Sensory Transcutaneous Electrical Stimulation Improves Post-Stroke Dysphagic Patients

Abstract

Oropharyngeal dysphagia is frequent in stroke patients and increases mortality, mainly because of pulmonary complications. We hypothesized that sensitive transcutaneous electrical stimulation applied submentally during swallowing could help rehabilitate post-stroke oropharyngeal dysphagia by improving cortical sensory motor circuits. Eleven patients were recruited for the study (5 females, 68 ± 11 years). They all suffered from recent oropharyngeal dysphagia (>eight weeks) induced by a hemispheric (n = 7) or brainstem (n = 4) stroke, with pharyngeal residue and/or laryngeal aspiration diagnosed by videofluoroscopy. Submental electrical stimulations were performed for 1 h every day for 5 days (electrical trains: 5 s every minute, 80 Hz, under motor threshold). During the electrical stimulations, the patients were asked to swallow one teaspoon of paste or liquid. Swallowing was evaluated before and after the week of stimulations using a dysphagia handicap index questionnaire, videofluoroscopy, and cortical mapping of pharyngeal muscles. The results of the questionnaire showed that oropharyngeal dysphagia symptoms had improved (p < 0.05), while the videofluoroscopy measurements showed that laryngeal aspiration (p < 0.05) and pharyngeal residue (p < 0.05) had decreased and that swallowing reaction time (p < 0.05) had improved. In addition, oropharyngeal transit time, pharyngeal transit time, laryngeal closure duration, and cortical pharyngeal muscle mapping after the task had not changed. These results indicated that sensitive submental electrical stimulations during swallowing tasks could help to rehabilitate post-stroke swallowing dysphagia by improving swallowing coordination. Plasticity of the sensory swallowing cortex is suspected.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Lindgren S, Janzon L. Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population. Dysphagia. 1991;64:187–92.

    Article  Google Scholar 

  2. 2.

    Siebens H, Trupe E, Siebens A, Cook F, Anshen S, Hanauer R, et al. Correlates and consequences of eating dependency in institutionalized elderly. J Am Geriatr Soc. 1986;343:192–8.

    Google Scholar 

  3. 3.

    Gordon C, Hewer RL, Wade DT. Dysphagia in acute stroke. Br Med J (Clin Res Ed). 1987;295(6595):411–4.

    CAS  Article  Google Scholar 

  4. 4.

    Verin E, Leroi AM. Poststroke dysphagia rehabilitation by repetitive transcranial magnetic stimulation: a noncontrolled pilot study. Dysphagia. 2009;24(2):204–10.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Machii K, Cohen D, Ramos-Estebanez C, Pascual-Leone A. Safety of rTMS to non-motor cortical areas in healthy participants and patients. Clin Neurophysiol. 2006;1172:455–71.

    Article  Google Scholar 

  6. 6.

    Vanderhasselt MA, De Raedt R, Baeken C, Leyman L, D’haenen H. The influence of rTMS over the right dorsolateral prefrontal cortex on intentional set switching. Exp Brain Res. 2006;172(4):561–5.

    Article  PubMed  Google Scholar 

  7. 7.

    Ziemann U. Improving disability in stroke with RTMS. Lancet Neurol. 2005;48:454–5.

    Article  Google Scholar 

  8. 8.

    Levin MF, Hui-Chan CW. Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Electroencephalogr Clin Neurophysiol. 1992;852:131–42.

    Google Scholar 

  9. 9.

    Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respir Care. 2001;465:466–744.

    Google Scholar 

  10. 10.

    Bulow M, Speyer R, Baijens L, Woisard V, Ekberg O. Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia. 2008;233:302–9.

    Article  Google Scholar 

  11. 11.

    Liepert J, Hamzei F, Weiller C. Motor cortex disinhibition of the unaffected hemisphere after acute stroke. Muscle Nerve. 2000;2311:1761–3.

    Article  Google Scholar 

  12. 12.

    Jenkins WM, Merzenich MM, Ochs MT, Allard T, Guic-Robles E. Functional reorganization of primary somatosensory cortex in adult owl monkeys after behaviorally controlled tactile stimulation. J Neurophysiol. 1990;631:82–104.

    Google Scholar 

  13. 13.

    Chokroverty S, Hening W, Wright D, Walczak T, Goldberg J, Burger R, et al. Magnetic brain stimulation: safety studies. Electroencephalogr Clin Neurophysiol. 1995;971:36–42.

    Article  Google Scholar 

  14. 14.

    Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–5.

    CAS  PubMed  Google Scholar 

  15. 15.

    Woisard V, Andrieux MP, Puech M. Validation of a self-assessment questionnaire for swallowing disorders (Deglutition Handicap Index). Rev Laryngol Otol Rhinol (Bord). 2006;1275:315–25.

    Google Scholar 

  16. 16.

    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;112:93–8.

    Article  Google Scholar 

  17. 17.

    Hamdy S, Aziz Q, Rothwell JC, Singh KD, Barlow J, Hughes DG, et al. The cortical topography of human swallowing musculature in health and disease. Nat Med. 1996;211:1217–24.

    Article  Google Scholar 

  18. 18.

    Hamdy S, Aziz Q, Rothwell JC, Crone R, Hughes D, Tallis RC, et al. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke. Lancet. 1997;350(9079):686–92.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Hamdy S, Aziz Q, Rothwell JC, Hobson A, Thompson DG. Sensorimotor modulation of human cortical swallowing pathways. J Physiol. 1998;506(Pt 3):857–66.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Gallas S, Moirot P, Debono G, Navarre I, Denis P, Marie JP, et al. Mylohyoid motor-evoked potentials relate to swallowing function after chronic stroke dysphagia. Neurogastroenterol Motil. 2007;196:453–8.

    Article  Google Scholar 

  21. 21.

    Jego A, Chassagne P, Landrin-Dutot I, Capet C, Havard C, Hellot MF, et al. Does age play a role in mylohyoideus muscle function? Neurogastroenterol Motil. 2001;131:81–7.

    Article  Google Scholar 

  22. 22.

    Leelamanit V, Limsakul C, Geater A. Synchronized electrical stimulation in treating pharyngeal dysphagia. Laryngoscope. 2002;112(12):2204–10.

    Article  PubMed  Google Scholar 

  23. 23.

    Power ML, Hamdy S, Singh S, Tyrrell PJ, Turnbull I, Thompson DG. Deglutitive laryngeal closure in stroke patients. J Neurol Neurosurg Psychiatry. 2007;782:141–6.

    Article  Google Scholar 

  24. 24.

    Bosma J. Deglutition: pharyngeal stage. Physiol Rev. 1957;37:275–300.

    CAS  PubMed  Google Scholar 

  25. 25.

    Ludlow CL, Bielamowicz S, Daniels Rosenberg M, Ambalavanar R, Rossini K, Gillespie M, et al. Chronic intermittent stimulation of the thyroarytenoid muscle maintains dynamic control of glottal adduction. Muscle Nerve. 2000;231:44–57.

    Article  Google Scholar 

  26. 26.

    Ng SS, Hui-Chan CW. Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke. Stroke. 2007;3811:2953–9.

    Article  Google Scholar 

  27. 27.

    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;123:161–6.

    Article  Google Scholar 

  28. 28.

    Fraser C, Rothwell J, Power M, Hobson A, Thompson D, Hamdy S. Differential changes in human pharyngoesophageal motor excitability induced by swallowing, pharyngeal stimulation, and anesthesia. Am J Physiol Gastrointest Liver Physiol. 2003;2851:G137–44.

    Google Scholar 

  29. 29.

    Jean A, Car A. Inputs to the swallowing medullary neurons from the peripheral afferent fibers and the swallowing cortical area. Brain Res. 1979;178(2–3):567–72.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Martin RE, Sessle BJ. The role of the cerebral cortex in swallowing. Dysphagia. 1993;83:195–202.

    Article  Google Scholar 

  31. 31.

    Hamdy S, Mikulis DJ, Crawley A, Xue S, Lau H, Henry S, Diamant NE, Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol 1999; 277(1 Pt 1):G219-G225.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Eric Verin.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gallas, S., Marie, J.P., Leroi, A.M. et al. Sensory Transcutaneous Electrical Stimulation Improves Post-Stroke Dysphagic Patients. Dysphagia 25, 291–297 (2010). https://doi.org/10.1007/s00455-009-9259-3

Download citation

Keywords

  • Electrical stimulation
  • Swallowing
  • Stroke
  • Human
  • Deglutition
  • Deglutition disorders