Effortful Swallowing Training Combined with Electrical Stimulation in Post-Stroke Dysphagia: A Randomized Controlled Study

Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, 814, Siksa-dong, Ilsandong-gu, Gyeonggi-do, Goyang-si, 410-773, Republic of Korea, .
Dysphagia (Impact Factor: 2.03). 03/2012; 27(4). DOI: 10.1007/s00455-012-9403-3
Source: PubMed


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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    • "As stated by Bradley, a behavioral response to stimuli can be cortically modulated if perceived7, and this is true for both swallowing and cough. The modulation of swallowing is routinely used in the rehabilitation of dysphagia79,80,111. Treatment paradigms such as the supraglottic swallow, effortful swallow, and Mendelsohn maneuver require that volitional control is exerted over motor output, changing some physiological aspects of the resulting swallow. "
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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. DOI:10.1590/1678-775720140132 · 0.92 Impact Factor
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    • "Initial swallow score in SFSS c = 0.76 ± 1.04 Posttreatment swallow score in SFSS = 4.52 ± 1.69 (í µí±ƒ = 0.0048) Group 2. Initial swallow score in SFSS = 0.75 ± 1.20 Posttreatment swallow score in SFSS = 1.39 ± 1.13 (í µí±ƒ < 0.0001) Bülow et al. (2008) [26] 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) [27] 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±ƒ = 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±ƒ < 0.001) Park et al. (2012) [28] 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 µí¼‡s Intensity: 7.33 ± 1.12 mA Duration: 20 min per week for 4 weeks Motor level Group 2: Frequency: 80 Hz "
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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 04/2014; 2014:918057. DOI:10.1155/2014/918057
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    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 · 2.03 Impact Factor
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