Effortful Swallowing Training Combined with Electrical Stimulation in Post-Stroke Dysphagia: A Randomized Controlled Study.
ABSTRACT We tested the effect of effortful swallow combined with surface electrical stimulation used as a form of resistance training in post-stroke patients with dysphagia. Twenty post-stroke dysphagic patients were randomly divided into two groups: those who underwent effortful swallow with infrahyoid motor electrical stimulation (experimental group, n = 10) and effortful swallow with infrahyoid sensory electrical stimulation (control group, n = 10). In the experimental group, electrical stimulation was applied to the skin above the infrahyoid muscle with the current was adjusted until muscle contraction occurred and the hyoid bone was depressed. In the control group, the stimulation intensity was applied just above the sensory threshold. The patients in both groups were then asked to swallow effortfully in order to elevate their hyolaryngeal complex when the stimulation began. A total of 12 sessions of 20 min of training for 4 weeks were performed. Blinded biomechanical measurements of the extent of hyolaryngeal excursion, the maximal width of the upper esophageal sphincter (UES) opening, and the penetration-aspiration scale before and after training were performed. In the experimental group, the maximal vertical displacement of the larynx was increased significantly after the intervention (p < 0.05). The maximal vertical displacement of the hyoid bone and the maximal width of the UES opening increased but the increase was not found to be significant (p = 0.066). There was no increase in the control group. Effortful swallow training combined with electrical stimulation increased the extent of laryngeal excursion. This intervention can be used as a new treatment method in post-stroke patients with dysphagia.
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ABSTRACT: Neuromuscular electrical stimulation (NMES) for treating dysphagia is a relatively new therapeutic method. There is a paucity of evidence about the use of NMES in patients with dysphagia caused by stroke. The present review aimed to introduce and discuss studies that have evaluated the efficacy of this method amongst dysphagic patients following stroke with emphasis on the intensity of stimulation (sensory or motor level) and the method of electrode placement on the neck. The majority of the reviewed studies describe some positive effects of the NMES on the neck musculature in the swallowing performance of poststroke dysphagic patients, especially when the intensity of the stimulus is adjusted at the sensory level or when the motor electrical stimulation is applied on the infrahyoid muscles during swallowing.Stroke research and treatment. 01/2014; 2014:918057.
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ABSTRACT: Deficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough28 (2009) by Hegland, et al.42 (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.Journal of applied oral science: revista FOB 07/2014; 22(4):251-260. · 0.80 Impact Factor
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ABSTRACT: This review presents a synopsis of the current research in the field of peripheral and central neurostimulation for dysphagia and its relationship to advancing our knowledge in the field of human swallowing neurophysiology. Advances in the field of neurorehabilitation of motor systems in general have led to a wide range of approaches and are currently under rigorous investigations. Our field of dysphagia neurorehabilitation is sharing some of the formulated hypotheses and concepts for functional rehabilitation with neurostimulation. Importantly, results from studies looking into the cortical and subcortical control of human swallowing have been used as working hypotheses in the dysphagia neurorehabilitation field. For instance, based on our knowledge that peripheral and central inputs influence the swallowing network, experimental paradigms targeting swallowing neural reorganization have been trialled recently, prior to their translation into clinical practice for dysphagia rehabilitation. Here, we highlight the recent findings in the past year with the intention to stimulate potential research questions not yet investigated.Current Physical Medicine and Rehabilitation Reports. 09/2013; 1(4):257-266.