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.
- SourceAvailable from: Noureddin nakhosin Ansari
[Show abstract] [Hide abstract]
- "Initial swallow score in SFSS c = 0.76 ± 1.04 Posttreatment swallow score in SFSS = 4.52 ± 1.69 (í µí± = 0.0048) Group 2. Initial swallow score in SFSS = 0.75 ± 1.20 Posttreatment swallow score in SFSS = 1.39 ± 1.13 (í µí± < 0.0001) Bülow et al. (2008)  Randomized trial Group 1 (ES): í µí± = 12 stroke patients (>3 months) Group 2 (TDT): í µí± = 13 stroke patients (>3 months) Group 1: only hemispheric stroke Group 2: only hemispheric stroke Group 1: 15 sessions Group 2: 15 sessions Intensity: 4.5 to 25 mA Duration: 60 minutes a day for 5 days a week over 3 weeks Motor level Thyrohyoid muscles Group 1. Initial median score in ANS g = 2.5 Posttreatment median score in ANS = 1.5 Group 2. Initial median score in ANS = 3 Posttreatment median score in ANS = 3 Permsirivanich et al. (2009)  Randomized controlled study Group 1 (ES + oral motor exercises): í µí± = 12 patients with postacute stroke (>2 wk) Group 2 (RST h ): í µí± = 11 patients with postacute stroke (>2 wk) NR Group 1: 17.25 ± 5.64 sessions (mean ± SD) Group 2: 18.36 ± 3.23 sessions (mean ± SD) (í µí± = 0.57) Frequency: 80 Hz Pulse duration: 700 ms Duration: 60 minutes a day for a 5 days a week Motor level Thyrohyoid muscles Group 1. Average changes in FOIS i score = 3.17 ± 1.27 Group 2. Average changes in FOIS score= 2.46 ± 1.04 (í µí± < 0.001) Park et al. (2012)  Randomized controlled study Group 1 (effortful swallow + motor ES): í µí± = 9 patients with stroke (>1 month) Group 2 (effortful swallow + sensory ES): í µí± = 9 patients with stroke (>1 month) NR 12 sessions Group 1: Frequency: 80 Hz Pulse width: 700 í µí¼s Intensity: 7.33 ± 1.12 mA Duration: 20 min per week for 4 weeks Motor level Group 2: Frequency: 80 Hz "
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.04/2014; 2014:918057. DOI:10.1155/2014/918057
- [Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study was to assess the effect of repeated sessions of electrical stimulation therapy (EST) on the neck muscles with respect to the stimulation site by using quantitative kinematic analysis of videofluoroscopic swallowing studies (VFSS) in dysphagia patients with acquired brain injury. We analyzed 50 patients in a tertiary hospital who were randomly assigned into two different treatment groups. One group received EST on the suprahyoid muscle only (SM), and the other group received stimulation with one pair of electrodes on the suprahyoid muscle and the other pair on the infrahyoid muscle (SI). All patients received 10-15 sessions of EST over 2-3 weeks. The VFSS was carried out before and after the treatment. Temporal and spatial parameters of the hyoid excursion and laryngeal elevation during swallowing were analyzed by two-dimensional motion analysis. The SM group (n = 25) revealed a significant increase in maximal anterior hyoid excursion distance (mean ± SEM = 1.56 ± 0.52 mm, p = 0.008) and velocity (8.76 ± 3.42 mm/s, p = 0.017), but there was no significant increase laryngeal elevation. The SI group (n = 25), however, showed a significant increase in maximal superior excursion distance (2.09 ± 0.78 mm, p = 0.013) and maximal absolute excursion distance (2.20 ± 0.82 mm, p = 0.013) of laryngeal elevation, but no significant increase in hyoid excursion. There were no significant differences between the two groups with respect to changes in maximal anterior hyoid excursion distance (p = 0.130) and velocity (p = 0.254), and maximal distance of superior laryngeal elevation (p = 0.525). EST on the suprahyoid muscle induced an increase in anterior hyoid excursion, and infrahyoid stimulation caused an increase in superior laryngeal elevation. Hyolaryngeal structural movements were increased in different aspects according to the stimulation sites. Targeted electrical stimulation based on pathophysiology is necessary.Dysphagia 04/2013; 28(4). DOI:10.1007/s00455-013-9465-x · 1.60 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Dysphagia is common after stroke, leading to adverse outcome. There is a paucity of high-quality evidence for dysphagia therapy, thus making it difficult to determine the best approaches to treatment. Clinical decisions are often based on usual practice, however no formal method of monitoring practice patterns exists. To determine speech and language therapists' (SLTs) approaches to direct dysphagia therapy with stroke patients in the UK and Ireland. A 24-item questionnaire was developed, piloted and delivered in a web-based cross-sectional survey targeting all SLTs working with stroke patients in the UK and Ireland. A total of 138 SLTs responded from a range of clinical settings and levels of experience. There was variation in the responses to all questions. Respondents reported treating patients a median of once a day, 3 days a week for 15 min. The most commonly recommended direct exercises were supervised swallow trials (recommended 'frequently or always' by 73%). Despite most respondents having access to an instrumental swallowing assessment, over half reported rarely or never conducting one before recommending exercises. Most (93%) did not use a protocol for systematically progressing patients' exercises and only 37% reported using standardized outcome measures. This survey gives valuable insight into the direct dysphagia therapy practices of SLTs based in the UK and Ireland working in stroke. It highlights discrepancies between reported approaches and recommendations from existing evidence and clinical guidelines. The variation in responses indicates a need to develop a consensus statement and further research to guide practice.International Journal of Language & Communication Disorders 05/2013; 48(3):283-96. DOI:10.1111/1460-6984.12006 · 1.39 Impact Factor