Effective electrical stimulation placement combined with effortful swallowing maneuver for post-stroke dysphagia therapy

Abstract

The objective of this study is to evaluate which type of neuromuscular electrical stimulation (NMES) electrode placement is more effective for post-stroke dysphagia therapy. Thirty-one post-stroke dysphagic patients were randomly divided into the three groups according to NMES electrode placement types; in group A ( n = 10), both pair of electrodes were horizontally attached on the suprahyoid muscles above the hyoid bone and on the infrahyoid muscles below it, in group B ( n = 11), each pair of electrodes was horizontally and vertically attached on the suprahyoid muscles above the hyoid bone and on the infrahyoid muscles below it, and in group C ( n = 10), both pair of electrodes were vertically attached across the hyoid bone above the thyroid notch and across the cricoid cartilage below the thyroid cartilage. All patients received NMES combined with effortful swallowing maneuver five times a week for a 4-week period as rehabilitation treatment. The effect of NMES electrode placement was assessed by comparing functional dysphagia scale (FDS) and dysphagia outcome and severity scale (DOSS) scores about thin liquid swallowing at the initial videofluoroscopic swallowing study (VFSS) and the follow-up VFSS after intervention. Additionally, FDS scores were categorized into oral phase (FDS-O) and pharyngeal phase (FDS-P). Significant improvement of FDS and DOSS scores was observed in all three types of electrode placements. However, only group A electrode placement showed significant difference in FDS and FDS-P scores compared to group B and group C after the intervention. The group A electrode placement was significantly more effective than other electrode placements in NMES therapy for post-stroke dysphagia patients.