The Value of Adding Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) to Traditional Therapy for Poststroke Dysphagia

Abstract

Background: Dysphagia may delay the functional recovery and substantially affects the quality of life after stroke, mainly if left untreated. Electrical stimulation has been reported as a treatment for pharyngeal dysphagia in recent studies, but the therapeutic effect of neuromuscular electrical stimulation (VitalStim) therapy lacks convincing supporting evidence and needs further clinical investigation. Methods: A total of 135 subjects were randomly divided into 3 groups: traditional swallowing therapy (n = 45), VitalStim therapy (n = 45), and VitalStim therapy plus traditional swallowing therapy (n = 45). The traditional swallowing therapy included basic training and direct food intake training. Electrical stimulation was applied by an occupational therapist, using a modified handheld battery-powered electrical stimulator (VitalStim Dual Channel Unit and electrodes, Chattanooga Group, Hixson, Tennessee). The surface electromyography (sEMG), standardized swallowing assessment (SSA), videofluoroscopic swallowing study (VFSS), and visual analog scale (VAS) were used to assess swallowing function before and 4 weeks after the treatment. Results: A total of 118 subjects with dysphagia completed the study, 40 in the traditional swallowing group and VitalStim therapy group and 38 in the VitalStim and traditional swallowing therapy group. There were significant differences in sEMG values and SSA and VFSS scores in each group after the treatment (P < .001). After 4-week treatment, sEMG value (917.1; standard deviation [SD], 91.2), SSA value (21.8; SD, 3.5), oral transit time (0.4; SD, 0.1), and pharyngeal transit time (0.8; SD, 0.1) were significantly improved in the VitalStim and traditional swallowing therapy group than in the other 2 groups (P < .001). Conclusions: Data suggest that VitalStim therapy coupled with traditional swallowing therapy may be beneficial for poststroke dysphagia.

Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

“…This observation calls for further improvement in the management of dysphagic patients. Recent studies indicate that functional magnetic or electrical stimulation may improve dysphagia as compared to conventional swallowing therapy, but these results need to be confirmed by larger studies [ 32 , 33 ]. There could be a need for such novel approaches, as swallowing dysfunction may persist in many patients for a longer time [ 34 , 35 ].…”

Effect of neuromuscular electrical stimulation on facial muscle strength and oral function in stroke patients with facial palsy

“…NMES is effective in muscle strengthening, prevention of muscle atrophy, and neuromuscular re-education2, 3 ) . However, most studies have reported applying it on the swallowing-related muscles located on the front side of the neck in patients with pharyngeal dysphagia to examine the effects on swallowing function4, 5 ) . Therefore, there is insufficient evidence on the effects of NMES on patients with oral phase dysphagia accompanied by CFP.…”

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

“…Numerous studies have shown that NMES significantly enhanced the recovery of the swallowing function [28,29]. Li et al [14] examined the effectiveness of a swallowing therapy in 118 patients for 4 weeks and reported that the combination of NMES and a traditional dysphagia therapy improved the swallowing function than the NMES-only treatment or the traditional rehabilitation therapy only treatment. Bulow et al [28] compared the effects of traditional swallowing disorder therapies with those of NMES, using a randomized controlled trial (RCT) design and showed that there was no significant difference between them.…”

“…Many studies have consistently shown that NMES is effective for compensatory strategies and rehabilitation therapy [11,12]. On the contrary, several studies reported that NMES was not effective [13][14][15][16][17]. Therefore, further studies are needed to verify the effectiveness of NMES.…”

“…Therefore, further studies are needed to verify the effectiveness of NMES. Above all, most of the previous studies compared the treatment effects of NMES and those of an individual traditional therapy, and only a few studies (e.g., Li et al [14]) have examined the effectiveness of compound interventions, including Li et al [14].…”