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Combined Neuromuscular Electrical Stimulation (NMES) with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Traditional Swallowing Rehabilitation in the Treatment of Stroke-Related Dysphagia

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Abstract

Dysphagia is common after stroke. Neuromuscular electrical stimulation (NMES) and fiberoptic endoscopic evaluation of swallowing (FEES) for the treatment of dysphagia have gained in popularity, but the combined application of these promising modalities has rarely been studied. We aimed to evaluate whether combined NMES, FEES, and traditional swallowing rehabilitation can improve swallowing functions in stroke patients with moderate to severe dysphagia. Thirty-two patients with moderate to severe dysphagia poststroke (≥3 weeks) were recruited. Patients received 12 sessions of NMES for 1 h/day, 5 days/week within a period of 2–3 weeks. FEES was done before and after NMES for evaluation and to guide dysphagic therapy. All patients subsequently received 12 sessions of traditional swallowing rehabilitation (50 min/day, 3 days/week) for 4 weeks. Primary outcome measure was the Functional Oral Intake Scale (FOIS). Secondary outcome measures included clinical degree of dysphagia, the patient’s self-perception of swallowing ability, and the patient’s global satisfaction with therapy. Patients were assessed at baseline, after NMES, at 6-month follow-up, and at 2-year follow-up. Twenty-nine patients completed the study. FOIS, degree of dysphagia, and patient’s self-perception of swallowing improved significantly after NMES, at the 6-month follow-up, and at the 2-year follow-up (p < 0.001, each compared with baseline). Most patients reported considerable satisfaction with no serious adverse events. Twenty-three of the 29 (79.3 %) patients maintained oral diet with no pulmonary complications at 2-year follow-up. This preliminary case series demonstrated that combined NMES, FEES, and traditional swallowing rehabilitation showed promise for improving swallowing functions in stroke patients with moderate-to-severe dysphagia. The benefits were maintained for up to 2 years. The results are promising enough to justify further studies.

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Acknowledgments

This study was supported by an academic research fund from Kaohsiung Veterans General Hospital (VGHKS96-079). The study is registered in http://www.clinicaltrials.gov (unique identifier: NCT01731847).

Conflict of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st Road, Kaohsiung, 813, Taiwan

    Shu-Fen Sun, Ping-Hsin Chang, Wan-Ling Hsieh & Jue-Long Wang

  2. National Yang-Ming University School of Medicine, Taipei, Taiwan

    Shu-Fen Sun & Chien-Wei Hsu

  3. Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Chien-Wei Hsu

  4. School of Nursing, Fooyin University, Kaohsiung, Taiwan

    Huey-Shyan Lin

  5. Department of General Surgery, Cheng Ching Hospital, Taichung, Taiwan

    Hsien-Pin Sun

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  1. Shu-Fen Sun
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Correspondence to Shu-Fen Sun.

Appendices

Appendix 1

See Table 6.

Table 6 Functional Oral Intake Scale and degree of dysphagia
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Appendix 2

See Table 7.

Table 7 Scores for fiberoptic endoscopic evaluation of swallowing
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Sun, SF., Hsu, CW., Lin, HS. 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 28, 557–566 (2013). https://doi.org/10.1007/s00455-013-9466-9

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  • DOI: https://doi.org/10.1007/s00455-013-9466-9

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