Ann Rehabil Med.  2014 Apr;38(2):153-159.

The Effect of Early Neuromuscular Electrical Stimulation Therapy in Acute/Subacute Ischemic Stroke Patients With Dysphagia

• Lee KW
• Kim SB
• Lee JH
• Lee SJ
• Ri JW
• Park JG

Abstract

OBJECTIVE
To compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS).
METHODS
Fifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one patients received NMES combined with TDT (NMES/TDT group) and 26 patients received TDT only (TDT group). Electrical stimulation with a maximal tolerable intensity was applied on both suprahyoid muscles for 30 minutes, 5 days per week during 3 weeks. The swallowing function was evaluated at baseline and 3, 6, and 12 weeks after baseline. Outcomes of the VFSS were assessed using the Functional Oral Intake Scale (FOIS).
RESULTS
The mean ages were 63.5+/-11.4 years in the NMES/TDT group and 66.7+/-9.5 years in the TDT group. Both groups showed a significant improvement on the FOIS after treatment. The FOIS score was significantly more improved at 3 and 6 weeks after baseline in the NMES/TDT group than in the TDT group (p<0.05).
CONCLUSION
An early application of NMES combined with TDT showed a positive effect in acute/subacute ischemic stroke patients with dysphagia. These results indicated that the early application of NMES could be used as a supplementary treatment of TDT to help rehabilitate acute/subacute dysphagic stroke patients by improving their swallowing coordination.

Keyword

Dysphagia; Acute stroke; Neuromuscular electrical stimulation

MeSH Terms

Deglutition
Deglutition Disorders*
Electric Stimulation
Electric Stimulation Therapy*
Humans
Muscles
Stroke*

Figure

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  Fig. 1 Flow chart of patient group assignment and treatment. NMES, neuromuscular electrical stimulation; TDT, traditional dysphagia therapy.

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  Fig. 2 The change of FOIS in both groups. FOIS significantly increased in NMES/TDT group compare with TDT group at 3 weeks, 6 weeks, and 12 weeks. FOIS, Functional Oral Intake Scale; NMES/TDT group: patients treated by neuromuscular electrical stimulation combined with traditional dysphagia therapy; TDT group, patients treated by traditional dysphagia therapy only. *p<0.05 (independent sample t-test).

Reference

1. Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL. Aspiration in patients with acute stroke. Arch Phys Med Rehabil. 1998; 79:14–19. PMID: 9440410.

2. Roth EJ, Lovell L, Harvey RL, Heinemann AW, Semik P, Diaz S. Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke. 2001; 32:523–529. PMID: 11157192.

3. Horner J, Massey EW. Silent aspiration following stroke. Neurology. 1988; 38:317–319. PMID: 3340301.

4. Teasell RW, Bach D, McRae M. Prevalence and recovery of aspiration poststroke: a retrospective analysis. Dysphagia. 1994; 9:35–39. PMID: 8131423.

5. Dziewas R, Ritter M, Schilling M, Konrad C, Oelenberg S, Nabavi DG, et al. Pneumonia in acute stroke patients fed by nasogastric tube. J Neurol Neurosurg Psychiatry. 2004; 75:852–856. PMID: 15145999.

6. Logemann JA. Update on clinical trials in dysphagia. Dysphagia. 2006; 21:116–120. PMID: 16685468.

7. Sun SF, Hsu CW, Lin HS, Sun HP, Chang PH, Hsieh WL, et al. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia. Dysphagia. 2013; 28:557–566. PMID: 23584790.

8. Crary MA, Carnaby-Mann GD, Faunce A. Electrical stimulation therapy for dysphagia: descriptive results of two surveys. Dysphagia. 2007; 22:165–173. PMID: 17318684.

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

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

11. Kushner DS, Peters K, Eroglu ST, Perless-Carroll M, Johnson-Greene D. Neuromuscular electrical stimulation efficacy in acute stroke feeding tube-dependent dysphagia during inpatient rehabilitation. Am J Phys Med Rehabil. 2013; 92:486–495. PMID: 23478451.

12. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005; 86:1516–1520. PMID: 16084801.

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

14. 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.

15. 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.

16. Gallas S, Marie JP, Leroi AM, Verin E. Sensory transcutaneous electrical stimulation improves post-stroke dysphagic patients. Dysphagia. 2010; 25:291–297. PMID: 19856025.

17. 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.

18. Verin E, Maltete D, Ouahchi Y, Marie JP, Hannequin D, Massardier EG, et al. Submental sensitive transcutaneous electrical stimulation (SSTES) at home in neurogenic oropharyngeal dysphagia: a pilot study. Ann Phys Rehabil Med. 2011; 54:366–375. PMID: 21889432.

19. Smithard DG, O'Neill PA, Martin DF, England R. Aspiration following stroke: is it related to the side of the stroke? Clin Rehabil. 1997; 11:73–76. PMID: 9065363.

20. Schroeder MF, Daniels SK, McClain M, Corey DM, Foundas AL. Clinical and cognitive predictors of swallowing recovery in stroke. J Rehabil Res Dev. 2006; 43:301–310. PMID: 17041816.

21. Kumar S, Langmore S, Goddeau RP Jr, Alhazzani A, Selim M, Caplan LR, et al. Predictors of percutaneous endoscopic gastrostomy tube placement in patients with severe dysphagia from an acute-subacute hemispheric infarction. J Stroke Cerebrovasc Dis. 2012; 21:114–120. PMID: 20851628.

22. Ickenstein GW, Hohlig C, Prosiegel M, Koch H, Dziewas R, Bodechtel U, et al. Prediction of outcome in neurogenic oropharyngeal dysphagia within 72 hours of acute stroke. J Stroke Cerebrovasc Dis. 2012; 21:569–576. PMID: 21683618.

23. Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J. 2006; 82:383–391. PMID: 16754707.

24. Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil. 1995; 76:1130–1133. PMID: 8540789.

25. Shaw GY, Sechtem PR, Searl J, Keller K, Rawi TA, Dowdy E. Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality? Ann Otol Rhinol Laryngol. 2007; 116:36–44. PMID: 17305276.