Ann Rehabil Med.  2015 Aug;39(4):535-544. 10.5535/arm.2015.39.4.535.

Different Movement of Hyolaryngeal Structures by Various Application of Electrical Stimulation in Normal Individuals

  • 1Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea.
  • 2Department of Physical Medicine and Rehabilitation, Seoul National University College of Medicine, Seoul, Korea.


To identify the differences in the movement of the hyoid bone and the vocal cord with and without electrical stimulation in normal subjects.
Two-dimensional motion analysis using a videofluoroscopic swallowing study with and without electrical stimulation was performed. Surface electrical stimulation was applied during swallowing using electrodes placed at three different locations on each subject. All subjects were analyzed three times using the following electrode placements: with one pair of electrodes on the suprahyoid muscles and a second pair on the infrahyoid muscles (SI); with placement of the electrode pairs on only the infrahyoid muscles (IO); and with the electrode pairs placed vertically on the suprahyoid and infrahyoid muscles (SIV).
The main outcomes of this study demonstrated an initial downward displacement as well as different movements of the hyoid bone with the three electrode placements used for electrical stimulation. The initial positions of the hyoid bone with the SI and IO placements resulted in an inferior and anterior displaced position. During swallowing, the hyoid bone moved in a more superior and less anterior direction, resulting in almost the same peak position compared with no electrical stimulation.
These results demonstrate that electrical stimulation caused an initial depression of the hyoid bone, which had nearly the same peak position during swallowing. Electrical stimulation during swallowing was not dependent on the position of the electrode on the neck, such as on the infrahyoid or on both the suprahyoid and infrahyoid muscles.


Dysphagia; Deglutition; Neck muscles; Hyoid bone

MeSH Terms

Deglutition Disorders
Electric Stimulation*
Hyoid Bone
Neck Muscles
Vocal Cords


  • Fig. 1 Different placements of the surface electrodes. (A) Placement I has two pairs of surface electrodes attached to the suprahyoid and infrahyoid muscles. (B) Placement II has two pairs of electrodes attached to only the infrahyoid muscles. (C) In placement III, the suprahyoid and infrahyoid muscles receive electrical stimulation from vertically positioned surface electrodes (the hyoid bone is indicated by a line, and the surface electrodes are indicated by circles).

  • Fig. 2 The coordinate axes were determined as follows. The zero point was defined as the anterior-inferior margin of the fourth cervical vertebral body. The vertical axis was defined as the straight line connecting the zero point with the anterior-inferior margin of the second cervical vertebral body. The horizontal axis was the axis perpendicular to the vertical axis at the zero point. The movements of the hyoid bone (arrow) and vocal cord (arrow head) were analyzed using these coordinate axes. A, the zero point; B, the anterior-inferior margin of the second cervical vertebral body.

  • Fig. 3 The schematic depiction of the initial points, peak points and the movements of the hyoid bone according to the different placement patterns for the surface electrodes. (A) Placement I involves two pairs of surface electrodes attached on the suprahyoid and infrahyoid muscles. (B) Placement II involves two pairs of electrodes attached on only the infrahyoid muscles. (C) In placement III, the suprahyoid and infrahyoid muscles receive electrical stimulation from vertically positioned surface electrodes.

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Ann Rehabil Med. 2016;40(5):878-884.    doi: 10.5535/arm.2016.40.5.878.


1. Ashford J, McCabe D, Wheeler-Hegland K, Frymark T, Mullen R, Musson N, et al. Evidence-based systematic review: oropharyngeal dysphagia behavioral treatments. Part III: impact of dysphagia treatments on populations with neurological disorders. J Rehabil Res Dev. 2009; 46:195–204. PMID: 19533533.
2. Park CL, O'Neill PA, Martin DF. A pilot exploratory study of oral electrical stimulation on swallow function following stroke: an innovative technique. Dysphagia. 1997; 12:161–166. PMID: 9190102.
3. Clark H, Lazarus C, Arvedson J, Schooling T, Frymark T. Evidence-based systematic review: effects of neuromuscular electrical stimulation on swallowing and neural activation. Am J Speech Lang Pathol. 2009; 18:361–375. PMID: 19726568.
4. Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respir Care. 2001; 46:466–474. PMID: 11309186.
5. Steele CM, Thrasher AT, Popovic MR. Electric stimulation approaches to the restoration and rehabilitation of swallowing: a review. Neurol Res. 2007; 29:9–15. PMID: 17427268.
6. Blumenfeld L, Hahn Y, Lepage A, Leonard R, Belafsky PC. Transcutaneous electrical stimulation versus traditional dysphagia therapy: a nonconcurrent cohort study. Otolaryngol Head Neck Surg. 2006; 135:754–757. PMID: 17071307.
7. Kiger M, Brown CS, Watkins L. Dysphagia management: an analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy. Dysphagia. 2006; 21:243–253. PMID: 17216386.
8. Ludlow CL. Electrical neuromuscular stimulation in dysphagia: current status. Curr Opin Otolaryngol Head Neck Surg. 2010; 18:159–164. PMID: 20463480.
9. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008; 19:691–707. PMID: 18940636.
10. Leelamanit V, Limsakul C, Geater A. Synchronized electrical stimulation in treating pharyngeal dysphagia. Laryngoscope. 2002; 112:2204–2210. PMID: 12461342.
11. Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Crujido L, Wright-Harp W, et al. The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol (1985). 2006; 101:1657–1663. PMID: 16873602.
12. Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L. Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia. 2007; 22:1–10. PMID: 16718620.
13. Park JW, Kim Y, Oh JC, Lee HJ. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia. 2012; 27:521–527. PMID: 22447240.
14. Leigh JH, Oh BM, Seo HG, Lee GJ, Min Y, Kim K, et al. Influence of the chin-down and chin-tuck maneuver on the swallowing kinematics of healthy adults. Dysphagia. 2015; 30:89–98. PMID: 25358491.
15. Pearson WG Jr, Langmore SE, Zumwalt AC. Evaluating the structural properties of suprahyoid muscles and their potential for moving the hyoid. Dysphagia. 2011; 26:345–351. PMID: 21069388.
16. Park JW, Oh JC, Lee HJ, Park SJ, Yoon TS, Kwon BS. Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing. Dysphagia. 2009; 24:296–301. PMID: 19255707.
17. Nam HS, Beom J, Oh BM, Han TR. Kinematic effects of hyolaryngeal electrical stimulation therapy on hyoid excursion and laryngeal elevation. Dysphagia. 2013; 28:548–556. PMID: 23605128.
18. Berretin-Felix G, Sia I, Barikroo A, Carnaby GD, Crary MA. Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults. Gerodontology. 2014; 11. 12. [Epub]. DOI: 10.1111/ger.12166.
19. Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA, Kahrilas PJ, Smith CH. Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res. 2000; 43:1264–1274. PMID: 11063246.
20. Lundy DS, Smith C, Colangelo L, Sullivan PA, Logemann JA, Lazarus CL, et al. Aspiration: cause and implications. Otolaryngol Head Neck Surg. 1999; 120:474–478. PMID: 10187936.
21. Jung SH, Lee KJ, Hong JB, Han TR. Validation of clinical dysphagia scale: based on videofluoroscopic swallowing study. J Korean Acad Rehabil Med. 2005; 29:343–350.
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