# Kangaroo Stimulation Game in Tracheostomized Intensive Care–Related Dysphagia: Interventional Feasibility Study

## TL;DR

This study tested a biofeedback system to help ICU patients with swallowing issues and found it to be feasible, though no direct link was found between muscle signals and improvement.

## Contribution

The study introduces the feasibility of using the Rephagia system for dysphagia rehabilitation in tracheostomized ICU patients.

## Key findings

- The Rephagia system was feasible for use in ICU patients with dysphagia.
- No significant changes in sEMG values were observed before and after training.
- All patients showed clinical improvement in swallowing despite no change in sEMG signals.

## Abstract

Dysphagia is common in intensive care unit (ICU) patients. Using surface electromyography (sEMG) signals as biofeedback training exercises might offer a promising path to improving swallowing function. The Rephagia biofeedback system uses sEMG to assess muscle strength, stamina, and timing of the swallowing action.

The aim of this study was to evaluate the feasibility of the Rephagia system in ICU patients with dysphagia.

This feasibility study included patients admitted to a 14-bed mixed medical-surgical ICU. All patients underwent a new tracheostomy placement during ICU stay due to persistent aspiration and ICU-acquired weakness, accompanied by verified dysphagia. Following Rephagia training, patients completed a questionnaire assessing comprehension, satisfaction, and motivation. Swallowing characteristics were assessed via mean sEMG peak values during exercise.

Twenty patients with a mean age of 69.4 (SD 8.2) years were included. The means of sEMG values at the beginning of a measurement were not significantly different at baseline versus everyone’s last measurement (52 µV [23 µV] vs 57 µV [22 µV]; P=.50). The means of sEMG values obtained at the end of a measurement were not significantly different at baseline versus everyone’s last measurement (56 µV [18 µV] vs 59 µV [23 µV]; P=.62). However, dysphagia improved in all patients. Patients understood the importance of the game in relation to their swallowing problems (16/80, 89%), which kept them motivated to participate in the training sessions (9/18, 50%).

The Rephagia biofeedback system for stimulating swallowing actions in tracheotomized ICU patients with dysphagia is feasible. No relation was found between clinical improvement in swallowing function and sEMG signals.