Pharyngeal Electrical Stimulation Evaluation for Dysphagia After Stroke
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Dysphagia Following Cerebral Infarction
- Sponsor
- Phagenesis Ltd.
- Enrollment
- 50
- Locations
- 1
- Primary Endpoint
- To evaluate the efficacy of treatment in reducing the severity of unsafe swallows based on PAS(Penetration Aspiration Scale)of each swallow during VFSS
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
This is a randomized, sham-controlled, patient masked, outcome assessor-blinded study to assess a Pharyngeal Electrical Stimulation (PES) Catheter for treatment of oropharyngeal dysphagia following a stroke.
Detailed Description
Randomization will be stratified at each site in a 1:1 fashion. All patients will have the Phagenyx® Catheter placed prior to randomization, and will receive either an active treatment of Pharyngeal Electrical Stimulation (PES) or a sham treatment performed by a health care professional (HCP) that is un-blinded to treatment assignment. All other speech pathology standard dysphagia care will be provided by a speech language pathologist (SLP) that is blinded to treatment assignment. Administration of all protocol-specific assessments will be conducted by personnel blinded to treatment assignment. The study will follow an adaptive group sequential design with unblinded sample size re-assessment. To ensure 180 evaluable patients with 7-day data and assuming a 20% dropout rate, 225 patients will be enrolled initially. An interim analysis for futility will occur after the first 60 patients complete their 7-day visits and another interim analysis will be performed for efficacy and futility after 120 patients complete their 7-day visits. The total sample size may be increased up to 338 patients after the second interim analysis to ensure up to 270 evaluable patients. Up to 15 investigational centers across the US and possibly Europe will participate in this study. The enrollment period is expected to be approximately 24 months and patient participation will last for approximately 11 weeks. Patients will be assessed at the following intervals: baseline, 48 hours, 7 days, 14 days or at discharge, whichever is first, and 11 weeks after completion of the study treatments.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age ≥ 18 and ≤ 90 years.
- •Acute ischemic or hemorrhagic cerebral stroke within 7-28 days of baseline VFSS.
- •Score of 0 or 1 on NIHSS question 1a, Level of Consciousness.
- •Moderate to severe dysphagia (PAS \>4) on baseline VFSS (Baseline VFSS must meet the threshold criteria of demonstrating a PAS of ≥ 4, in three of the six boli (5 mL/1 tsp/bolus), during swallowing "thin liquid" barium media as assessed by the clinical staff administering the VFSS.).
- •Willing and able to have the Phagenyx® Catheter placed transnasally.
- •Willing and able to provide informed consent.
- •Stated willingness to comply with all study procedures and availability for the duration of the study.
Exclusion Criteria
- •Brainstem stroke.
- •Evidence of traumatic brain injury or subarachnoid hemorrhage.
- •Other known brain abnormalities documented by history and/or imaging (e.g., tumor, abnormal white matter, inflammatory neuropathy, myelin delamination, hydrocephalus).
- •Dysphagia from conditions other than stroke.
- •Pre-stroke history of swallowing complaints or treatment or history of diseases known to be associated with swallowing problems (other neurological, head and neck cancer.
- •Distorted oropharyngeal anatomy (e.g., pharyngeal pouch, major pharyngeal surgery or head /neck surgery)
- •Currently being treatment for pneumonia.
- •Mute, global aphasia; no usable speech or auditory comprehension (scores 3 on NIHSS question 9, Best Language)
- •NIHSS score of \>25
- •Presence of a tracheostomy
Outcomes
Primary Outcomes
To evaluate the efficacy of treatment in reducing the severity of unsafe swallows based on PAS(Penetration Aspiration Scale)of each swallow during VFSS
Time Frame: 48 hours post final treatment
VFSS (Vidoeflouroscopic Swallow Study) Swallowing safety of a bolus of thin and nectar consistency determined by a videofluoroscopic swallowing study.The PAS provides a scoring mechanism for airway closure and clearance during the VFSS. The PAS is a validated 8-point scale that measures penetration and aspiration. Scores are determined primarily by the depth to which material passes into the airway. 1. Material does not enter airway 2. Material enters the airway, remains above the vocal folds, and is ejected 3. Material remains above the vocal folds, and is not ejected from airway 4. Material contacts the vocal folds, and is ejected 5. Material contacts the vocal folds, and is not ejected 6. Material passes below the vocal folds , and is ejected out airway 7. Material passes below the vocal folds, and is not ejected from trachea 8. Material enters the airway , and no effort is made to eject it
Secondary Outcomes
- To evaluate the efficacy of Phagenyx® treatment in improving nutritional management(11 weeks post final treatment)