Ann Rehabil Med.  2011 Jun;35(3):322-327. 10.5535/arm.2011.35.3.322.

Electrical Stimulation of the Suprahyoid Muscles in Brain-injured Patients with Dysphagia: A Pilot Study

• Beom J
• Kim SJ
• Han TR

• KMID: 2266850
• DOI: http://doi.org/10.5535/arm.2011.35.3.322

Abstract

OBJECTIVE
To investigate the therapeutic effects of repetitive electrical stimulation of the suprahyoid muscles in brain-injured patients with dysphagia. METHOD: Twenty-eight brain-injured patients who showed reduced laryngeal elevation and supraglottic penetration or subglottic aspiration during a videofluoroscopic swallowing study (VFSS) were selected. The patients received either conventional dysphagia management (CDM) or CDM with repetitive electrical stimulation of the suprahyoid muscles (ESSM) for 4 weeks. The videofluoroscopic dysphagia scale (VDS) using the VFSS and American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing scale (ASHA level) was used to determine swallowing function before and after treatment.
RESULTS
VDS scores decreased from 29.8 to 17.9 in the ESSM group, and from 29.2 to 16.6 in the CDM group. However, there was no significant difference between the groups (p=0.796). Six patients (85.7%) in the ESSM group and 14 patients (66.7%) in the CDM group showed improvement according to the ASHA level with no significant difference between the ESSM and CDM groups (p=0.633).
CONCLUSION
Although repetitive neuromuscular electrical stimulation of the suprahyoid muscles did not further improve the swallowing function of dysphagia patients with reduced laryngeal elevation, more patients in the ESSM group showed improvement in the ASHA level than those in the CDM group. Further studies with concurrent controls and a larger sample group are required to fully establish the effects of repetitive neuromuscular electrical stimulation of the suprahyoid muscles in dysphagia patients.

Keyword

Electrical stimulation; Brain; Dysphagia; Swallowing

MeSH Terms

American Speech-Language-Hearing Association
Brain
Deglutition
Deglutition Disorders
Electric Stimulation
Humans
Muscles
Pilot Projects

Figure

• 

  Fig. 1 Location of electrodes during electrical stimulation of the suprahyoid muscles.

• 

  Fig. 2 VDS and ASHA levels in all patients before and after treatment. (A) VDS in the ESSM group. (B) VDS in the CDM group. (C) Comparison of △VDS between the ESSM and CDM groups. (D) ASHA level in the ESSM group. (E) ASHA level in the CDM group. (F) Comparison of △ASHA level between the ESSM and CDM groups. N.S.: Not significant.

Reference

1. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005; 36:2756–2763. PMID: 16269630.

2. Burnett TA, Mann EA, Cornell SA, Ludlow CL. Laryngeal elevation achieved by neuromuscular stimulation at rest. J Appl Physiol. 2003; 94:128–134. PMID: 12486019.

3. Leelamanit V, Limsakul C, Geater A. Synchronized electrical stimulation in treating pharyngeal dysphagia. Laryngoscope. 2002; 112:2204–2210. PMID: 12461342.

4. Kim DY, Koh ES, Kang BS, Han TR, Lee SU. Effects of electrical stimulation for dysphagia caused by stroke. J Korean Acad Rehabil Med. 2008; 32:9–14.

5. 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.

6. Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Crujido L, Wright-Harp W, Payne J, Jeffries N, Sonies BC, Ludlow CL. The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol. 2006; 101:1657–1663. PMID: 16873602.

7. Kim SJ, Han TR. Effect of surface electrical stimulation of suprahyoid muscles on hyolaryngeal movement. Neuromodulation. 2009; 12:134–140. PMID: 22151287.

8. Wijting Y, Freed M. VitalStim therapy training manual. 2004. 1st ed. Hixson: Chattanooga group;p. 108–109.

9. Han TR, Paik NJ, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001; 82:677–682. PMID: 11346847.

10. Wesling M, Brady S, Jensen M, Nickell M, Statkus D, Escobar N. Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation. Dysphagia. 2003; 18:203–210. PMID: 14506986.

11. Han TR, Paik NJ, Park JW, Kwon BS. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008; 23:59–64. PMID: 17602263.

12. Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respir Care. 2001; 46:466–474. PMID: 11309186.

13. Huckabee ML, Doeltgen S. Emerging modalities in dysphagia rehabilitation: neuromuscular electrical stimulation. N Z Med J. 2007; 120:U2744. PMID: 17972964.

14. Carnaby-Mann GD, Crary MA. Examining the evidence on neuromuscular electrical stimulation for swallowing: a meta-analysis. Arch Otolaryngol Head Neck Surg. 2007; 133:564–571. PMID: 17576907.

15. 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.

16. Gow D, Hobson AR, Furlong P, Hamdy S. Characterising the central mechanisms of sensory modulation in human swallowing motor cortex. Clin Neurophysiol. 2004; 115:2382–2390. PMID: 15351381.

17. Suiter DM, Leder SB, Ruark JL. Effects of neuromuscular electrical stimulation on submental muscle activity. Dysphagia. 2006; 21:56–60. PMID: 16544086.

18. Power M, Fraser C, Hobson A, Rothwell JC, Mistry S, Nicholson DA, Thompson DG, Hamdy S. Changes in pharyngeal corticobulbar excitability and swallowing behavior after oral stimulation. Am J Physiol Gastrointest Liver Physiol. 2004; 286:G45–G50. PMID: 12946939.