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Transcutaneous Electrical Stimulation on the Submental Area: The Relations of Biopsychological Factors with Maximum Amplitude Tolerance and Perceived Discomfort Level

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Abstract

Transcutaneous electrical stimulation (TES) is a frequently used adjunctive modality in dysphagia rehabilitation. Stimulating deeper swallowing muscles requires higher TES amplitude. However, TES amplitude is limited by maximum amplitude tolerance (MAT). Previous studies have reported high interindividual variability regarding MAT and perceived discomfort. This variability might be one of the potential reasons of conflicting outcomes in TES-based swallowing studies. MAT and perceived discomfort are influenced by a variety of biopsychological factors. The influence of these factors related to swallow applications is poorly understood. This study explored the relation of biopsychological factors with MAT and perceived discomfort related to TES in the submental area. A convenience sample of thirty community-dwelling older adults between 60 and 70 years of age provided data for this study. Gender, submental adipose tissue thickness, perceptual pain sensitivity, and pain-coping strategies were evaluated for each subject. Subsequently, MAT and perceived discomfort level were determined using TES on the submental area. Relation of different biopsychological variables with MAT and discomfort level was examined using Pearson and Spearman correlation, and Mann–Whitney U test. Results indicated that neither gender nor adipose thickness was related to MAT and perceived discomfort. Among studied pain-coping strategies, catastrophizing was significantly related to MAT(r = – 0.552, p < .002). Distraction was significantly related to perceived discomfort level (r = − 0.561, p < 0.002). Given the negative impact of pain catastrophizing on MAT and the positive impact of distraction on perceiving discomfort, these coping strategies should be considered as amplitude-limiting and discomfort-moderating factors in TES-based dysphagia rehabilitation.

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Funding

This study was partially supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA

    Ali Barikroo

  2. Upper Airway Dysfunction Lab, Department of Speech, Language, and Hearing Sciences, Gainesville, FL, USA

    Karen Hegland

  3. Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, Orlando, USA

    Giselle Carnaby & Michael Crary

  4. Department of Physiological Sciences, University of Florida, Gainesville, USA

    Donald Bolser

  5. Institute on Aging and the Department of Aging and Geriatric Research, University of Florida, Gainesville, USA

    Todd Manini

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  1. Ali Barikroo
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Correspondence to Ali Barikroo.

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Barikroo, A., Hegland, K., Carnaby, G. et al. Transcutaneous Electrical Stimulation on the Submental Area: The Relations of Biopsychological Factors with Maximum Amplitude Tolerance and Perceived Discomfort Level. Dysphagia 35, 301–307 (2020). https://doi.org/10.1007/s00455-019-10029-6

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