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Dysphagia

, Volume 28, Issue 4, pp 557–566 | Cite as

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

  • Shu-Fen Sun
  • Chien-Wei Hsu
  • Huey-Shyan Lin
  • Hsien-Pin Sun
  • Ping-Hsin Chang
  • Wan-Ling Hsieh
  • Jue-Long Wang
Original Article

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.

Keywords

Dysphagia Fiberoptic endoscopic evaluation of swallowing Neuromuscular electrical stimulation Rehabilitation Stroke 

Notes

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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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Shu-Fen Sun
    • 1
    • 2
  • Chien-Wei Hsu
    • 2
    • 3
  • Huey-Shyan Lin
    • 4
  • Hsien-Pin Sun
    • 5
  • Ping-Hsin Chang
    • 1
  • Wan-Ling Hsieh
    • 1
  • Jue-Long Wang
    • 1
  1. 1.Department of Physical Medicine and RehabilitationKaohsiung Veterans General HospitalKaohsiungTaiwan
  2. 2.National Yang-Ming University School of MedicineTaipeiTaiwan
  3. 3.Department of Internal MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
  4. 4.School of NursingFooyin UniversityKaohsiungTaiwan
  5. 5.Department of General SurgeryCheng Ching HospitalTaichungTaiwan

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