Combined Effects of NMES and Mendelsohn Maneuver on the Swallowing Function and Swallowing–Quality of Life of Patients with Stroke-Induced Sub-Acute Swallowing Disorders

Abstract

It is necessary to identify how to improve the swallowing-related quality of life, as well as the swallowing function, in order to evaluate the effect of treatments on swallowing disorders. This study aimed to prove the effects of a compound swallowing intervention (Mendelsohn maneuver + neuromuscular electrical stimulation (NMES)) on the swallowing function and the quality of life by applying the compound swallowing intervention to patients with sub-acute swallowing disorders due to cerebral infarction for eight weeks. This study analyzed 43 subjects who were diagnosed with swallowing disorders due to cerebral infarction. The experiment consisted of the Mendelsohn maneuver treatment group (n = 15), the NMES treatment group (n = 13), the compound intervention group (Mendelsohn maneuver + NMES; n = 15). The results of ANCOVA showed that the changes in Functional Dysphagia Scale (FDS) scores and Swallowing–Quality of Life (SWAL–QOL) score were different among groups. The compound intervention group had the highest FDS scores and SWAL–QOL score followed by Mendelsohn, and the NMES group had the lowest. The result of this study suggests that NMES can be more effective when it is combined with a traditional swallowing rehabilitation therapy rather than a single intervention method.

Effectiveness of Different Application Parameters of Neuromuscular Electrical Stimulation for the Treatment of Dysphagia after a Stroke: A Systematic Review

“…A total of 21 articles were found, of which eleven were focused on experimental researchs [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] and nine were randomized-controlled trials [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. The methodological characteristics of the analysed studies are shown in Table 2 and, in Table 3 , the characteristics of the interventions applied in them are presented.…”

“…The application of NMES was not conducted using the same parameters in the analysed investigations. Regarding the application frequency, the choice of 80 Hz was the most widely used [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 45 ], although, in several cases, this parameter was not mentioned [ 34 , 38 , 44 , 46 ] and in another two studies the authors selected lower frequencies (60 [ 47 ] and 30 Hz [ 43 ]). In all cases, the results were statistically significant; even those studies which used lower frequencies obtained significant reductions in oral and pharyngeal transit time [ 47 ], significant decreases in the severity of penetration and aspiration [ 43 ] and significant increases in the level of oral intake and quality of life [ 43 ].…”

“…The impulse time was also a parameter that varied depending on the study analysed. The most frequent duration was 700 μs [ 28 , 29 , 30 , 32 , 33 , 35 ], although there were studies that used shorter (300 μs [ 31 , 40 , 41 ]) and longer durations (300 [ 27 , 36 , 37 ], 700 [ 39 ] and 800 [ 44 ] ms). In all the analysed cases, the results were significantly positive; even the studies that used shorter impulse times detected improvements in the quality of sleep, level of oral intake, presence and severity of penetration and aspiration, and capacity to communicate and swallow (higher elevation of the pharynx, closing of the epiglottis and coaptation of the pharyngeal wall), although more notably in those cases in which NMES was combined with Mendelsohn maneuvers (and other conventional DP treatment techniques) compared to its use as a single treatment technique [ 31 , 40 , 41 ].…”

“…Regarding the intensity of the application, most of the obtained studies were aimed at reaching the motor threshold as the patient’s tolerance to the current increased with the sessions [ 28 , 29 , 30 , 35 , 42 , 43 , 45 , 46 , 47 ]. In contrast, other studies reached the pain threshold of the patient [ 31 ] or aimed to reach a certain level of intensity as the patient’s tolerance increased with each session: up to 7 [ 37 , 38 ], 8.5 [ 32 ], 12.5 [ 41 ], 20 [ 36 ], 25 [ 40 ] and 28 mA [ 37 ]. Specifically, Park et al [ 35 ] compared the effects of applying NMES at different intensities: an intervention group received it at motor threshold, whereas the control group received it at sensitivity threshold.…”

“…The electrodes were preferentially placed in the anterior side of the neck: suprahyoid [ 27 , 31 , 32 , 33 , 36 , 37 , 38 , 39 , 42 , 43 , 44 , 45 , 46 , 47 ] or infrahyoid area [ 35 ], thyroid muscles [ 28 , 41 , 44 ], and lateral regions of the pharynx [ 40 ], although some authors also applied NMES in the cranium: in the paretic facial area [ 29 ], orbicularis orbis muscle [ 30 ] and masseters [ 37 ]. Two of the analysed articles were focused on comparing the effects of different application areas.…”