, Volume 21, Issue 1, pp 49–55 | Cite as

Evaluating Oral Stimulation as a Treatment for Dysphagia after Stroke

  • Maxine L. Power
  • Christopher H. Fraser
  • Anthony Hobson
  • Salil Singh
  • Pippa Tyrrell
  • David A. Nicholson
  • Ian Turnbull
  • David G. Thompson
  • Shaheen Hamdy


Deglutitive aspiration is common after stroke and can have devastating consequences. While the application of oral sensory stimulation as a treatment for dysphagia remains controversial, data from our laboratory have suggested that it may increase corticobulbar excitability, which in previous work was correlated with swallowing recovery after stroke. Our study assessed the effects of oral stimulation at the faucial pillar on measures of swallowing and aspiration in patients with dysphagic stroke. Swallowing was assessed before and 60 min after 0.2-Hz electrical or sham stimulation in 16 stroke patients (12 male, mean age = 73 ± 12 years). Swallowing measures included laryngeal closure (initiation and duration) and pharyngeal transit time, taken from digitally acquired videofluoroscopy. Aspiration severity was assessed using a validated penetration-aspiration scale. Preintervention, the initiation of laryngeal closure, was delayed in both groups, occurring 0.66 ± 0.17 s after the bolus arrived at the hypopharynx. The larynx was closed for 0.79 ± 0.07 s and pharyngeal transit time was 0.94 ± 0.06 s. Baseline swallowing measures and aspiration severity were similar between groups (stimulation: 24.9 ± 3.01; sham: 24.9 ± 3.3, p = 0.2). Compared with baseline, no change was observed in the speed of laryngeal elevation, pharyngeal transit time, or aspiration severity within subjects or between groups for either active or sham stimulation. Our study found no evidence for functional change in swallow physiology after faucial pillar stimulation in dysphagic stroke. Therefore, with the parameters used in this study, oral stimulation does not offer an effective treatment for poststroke patients.


Aspiration Deglutition disorders Stroke Treatment Deglutition 



The authors thank Ms. L. Renaut (radiography department) and Dr. A. Vail (statistician) for their invaluable assistance. Maxine Power was an MRC (UK) Clinical Training Fellow and Shaheen Hamdy is an MRC (UK) Clinician Scientist. Salil Singh is a Research Fellow funded by the Health Foundation.


  1. 1.
    Doty RW: Neural organisation of deglutition. Handb Physiol 4:1861–1902, 1968Google Scholar
  2. 2.
    Mann G: Review of reports on relative prevalence of swallowing disorders after acute stroke (Dysphagia 16:141–142, 2001). Dysphagia 17(1):81–82, 2002Google Scholar
  3. 3.
    Wolfe CDA: The impact of stroke. Br Med Bull 56:275–286, 2000PubMedCrossRefGoogle Scholar
  4. 4.
    Schmidt J, Holas M, Halvorson K, Reding M: Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia 9(1):7–11, 1994PubMedCrossRefGoogle Scholar
  5. 5.
    Smithard DG, O’Neill PA, England RE, Park CL, Wyatt R, Martin DF, et al.: The natural history of dysphagia following a stroke. Dysphagia 12(4):188–193, 1997PubMedCrossRefGoogle Scholar
  6. 6.
    Logemann JA: Evaluation and treatment of swallowing disorders. San Diego, CA: C.H. Press, 1983Google Scholar
  7. 7.
    Lazzara G, Lazarus K, Logemann JA: Impact of thermal stimulation on the triggering of the swallow reflex. Dysphagia 1:73–77, 1986CrossRefGoogle Scholar
  8. 8.
    Rosenbek JC, Robbins J, Willford WO, Kirk G, Schiltz A, Sowell TW, et al.: Comparing treatment intensities of tactile-thermal application. Dysphagia 13(1):1–9, 1998PubMedCrossRefGoogle Scholar
  9. 9.
    Fraser C, Power M, Hamdy S, Rothwell J, Hobday D, Hollander I, et al.: Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury. Neuron 34(5):831–840, 2002PubMedCrossRefGoogle Scholar
  10. 10.
    Power M, Fraser C, Hobson A, Rothwell J, Mistry S, Nicholson DA, et al.: Changes in pharyngeal corticobulbar excitability and swallowing behaviour after oral stimulation. Am J Physiol 286(1):G45–G50, 2004Google Scholar
  11. 11.
    Medical Research Council: Aids to the examination of the peripheral nervous system. London: Pendragon House, 1976, pp 6–7Google Scholar
  12. 12.
    Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, et al.: Use of the Alberta Stroke Program early CT score (aspects) for assessing CT scans in patients with acute stroke. Am J Neuroradiol 22(8):1534–1542, 2001PubMedGoogle Scholar
  13. 13.
    Logemann JA: Manual for the videofluorographic study of swallowing, 2nd ed. Austin, TX: Pro-Ed, 1993Google Scholar
  14. 14.
    Rosenbek JC, Robbins J, Roecker EB, Coyle MA, Wood JL: A penetration-aspiration scale. Dysphagia 11:93–98, 1996PubMedCrossRefGoogle Scholar
  15. 15.
    Kahrilas PJ, Lin S, Rademaker AW, Logemann JA: Impaired deglutitive airway protection: A videofluoroscopic analysis of severity and mechanism. Gastroenterology 113(5):1457–1464, 1997PubMedCrossRefGoogle Scholar
  16. 16.
    Cook IJ, Kahrilas PJ: AGA technical review on management of oropharyngeal dysphagia. Gastroenterology 116(2):455–478, 1999PubMedCrossRefGoogle Scholar
  17. 17.
    Rosenbek JC, Roecker EB, Wood JL, Robbins J: Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia 11(4):225–233, 1996PubMedCrossRefGoogle Scholar
  18. 18.
    Parker C, Power M, Hamdy S, Bowen A, Tyrrell P, Thompson DG: Awareness of dysphagia by patients following stroke predicts swallowing performance. Dysphagia 19(1):28–35, 2004PubMedCrossRefGoogle Scholar
  19. 19.
    Pommerenke WT: A study of the sensory areas eliciting the swallowing reflex. Am J Physiol 84(1):36–41, 1927Google Scholar
  20. 20.
    Ali GN, Laundl TM, Wallace KL, deCarle DJ, Cook IJ: Influence of cold stimulation on the normal pharyngeal swallow response. Dysphagia 11(1):2–8, 1996PubMedCrossRefGoogle Scholar
  21. 21.
    Ali GN, Laundl TM, Wallace KL, Shaw DW, Decarle DJ, Cook IJ: Influence of mucosal receptors on deglutitive regulation of pharyngeal and upper esophageal sphincter function. Am J Physiol 267(4 Pt 1):G644–G649, 1994PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Maxine L. Power
    • 1
    • 5
  • Christopher H. Fraser
    • 2
  • Anthony Hobson
    • 2
  • Salil Singh
    • 2
  • Pippa Tyrrell
    • 3
  • David A. Nicholson
    • 4
  • Ian Turnbull
    • 4
  • David G. Thompson
    • 2
  • Shaheen Hamdy
    • 2
  1. 1.Department of Rehabilitation and Human Performance ResearchUniversity of SalfordSalfordUnited Kingdom
  2. 2.Department of Gastrointestinal ScienceUniversity of ManchesterManchesterUnited Kingdom
  3. 3.Department of Stroke MedicineUniversity of ManchesterManchesterUnited Kingdom
  4. 4.Department of RadiologyUniversity of ManchesterManchesterUnited Kingdom
  5. 5.Department of Stroke MedicineClinical Sciences Building, Hope HospitalSalfordUnited Kingdom

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