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The Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Post-stroke Dysphagia: A Randomized Controlled Trial

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Abstract

The study aimed to evaluate the effects of traditional dysphagia therapy (TDT) and neuromuscular electrical stimulation (NMES) combined with TDT on functionality of oral intake, dysphagia symptom severity, swallowing- and voice-related quality of life, leakage, penetration–aspiration, and residue levels in patients with post-stroke dysphagia (PSD). Thirty-four patients with PSD were included in our prospective, randomized, controlled, and single-blind study. The patients were divided into two groups: (1) TDT only (control group, n = 17) and (2) TDT with NMES (experimental group, n = 17). TDT was applied to both groups for three consecutive weeks, 5 days a week, 45 min a day. Sensory NMES was applied to the experimental group for 45 min per session. Patients were evaluated by the functional oral intake scale (FOIS), the eating assessment tool (EAT-10), the swallowing quality of life questionnaire (SWAL-QOL), and the voice-related quality of life questionnaire (VRQOL) at baseline, immediately post-intervention, and at the 3rd month post-intervention. Fiberoptic endoscopic evaluation of swallowing (FEES) with liquid and semi-solid food was performed pre- and post-intervention. A significant post-intervention improvement was observed on all scales in both groups, and these improvements were maintained 3 months post-intervention. Leakage and penetration–aspiration levels with semi-solid food declined only in the experimental group. In conclusion, TDT is a non-invasive and inexpensive method that leads to improvement in many swallowing-related features in stroke patients; however, NMES as an adjunct therapy is costly but can provide additional benefits for improving features, such as penetration–aspiration and residue levels.

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Acknowledgements

The authors would like to thank clinical pharmacist Metin Sinan Elmalioglu for his assistance in editing the English version of this article and Rana Konyalioglu for her contributions in statistical evaluations. The authors are also grateful to Istanbul University Scientific Research Projects Coordination Unit for funding the study (Project Number 37068).

Funding

This study was funded by Istanbul University Scientific Research Projects Coordination Unit (Project Number 37068).

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Elif Tarihci Cakmak, Ekin Ilke Sen, Selim Sezikli & Ayse Yaliman

  2. Department of Otorhinolaryngology - Head and Neck Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Can Doruk & Comert Sen

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Tarihci Cakmak, E., Sen, E.I., Doruk, C. et al. The Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Post-stroke Dysphagia: A Randomized Controlled Trial. Dysphagia 38, 874–885 (2023). https://doi.org/10.1007/s00455-022-10512-7

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