Sensory Transcutaneous Electrical Stimulation Improves Post-Stroke Dysphagic Patients

Abstract

Oropharyngeal dysphagia is frequent in stroke patients and increases mortality, mainly because of pulmonary complications. We hypothesized that sensitive transcutaneous electrical stimulation applied submentally during swallowing could help rehabilitate post-stroke oropharyngeal dysphagia by improving cortical sensory motor circuits. Eleven patients were recruited for the study (5 females, 68 ± 11 years). They all suffered from recent oropharyngeal dysphagia (>eight weeks) induced by a hemispheric (n = 7) or brainstem (n = 4) stroke, with pharyngeal residue and/or laryngeal aspiration diagnosed by videofluoroscopy. Submental electrical stimulations were performed for 1 h every day for 5 days (electrical trains: 5 s every minute, 80 Hz, under motor threshold). During the electrical stimulations, the patients were asked to swallow one teaspoon of paste or liquid. Swallowing was evaluated before and after the week of stimulations using a dysphagia handicap index questionnaire, videofluoroscopy, and cortical mapping of pharyngeal muscles. The results of the questionnaire showed that oropharyngeal dysphagia symptoms had improved (p < 0.05), while the videofluoroscopy measurements showed that laryngeal aspiration (p < 0.05) and pharyngeal residue (p < 0.05) had decreased and that swallowing reaction time (p < 0.05) had improved. In addition, oropharyngeal transit time, pharyngeal transit time, laryngeal closure duration, and cortical pharyngeal muscle mapping after the task had not changed. These results indicated that sensitive submental electrical stimulations during swallowing tasks could help to rehabilitate post-stroke swallowing dysphagia by improving swallowing coordination. Plasticity of the sensory swallowing cortex is suspected.

O efeito da eletroestimulação neuromuscular na contração da musculatura supra-hióidea durante a deglutição de indivíduos com disfagia

“…While some studies 1,3,[8][9][10][11][12][13][14][15][16] show benefits in the pathophysiology of swallowing in patients with oropharyngeal dysphagia submitted to NMES, others [5][6][7] report the absence of physiological and functional changes resulting from these stimuli. It must be said that even the publications that demonstrate positive results present questionable methodological designs in scientific relevance.…”

“…The scientific literature about the therapeutic effectiveness of NMES in dysphagia is still controversial, lying since studies [5][6][7] that does not correlate improvement of biomechanic of swallowing as a result of its use, as well as studies that verified this biomechanic optimization and, consequently of dysphagia 1,3,[8][9][10][11][12][13][14][15][16] .…”

Disfagia orofaríngea neurogênica: análise de protocolos de videofluoroscopia brasileiros e norte-americanos

“…To identify stroke patients who are at increased risk of aspiration Based on the findings of videofluoroscopy, 33 patients (34%) were at high risk of aspiration and (66%) were nonaspirators Sensory transcutaneous electrical stimulation improves post-stroke dysphagic patients Gallas et al (21) 2010…”

“…The instruments used for offering the bolus is another important aspect of methodology, once tools may change the dynamics of capture of the bolus. The syringe, despite uncommon for feeding, becomes interesting for standardization and for greater control over the bolus offered 14,16,20,21,26,30 .…”

Eficácia da eletroestimulação muscular expiratória na tosse de pacientes após acidente vascular encefálico

“…Sabe-se que o treino de força no músculo reto abdominal através de dispositivos de expiração forçada, melhora o recrutamento de fibras, e consequentemente a tosse, mas existe uma série de condições clínicas e limitações que contraindica o uso destes para essa finalidade [16][17][18][19] . Além disso, já existem evidências que a eletroestimulação transcutânea em musculatura respiratória tem bons efeitos em pacientes crônicos, inclusive neurológicos, em quadros de atrofia muscular [20][21][22][23][24][25] . A aplicação da corrente Russa é feita com eletrodos de superfície na musculatura esquelética para fornecimento de corrente elétrica gerada por um estimulador que despolariza o neurônio motor e induz contrações musculares involuntárias, e já existem evidências científicas sobre sua aplicabilidade clínica [26][27][28] .…”