Effects of Neuromuscular Electrical Stimulation (NMES) Plus Upper Cervical Spine Mobilization on Forward Head Posture and Swallowing Function in Stroke Patients with Dysphagia

Abstract

After a stroke, forward head posture occurs, resulting in swallowing dysfunction. Neuromuscular electrical stimulation (NMES) combined with upper cervical spine mobilization has demonstrated enhanced recovery of the swallowing function in stroke patients. This study investigated the therapeutic effects of NMES in conjunction with upper cervical mobilization in stroke patients with dysphagia. Thirty-four stroke patients were recruited (in a randomized controlled clinical trial) and divided into an experimental group (n = 17; NMES plus upper cervical spine mobilization) and a control group (n = 17; NMES plus sham mobilization). Forward head posture was measured by craniocervical flexion test (CCFT) and craniovertebral angle (CVA). Swallowing function was measured by variations in video fluoroscopic dysphagia scale (VDS) and penetration–aspiration scale (PAS) scores using the video fluoroscopic swallowing study (VFSS). All measurements were done at baseline and after four weeks of NMES plus mobilization. A significant increase was observed in CCFT, CVA, VDS (total VDS score, oral stage score, pharyngeal stage score), and PAS score in all variations in the experimental group. The CCFT, CVA, pharyngeal stage score, total VDS, and PAS score were significantly higher in the experimental group when compared to the control group. NMES plus upper cervical spine mobilization can be regarded as a promising method to improve swallowing function and forward head posture changes in stroke patients with dysphagia.

Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

“…bilitative interventions, combined compensatory and rehabilitative interventions, and no dysphagia intervention. Seventeen studies were excluded from meta-analyses: one study included patients with self-reported swallowing difficulties without confirmed OD diagnosis by instrumental assessment (VFSS or FEES) [48], four studies did not report on instrumental or clinical non-instrumental outcome data [20,28,37,40], ten studies provided insufficient data for meta-analysis [21,24,27,34,38,39,48,51,56,57], and two studies were excluded to reduce heterogeneity between studies [32,53].…”

Effects of Cervical Mobilization on Balance and Gait Parameters in Individuals With Stroke: A Randomized Controlled Trial

“…We used G*Power 3.19 (Heinrich Heine University, Dusseldorf, Germany) for sample size calculations (Faul et al, 2009). Prior to commencing the investigation, we attempted to determine the sample size using the CVA (◦) average findings from the Jeon et al (2020) study. We calculated the total estimated required sample size for sufficient statistical power to be 20 (10 in the EG group, 10 in the control group), based on an assumed effect size of 1.443 (Jeon et al, 2020), statistical power of .80, and error probability of .05.…”

“…Prior to commencing the investigation, we attempted to determine the sample size using the CVA (•) average findings from the Jeon et al ( 2020) study. We calculated the total estimated required sample size for sufficient statistical power to be 20 (10 in the EG group, 10 in the control group), based on an assumed effect size of 1.443 (Jeon et al, 2020), statistical power of .80, and error probability of .05. We recruited a conveninence sample of 24 volunteers with a history of stroke who were receiving follow-up care in the Department of Neurological Rehabilitation at Pamukkale University, Denizli/Türkiye.…”

The Effect of Sling-Based Manual Therapy and Stabilization Exercise for Improving Cervical Alignment and Mobility in Individual With Forward Head Posture

“…The mobilization of the spinal joint, also known as the passive movement of the joint, is used to get the joint into the proper position with proper alignment and to increase the range of motion. Joint mobilization has the effect of inducing a reflex by stimulating articular receptors 17 . Meanwhile, the stabilization exercise provided stretching of the tight muscles and increasing the strength of weakened muscles so that the scapula muscles can be brought closer to the normal position 18 .…”