The Effect of Early Neuromuscular Electrical Stimulation Therapy in Acute/Subacute Ischemic Stroke Patients With Dysphagia

Abstract

ObjectiveTo compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS).MethodsFifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one patients received NMES combined with TDT (NMES/TDT group) and 26 patients received TDT only (TDT group). Electrical stimulation with a maximal tolerable intensity was applied on both suprahyoid muscles for 30 minutes, 5 days per week during 3 weeks. The swallowing function was evaluated at baseline and 3, 6, and 12 weeks after baseline. Outcomes of the VFSS were assessed using the Functional Oral Intake Scale (FOIS).ResultsThe mean ages were 63.5±11.4 years in the NMES/TDT group and 66.7±9.5 years in the TDT group. Both groups showed a significant improvement on the FOIS after treatment. The FOIS score was significantly more improved at 3 and 6 weeks after baseline in the NMES/TDT group than in the TDT group (p<0.05).ConclusionAn early application of NMES combined with TDT showed a positive effect in acute/subacute ischemic stroke patients with dysphagia. These results indicated that the early application of NMES could be used as a supplementary treatment of TDT to help rehabilitate acute/subacute dysphagic stroke patients by improving their swallowing coordination.

Combined electrical stimulation and exercise for swallow rehabilitation post‐stroke: a pilot randomized control trial

“…() found sustained benefit at 24 months post‐treatment (in a ‘preliminary case series’) and Lee et al . () at 12 weeks post‐treatment. We would therefore prioritize data collection on long‐term effects in a full‐scale study in order to clarify this issue in a larger group of patients.…”

“…Of the four studies that did look at long-term follow-up, two found no long-term effect at 12 weeks (Terre andMearin 2015, Guillen-Sola et al 2017) and two found a lasting effect: Sun et al (2013) found sustained benefit at 24 months post-treatment (in a 'preliminary case series') and Lee et al (2014) at 12 weeks post-treatment. We would therefore prioritize data collection on longterm effects in a full-scale study in order to clarify this issue in a larger group of patients.…”

Early Rehabilitation After Stroke: a Narrative Review

“…One investigated neuromuscular electrical stimulation (NMES) of the infrahyoid region for patients within 10 days of supratentorial stroke with dysphagia, and found benefit of NMES over SC on the Functional Oral Intake Scale (FOIS) at 3, 6, and 12 weeks, as well as in the likelihood and speed of resuming oral feeding [80]. Limitations of the trial include small sample size and high rates of spontaneous recovery.…”

Proceedings of Réanimation 2018, the French Intensive Care Society International Congress: physiotherapists’ communications

“…Coefficient of variation (CV) and bland-Altman analysis were used to assess agreement. Results: 15 patients (n = 5 and n = 10) of mean (SD) age 62 (16) and 66 (9) years old (p = 0,511), mean (SD) BMI 25 (3,5) and 28 (6) kg m −2 (p = 0,352) and mean (SD) IGS2 53 (26) and 52 (17) (p = 0,606) were included. In group 1 mean CV for each muscle was less than 6% and Bland-Altman analysis showed excellent agreement between examinations.…”