Oropharyngeal dysphagia is one of the most frequent and dangerous complications of stroke: it affects up to 65–78% of patients in the acute phase and, when not adequately treated, leads to aspiration pneumonia, malnutrition, dehydration, and premature death. Despite advances in conventional swallowing rehabilitation — including speech therapy exercises and neuromuscular electrical stimulation — many patients remain with severe residual dysphagia that profoundly compromises quality of life and functional recovery. A meta-analysis published in Cerebrovascular Diseases in 2024 systematically evaluated the impact of acupuncture as an adjunct in the rehabilitation of post-stroke dysphagia, gathering 20 studies and 1,718 participants with searches conducted through September 2024.
The included studies compared acupuncture combined with conventional rehabilitation versus conventional rehabilitation alone, evaluating four objective and subjective swallowing outcomes: the Standard Swallowing Assessment (SSA — lower score indicates better function), the Videofluoroscopic Swallowing Study (VFSS — higher score indicates better oropharyngeal coordination), the Water Swallow Test (WST — lower score indicates better performance), and the Swallowing Quality of Life (SWAL-QOL — higher score indicates better quality of life). The most frequently used acupoints included CV-23 (Lianquan), ST-36 (Zusanli), LI-11 (Quchi), GV-20 (Baihui), ST-6 (Jiache), and local cervical points.
MAIN RESULTS — 20 STUDIES, 1,718 PARTICIPANTS
Why is post-stroke dysphagia só difficult to treat?
Normal swallowing involves the precise coordination of more than 30 muscles and 6 cranial nerve pairs in a sequence that lasts less than 1 second. Stroke — depending on its location — can compromise the bilateral primary and premotor motor córtex, the brainstem (nuclei of the trigeminal, facial, glossopharyngeal, and vagus nerves), the corticobulbar pathways, and the swallowing control centers in the medulla (medullary reticular formation). The resulting dysphagia can be oropharyngeal (difficulty in the oral or pharyngeal phase) or esophageal, with particular risk of silent aspiration — when food or liquid passes through the vocal cords without provoking cough, making clinical detection impossible without videofluoroscopy.
Magnitude of effects: clinical relevance of the findings
The four outcomes demonstrated statistical and clinical significance. The improvement of MD = −3.64 in the SSA represents a substantial reduction in the risk of severe dysphagia — the SSA classifies patients into aspiration risk categories, and a reduction of more than 3 points frequently corresponds to the transition from “severe dysphagia” to “moderate dysphagia,” with direct implications for oral nutrition and quality of life. The improvement of MD = 1.49 in the VFSS indicates better coordination of the pharyngeal phase — an objective measure that directly reflects the competence of the neuromuscular structures involved in airway protection. The improvement of MD = 16.56 in the SWAL-QOL — a scale that ranges from 0 to 100 — represents a clinically relevant gain in dimensions such as eating enjoyment, communication about diet, fear of choking, and social aspects of meals.
Frequently Asked Questions
Most patients with clinically stable post-stroke dysphagia can benefit from acupuncture as an adjunct to rehabilitation. The main relative contraindications include: use of anticoagulants in high therapeutic doses (requires technique adjustment), active infections in the cervical region, severe coagulopathies, and clinical instability. In patients with severe dysphagia and high aspiration risk, acupuncture should be initiated with prior speech therapy assessment and careful monitoring. The clinical decision should be individualized by the responsible physician.
Yes — approximately 50–75% of patients with post-stroke dysphagia improve spontaneously in the first 2–3 weeks, especially those with unilateral stroke without brainstem involvement. Spontaneous recovery occurs through neuroplasticity and compensation by the unaffected hemisphere. However, for the 25–50% who persist with dysphagia after the acute phase, and to accelerate recovery in others, active rehabilitation — including speech therapy and acupuncture — is essential. Persistent dysphagia is associated with increased risk of aspiration pneumonia, which is the third leading cause of death after stroke.
Yes, acupuncture at cervical points such as CV-23 is safe when performed by a trained physician with precise anatomical knowledge of the region. The CV-23 point (Lianquan), located in the midline above the hyoid, is stimulated with a 0.25 × 25 mm needle at a slightly inclined direction — away from the carotid arteries, jugular veins, and laryngeal nerves. The main precautions include avoiding excessive depth, using clean technique with disposable needles, and monitoring the patient during the session. In patients on anticoagulation, adequate pressure is used after needle removal to prevent local hematoma.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).