TY  - JOUR
AU  - Jansen, Marjolein
AU  - van Iperen, Ingrid D
AU  - Kroner, Anke
AU  - Hemler, Raphael
AU  - Dekker-Holverda, Esther
AU  - Spronk, Peter E
PY  - 2025
DA  - 2025/3/5
TI  - Kangaroo Stimulation Game in Tracheostomized Intensive Care–Related Dysphagia: Interventional Feasibility Study
JO  - JMIR Serious Games
SP  - e60685
VL  - 13
KW  - dysphagia
KW  - swallowing
KW  - intensive care
KW  - ICU
KW  - swallowing disturbance
KW  - kangaroo stimulation
KW  - game
KW  - feasibility study
KW  - surface electromyography
KW  - training
KW  - exercise
KW  - Rephagia biofeedback
KW  - muscle strength
KW  - stamina
KW  - timing
KW  - tracheostomy
KW  - clinical
KW  - feasibility
AB  - Background: 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. Objectives: The aim of this study was to evaluate the feasibility of the Rephagia system in ICU patients with dysphagia. Methods: 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. Results: 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%). Conclusions: 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. 
SN  - 2291-9279
UR  - https://games.jmir.org/2025/1/e60685
UR  - https://doi.org/10.2196/60685
DO  - 10.2196/60685
ID  - info:doi/10.2196/60685
ER  -