, Volume 27, Issue 4, pp 521–527 | Cite as

Effortful Swallowing Training Combined with Electrical Stimulation in Post-Stroke Dysphagia: A Randomized Controlled Study

  • Jin-Woo Park
  • Youngsun Kim
  • Jong-Chi Oh
  • Ho-Jun Lee
Original Article


We tested the effect of effortful swallow combined with surface electrical stimulation used as a form of resistance training in post-stroke patients with dysphagia. Twenty post-stroke dysphagic patients were randomly divided into two groups: those who underwent effortful swallow with infrahyoid motor electrical stimulation (experimental group, n = 10) and effortful swallow with infrahyoid sensory electrical stimulation (control group, n = 10). In the experimental group, electrical stimulation was applied to the skin above the infrahyoid muscle with the current was adjusted until muscle contraction occurred and the hyoid bone was depressed. In the control group, the stimulation intensity was applied just above the sensory threshold. The patients in both groups were then asked to swallow effortfully in order to elevate their hyolaryngeal complex when the stimulation began. A total of 12 sessions of 20 min of training for 4 weeks were performed. Blinded biomechanical measurements of the extent of hyolaryngeal excursion, the maximal width of the upper esophageal sphincter (UES) opening, and the penetration-aspiration scale before and after training were performed. In the experimental group, the maximal vertical displacement of the larynx was increased significantly after the intervention (p < 0.05). The maximal vertical displacement of the hyoid bone and the maximal width of the UES opening increased but the increase was not found to be significant (p = 0.066). There was no increase in the control group. Effortful swallow training combined with electrical stimulation increased the extent of laryngeal excursion. This intervention can be used as a new treatment method in post-stroke patients with dysphagia.


Dysphagia Deglutition Stroke Treatment Electrical stimulation Deglutition disorder 


Conflict of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Gordon C, Hewer RL, Wade DT. Dysphagia in acute stroke. Br Med J (Clin Res Ed). 1987;295:411–4.CrossRefGoogle Scholar
  2. 2.
    Kidd D, Lawson J, Nesbitt R, MacMahon J. The natural history and clinical consequences of aspiration in acute stroke. QJM. 1995;88:409–13.PubMedGoogle Scholar
  3. 3.
    Smithard DG, O’Neill PA, England RE, Park CL, Wyatt R, Martin DF, Morris J. The natural history of dysphagia following a stroke. Dysphagia. 1997;12:188–93.PubMedCrossRefGoogle Scholar
  4. 4.
    Teasell RW, Bach D, McRae M. Prevalence and recovery of aspiration poststroke: a retrospective analysis. Dysphagia. 1994;9:35–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Park CL, O’Neill PA, Martin DF. A pilot exploratory study of oral electrical stimulation on swallow function following stroke: an innovative technique. Dysphagia. 1997;12:161–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respir Care. 2001;46:466–74.PubMedGoogle Scholar
  7. 7.
    Blumenfeld L, Hahn Y, Lepage A, Leonard R, Belafsky PC. Transcutaneous electrical stimulation versus traditional dysphagia therapy: a nonconcurrent cohort study. Otolaryngol Head Neck Surg. 2006;135:754–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Bulow M, Speyer R, Baijens L, Woisard V, Ekberg O. Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia. 2008;23:302–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Kiger M, Brown CS, Watkins L. Dysphagia management: an analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy. Dysphagia. 2006;21:243–53.PubMedCrossRefGoogle Scholar
  10. 10.
    Shaw GY, Sechtem PR, Searl J, Keller K, Rawi TA, Dowdy E. Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality? Ann Otol Rhinol Laryngol. 2007;116:36–44.PubMedGoogle Scholar
  11. 11.
    Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Crujido L, Wright-Harp W, Payne J, Jeffries N, Sonies BC, Ludlow CL. The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol. 2006;101:1657–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Suiter DM, Leder SB, Ruark JL. Effects of neuromuscular electrical stimulation on submental muscle activity. Dysphagia. 2006;21:56–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Park JW, Oh JC, Lee HJ, Park SJ, Yoon TS, Kwon BS. Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing. Dysphagia. 2009;24:296–301.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Kim Y, McCullough GH. Maximum hyoid displacement in normal swallowing. Dysphagia. 2008;23:274–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Kim Y, McCullough GH. Maximal hyoid excursion in poststroke patients. Dysphagia. 2010;25:20–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Lundy DS, Smith C, Colangelo L, Sullivan PA, Logemann JA, Lazarus CL, Newman LA, Murry T, Lombard L, Gaziano J. Aspiration: cause and implications. Otolaryngol Head Neck Surg. 1999;120:474–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Cook IJ, Dodds WJ, Dantas RO, Massey B, Kern MK, Lang IM, Brasseur JG, Hogan WJ. Opening mechanisms of the human upper esophageal sphincter. Am J Physiol. 1989;257:G748–59.PubMedGoogle Scholar
  19. 19.
    Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82:1661–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Bulow M, Olsson R, Ekberg O. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in healthy volunteers. Dysphagia. 1999;14:67–72.PubMedCrossRefGoogle Scholar
  21. 21.
    Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L. Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia. 2007;22:1–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jin-Woo Park
    • 1
  • Youngsun Kim
    • 2
  • Jong-Chi Oh
    • 3
  • Ho-Jun Lee
    • 1
  1. 1.Department of Physical Medicine and RehabilitationDongguk University Ilsan HospitalGoyang-siRepublic of Korea
  2. 2.Communication Sciences and Disorders, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, W233 Grover CenterOhio UniversityAthensUSA
  3. 3.Department of Occupational TherapyKyungdong UniversityGangwon-doRepublic of Korea

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