Neuromuscular electrical stimulation improves swallowing initiation in patients with post-stroke dysphagia

Abstract

ObjectiveMore than half of post-stroke patients develop dysphagia, which manifests as delayed swallowing and is associated with a high risk of aspiration. In this study, we aimed to investigate the immediate effect of neuromuscular electrical stimulation (NMES) on swallowing initiation in post-stroke patients using videofluoroscopic swallowing study (VFSS) data.Materials and methodsThis randomized, self-controlled crossover study included 35 patients with post-stroke dysphagia. All selected patients received real and sham NMES while swallowing 5 ml of thin liquid. Participants completed the conditions in random order, with a 10-min interval between conditions. The primary evaluation indicators included the Modified Barium Swallow Impairment Profile-6 (MBSImp-6) and Penetration-Aspiration Scale (PAS). Secondary indicators included oral transit time (OTT), pharyngeal transit time (PTT), and laryngeal closure duration (LCD).ResultsModified Barium Swallow Impairment Profile-6 (P = 0.008) and PAS (P < 0.001) scores were significantly lower in the Real-NMES condition than in the Sham-NMES condition. OTT (P < 0.001) was also significantly shorter during Real-NMES than during Sham-NMES. However, LCD (P = 0.225) and PTT (P = 0.161) did not significantly differ between the two conditions.ConclusionNeuromuscular electrical stimulation may represent a supplementary approach for promoting early feeding training in patients with post-stroke dysphagia.Clinical trial registration[https://clinicaltrials.gov/], identifier [ChiCTR2100052464].

Effects of transcutaneous neuromuscular electrical stimulation on post-stroke dysphagia: a systematic review and meta-analysis

“…Among the 46 studies included, 29 studies ( 18 , 20 , 22 , 23 , 25 – 27 , 29 , 32 – 34 , 36 , 37 , 39 , 42 , 46 , 48 , 51 – 62 ) selected and reported appropriate randomization methods, such as random number table, so they were assessed as low risk of bias, the other 17 studies ( 19 , 21 , 24 , 28 , 30 , 31 , 35 , 38 , 40 , 41 , 43 – 45 , 47 , 49 , 50 , 63 ) only mentioned randomization allocation, so they were assessed as having the unclear risk of bias.…”

“…A total of 25 studies ( 18 , 22 , 25 – 27 , 29 , 31 , 33 , 35 , 37 , 39 , 46 , 51 – 63 ) reported the registration and ethical review of clinical RCTs, so the risk of bias was low. The remaining 21 studies were identified as having an unclear risk of bias.…”

Clinical study on the efficacy of postural control combined with electroacupuncture in treating dysphagia after stroke

“…Conventional swallowing rehabilitation typically encompasses several components: (1) enhancement of the physical properties of food; (2) adjustment of eating position; (3) functional rehabilitation training for oropharyngeal and facial muscles, including sensory stimulation, oral and facial muscle strength training, coordination training for swallowing muscle movement, and swallowing skill training; (4) electrical stimulation of the pharyngeal muscles, including Neuromuscular Electrical stimulation (NMES), modified pharyngeal electrical stimulation (mPES) ( 7 ) and Pharyngeal electrical stimulation (PES) ( 6 , 8 , 11 ); (5) application of cold and hot stimulation to stimulate the pharyngeal mucosa; (6) Specific training for laryngeal elevation, hyoid muscle function, cricopharyngeal muscle function, pharyngeal cavity power, vocal cord function, and airway protection ( 11–13 ).…”

“…Moreover, individuals with dysphagia following stroke often endure persistent swallowing difficulties, persisting up to six months post-onset ( 5 ). Neuromuscular Electrical stimulation (NMES), Pharyngeal electrical stimulation (PES) and modified Pharyngeal electrical stimulation (mPES), also have been reported as an effective treatment ( 6 , 7 ). Nevertheless, the exact mechanism of NMES, PES and mPES is unclear, and there has been little consensus on optimal electrode placement as well as proper frequency and intensity for stimulation ( 8 ).…”

The impact of physical therapy on dysphagia in neurological diseases: a review

“…In patients with brain injury-related dysphagia, the NMES strengthens both suprahyoid and infrahyoid muscles, along with the muscles that assist in swallowing ( Seo et al, 2021 ). Moreover, the long-term application of NMES benefits the recovery of swallowing-related cortical neuroplasticity in stroke patients ( Zhang et al, 2022 ). Given the loss of swallowing motor control in stroke patients, functional muscle contraction patterns are primarily re-educated during NMES ( Miller et al, 2022 ).…”