Optimal placement of electrodes for treatment of post-stroke dysphagia by neuromuscular electrical stimulation combined with effortful swallowing

Abstract

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Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials—Part I: Pharyngeal and Neuromuscular Electrical Stimulation

“…NMES Intervention (n = 30: Tables 2 and 3). In total, 22 studies included two study arms or groups, whereas eight studies included three groups [31][32][33][34]38,40,55,57]. All but five NMES studies [29,39,43,53,54] combined neurostimulation with simultaneous DT consisting of a wide range of behavioural interventions (e.g., head and body positioning, bolus modification, oromotor exercises, or swallow manoeuvres).…”

“…All other participants in NMES groups received stimulation at motor level. Five studies compared different NMES electrode positions [28,34,[40][41][42] and seven studies included a sham stimulation group [36,39,48,50,[52][53][54].…”

“…Eleven studies were included in the NMES meta-analysis [28,29,34,37,40,42,45,47,49,51,55], of which six studies included two or three different intervention groups [28,34,40,42,45,55]. A total of 20 studies were excluded from metaanalysis for the following reasons: in three studies, OD diagnosis was not confirmed by instrumental assessment (VFSS or FEES); five studies provided insufficient data for metaanalyses; and, twelve studies were excluded to reduce heterogeneity: six studies including subject populations with medical diagnoses other than stroke (i.e., children with cerebral palsy, head and neck cancer patients, patients with Parkinson's disease, and elderly), five studies because of outcome measures (e.g., kinematic or biomechanical variables in VFS recordings), and one study using sensory NMES stimulation.…”

“…Between-study heterogeneity was significant (Q(17) = 106.7, and p < 0.001), with I 2 showing that heterogeneity accounted for 84.1% of variation in effect sizes across studies. [28,29,34,37,40,42,45,47,49,51,55]. Note.…”

A Systematic Review of Reported Methods of Stimulating Swallowing Function and their Classification

“…The main causes of functional dysphagia in the pharyngeal phase of swallowing are muscular weakness and delayed onset of the swallowing reflex. Attempts have long been made to restore muscle strength by applying neuromuscular electric stimulation to cause forced muscle contraction, resulting in the establishment of neuromuscular electrical stimulation (NMES) as the most common stimulation technique in diverse types of dysphagia (Suiter et al 2006;Bulow et al 2008;Lim et al 2009;Park et al 2009Park et al , 2012Park et al , 2016Park et al , 2018Permsirivanich et al 2009;Ryu et al 2009;Baijens et al 2012Baijens et al , 2013Holmes et al 2012;Heijnen et al 2012;Long and Wu 2013;Nam et al 2013;Rofes et al 2013a;Huang et al 2014;Toyama et al 2014;El-Tamawy et al 2015;Humbert et al 2015;Song et al 2015;Terré and Mearin 2015;Zhao et al 2015;Jing et al 2016;Langmore et al 2016;Zhang et al 2016Zhang et al , 2019Guillén-Solà et al 2017;Meng et al 2018;Sproson et al 2018;Zeng et al 2018;Konecny and Elfmark 2018;Bucyana et al 2019;Poorjavad et al 2019;Simonelli et al 2019;Carnaby et al 2020;Huh et al 2020;…”