Effect of Laryngopharyngeal Neuromuscular Electrical Stimulation on Dysphonia Accompanied by Dysphagia in Post-stroke and Traumatic Brain Injury Patients: A Pilot Study

Abstract

ObjectiveTo investigate the effect of laryngopharyngeal neuromuscular electrical stimulation (NMES) on dysphonia in patients with dysphagia caused by stroke or traumatic brain injury (TBI).MethodsEighteen patients participated in this study. The subjects were divided into NMES (n=12) and conventional swallowing training only (CST, n=6) groups. The NMES group received NMES combined with CST for 2 weeks, followed by CST without NMES for the next 2 weeks. The CST group received only CST for 4 weeks. All of the patients were evaluated before and at 2 and 4 weeks into the study. The outcome measurements included perceptual, acoustic and aerodynamic analyses. The correlation between dysphonia and swallowing function was also investigated.ResultsThere were significant differences in the GRBAS (grade, roughness, breathiness, asthenia and strain scale) total score and sound pressure level (SPL) between the two groups over time. The NMES relative to the CST group showed significant improvements in total GRBAS score and SPL at 2 weeks, though no inter-group differences were evident at 4 weeks. The improvement of the total GRBAS scores at 2 weeks was positively correlated with the improved pharyngeal phase scores on the functional dysphagia scale at 2 weeks.ConclusionThe results demonstrate that laryngopharyngeal NMES in post-stroke or TBI patients with dysphonia can have promising effects on phonation. Therefore, laryngopharyngeal NMES may be considered as an additional treatment option for dysphonia accompanied by dysphagia after stroke or TBI.

Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria – a prospective randomized trial

“…[ 14 – 16 ] Dysarthria (including wet voice) and dysphagia have similar pathogeneses in stroke patients, especially those related to the laryngopharyngeal functions. [ 17 ] The acoustic change in phonation following a swallow is a high-risk indicator of fluid aspiration. [ 18 ] Moreover, the subglottal pressure initiates and maintains the vocal fold vibration that facilitates voice production.…”

European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

“…Based on the same search as mentioned above (see 4a), 35 RCTs 173, 281-314 and 6 NRCT [315][316][317][318][319][320] were included in the meta-analysis (Table 15, supplement 11). All trials reported data on swallowing performance using a variety of different scales and nearly all trials used a local…”

“…In addition, in some studies, a three-arm design was adopted, where either two different interventions were compared against a sham condition or a combination of treatments were studied against each single intervention. To account for these differences in trial design, the WG formulated two PICO questions: Based on the same search as mentioned above (see 4a), 35 RCTs 173, 281-314 and 6 NRCT [315][316][317][318][319][320] were included in the meta-analysis (Table 15, supplement 11). All trials reported data on swallowing performance using a variety of different scales and nearly all trials used a local The number of trials included into the different meta-analyses pertinent to this topic is, in part, quite high and most results of single trials have a similar trend which in most cases is also in line with results from non-randomized trials.…”

“…Based on the same search as mentioned above (see Dietary Interventions), 35 RCTs 173,281-314 and 6 NRCT [315][316][317][318][319][320] were included in the meta-analysis (Supplement 1, Table 15). All trials reported data on swallowing performance using a variety of different scales and nearly all trials used a local standard of care, mostly consisting of different behavioural swallow interventions as control.…”

Effects of Synchronized Neuromuscular Electrical Stimulation (NMES) on the Submental Muscles During Ingestion of a Specified Volume of Soft Food in Patients with Mild-to-Moderate Dysphagia Following Stroke

“…NMES is a non-behavioral therapy for dysphagia and the frequency range for the systems is 10 to 50 Hz, which induces muscle contraction or simulates normal autonomic movement through excitatory contraction to improve or restore the function of stimulated muscles or muscle groups [ 16 ]. A number of studies have confirmed that NMES treatment improves the degree of laryngeal elevation and of openness and coordination of the pharyngeal muscles, reduces aspiration, and improves swallowing function [ 32 – 36 ]. In addition to the kinesthetic response, the frequency can induce sensory stimulation below the electrodes, triggering reflexes in the pharynx, trigeminal, and vagal nerves, among others, which send sensory feedback to the central pattern generator (CPG) and the cortex and subcortical center.…”