Effect of Neuromuscular Electrical Stimulation (NMES) on swallowing in Persons with Parkinson’s disease exhibiting Dysphagia: A Systematic Review

M Sonam Belliappa

doi:10.31579/2690-4861/105

Abstract

Swallowing is an essential activity required for survival. The global definition of dysphagia is simply difficulty in swallowing. Around 80% of individuals with Parkinson’s disease (PD) are diagnosed with dysphagia in any stage of their disease progression. Dysphagia therapy in these individuals has gained considerable importance in improving the quality of life in the recent past. With the advancement of technology related to dysphagia management, the use of Neuromuscular Electrical Stimulation (NMES) in dysphagia management is studied extensively, and the efficacy of it in successfully easing dysphagia symptoms in PD is still being evaluated. Hence this systematic review is aimed to give an overview regarding the current status of the literature available on the effect of NMES as a method of dysphagia rehabilitation on swallowing function in persons with PD. The present review will collate and critically analyse the existing knowledge of neuromuscular electrical stimulation in dysphagia management of persons with Parkinson’s disease. The authors did a systematic literature search following the PRISMA guidelines using electronic databases for studies reporting the use or effect of NMES on swallow function, aiding management of dysphagia in persons with PD. The quality and the levels of evidence of articles included were in accordance with the ABC rating scale by Siwek et al [20]. 3 out of 38 publications identified met the inclusion criteria. The authors carried out a systematic, qualitative and critical analysis of the articles finalised. The summary of the reviewed articles revealed the dearth of evidence and several methodological flaws as well as highlighted the prevailing research gap in this arena. This review additionally aids Speech-Language and Swallow Pathologists in clinical decision making and future directions concerning selecting Neuromuscular Electrical Stimulation (NMES) as a treatment option for managing dysphagia in persons with PD.

Highlights

Parkinson’s disease (PD) is one of the most commonly occurring neurological disorders globally, with a prevalence of more than 10 million people living worldwide [7]
The mesh terms used were swallowing or dysphagia combined with PD, Neuromuscular Electrical Stimulation (NMES) or electrical stimulation or vital stim combined with PD
NMES can be advantageous in PD due to its non-invasive nature, ease to use with reduced muscle fatigue not involving the active participation of the persons receiving it and clinician driven, Critical analysis of the finalised articles revealed that the studies were carried out by the same authors, suggesting lack of research on the topic proving the efficacy of the use of NMES as a dysphagia management approach in persons with PD

Summary

Introduction

Parkinson’s disease (PD) is one of the most commonly occurring neurological disorders globally, with a prevalence of more than 10 million people living worldwide [7]. Dysphagia often is asymptomatic in mildly impaired PD [15], [18] and can progress to become significantly debilitating as it is associated with neuronal degeneration and subsequent depletion of dopamine and its metabolites within the basal ganglia. Around 80-95% of individuals with PD exhibit swallowing problems at any stage of disease progression [17], [11] and 30-45 % die of aspiration pneumonia [24]. The physiological changes causing dysphagia is multifactorial, including cognitive impairment, head and neck posturing during meals, generalised upper extremity dysmotility and impulsive feeding behaviour [21]. Videofluroscopic Swallowing Studies (VFSS) studies report specific problems seen in all three stages of swallow including slow Pharyngeal Transit Time (PTT), Oral Transit Time (OTT), vallecular pooling and aspiration [2]

Methods

Discussion

Conclusion