid, and DOSS scores, and led to statistically significant improvements in PAS-Semisolid and DHI scores. In conclusion, the inclusion of game-based EMG-biofeedback therapy in swallowing rehabilitation programs may have a positive impact on treatment outcomes.