Abstract
BackgroundTo date, conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles.ObjectiveTo evaluate and compare the rehabilitative effectiveness of the sequential 4-channel NMES with that of conventional 2-channel NMES.MethodsIn this prospective randomized case–control study, 26 subjects with dysphagia were enrolled. All participants received 2- or 4-channel NMES for 2–3 weeks (minimal session: 7 times, treatment duration: 300–800 min). Twelve subjects in the 4-channel NMES group and eleven subjects in the 2-channel NMES group completed the intervention. Initial and follow-up evaluations were performed using the videofluoroscopic dysphagia scale (VDS), the penetration-aspiration scale (PAS), the MD Anderson dysphagia inventory (MDADI), the functional oral intake scale (FOIS), and the Likert scale.ResultsThe sequential 4-channel NMES group experienced significant improvement in their VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical subsets) scores, based on their pretreatment data. VDS (oral, pharyngeal, and total) and MDADI (emotional and physical subsets) scores, but not PAS and FOIS scores, significantly improved in the 2-channel NMES group posttreatment. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS scores.ConclusionsThe sequential 4-channel NMES, through its activation of the suprahyoid and thyrohyoid muscles, and other infrahyoid muscles mimicking physiological activation, may be a new effective treatment for dysphagia.Trial registration: clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1.
Highlights
Dysphagia is a common and serious problem in patients with stroke and its prevalence ranges from 37 to 78% [1]
Decreased laryngeal elevation caused by pharyngeal muscle weakness is the main cause of dysphagia in patients with stroke, and this can result in aspiration and pharyngeal residue during swallowing [2, 3]
Freed et al and Blumenfeld et al indicated that transcutaneous electrical stimulation is superior to conventional dysphagia management probably due to the stimulation of the sensory cortex of the cerebrum, the recruitment of more motor units rather than volitional contractions, and increased local blood flow [5, 6]
Summary
Dysphagia is a common and serious problem in patients with stroke and its prevalence ranges from 37 to 78% [1]. Diverse methods, such as oropharyngeal exercises, compensatory maneuvers, neuromuscular electrical stimulation (NMES), and diet control, are used for dysphagia treatment. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy and the method of stimulation [8]. No previous study has provided the basis for the effectiveness of the co-stimulation of the suprahyoid and infrahyoid muscles, and a recent randomized controlled trial failed to prove the efficacy of 2-channel NMES in patients with stroke [7, 9]. Conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles
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