51
|
Kim MS, Kim GW, Rho YS, Kwon KH, Chung EJ. Office-based Electromyography-guided Botulinum Toxin Injection to the Cricopharyngeus Muscle: Optimal Patient Selection and Technique. Ann Otol Rhinol Laryngol 2017; 126:349-356. [DOI: 10.1177/0003489416689469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This retrospective study was carried out to investigate the effectiveness and safety of office-based electromyography-guided injection of botulinum toxin in the cricopharyngeus muscle of patients who did not show upper esophageal sphincter passage in a swallowing study in spite of maximal swallowing rehabilitation. Methods: Thirty-six patients who showed no or limited ability to oral feed after maximum swallowing rehabilitation were enrolled. Video fluoroscopic swallowing study, flexible endoscopic evaluation of swallowing, disability rating scale, penetration aspiration score, and National Institutes of Health swallowing safety scale were used in the evaluation of dysphagia. Results: Success was defined as nondependence on gastrostomy for patients who previously were dependent on gastrostomy and improvement in disability rating scale score after botulinum toxin injections. The total success rate was 63.9%. The complication rate was very low, with only 1 patient showing temporary unilateral vocal fold paralysis. Botulinum toxin injection was more effective in patients with cranial nerve IX or X palsy than in those without it ( P = .006). Conclusions: This procedure can be a simple, safe, and effective tool in patients with cricopharyngeal dysfunction after swallowing rehabilitation, especially for cranial nerve IX or X palsy.
Collapse
Affiliation(s)
- Min-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - Go-Woon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University College of Medicine, Seoul, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University College of Medicine, Seoul, Korea
| | - Kee-Hwan Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
52
|
25 Years of Dysphagia Rehabilitation: What Have We Done, What are We Doing, and Where are We Going? Dysphagia 2017; 32:50-54. [DOI: 10.1007/s00455-016-9769-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
|
53
|
Ras YA, Imam M, El-Banna MM, Hamouda NH. Voice outcome following electrical stimulation-supported voice therapy in cases of unilateral vocal fold paralysis. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2016. [DOI: 10.4103/1012-5574.192543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
54
|
Li CM, Lee HY, Hsieh SH, Wang TG, Wang HP, Chen JJJ. Development of Innovative Feedback Device for Swallowing Therapy. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
55
|
Guillén-Solà A, Messagi Sartor M, Bofill Soler N, Duarte E, Barrera MC, Marco E. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clin Rehabil 2016; 31:761-771. [PMID: 27271373 DOI: 10.1177/0269215516652446] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of inspiratory/expiratory muscle training (IEMT) and neuromuscular electrical stimulation (NMES) to improve dysphagia in stroke. DESIGN Prospective, single-blind, randomized-controlled trial. SETTING Tertiary public hospital. SUBJECTS Sixty-two patients with dysphagia were randomly assigned to standard swallow therapy (SST) (Group I, controls, n=21), SST+ IEMT (Group II, n=21) or SST+ sham IEMT+ NMES (Group III, n=20). INTERVENTIONS All patients followed a 3-week standard multidisciplinary rehabilitation program of SST and speech therapy. The SST+IEMT group's muscle training consisted of 5 sets/10 repetitions, twice-daily, 5 days/week. Group III's sham IEMT required no effort; NMES consisted of 40-minute sessions, 5 days/week, at 80Hz. MAIN OUTCOMES Dysphagia severity, assessed by Penetration-Aspiration Scale, and respiratory muscle strength (maximal inspiratory and expiratory pressures) at the end of intervention and 3-month follow-up. RESULTS Maximal respiratory pressures were most improved in Group II: treatment effect was 12.9 (95% confidence interval 4.5-21.2) and 19.3 (95% confidence interval 8.5-30.3) for maximal inspiratory and expiratory pressures, respectively. Swallowing security signs were improved in Groups II and III at the end of intervention. No differences in Penetration-Aspiration Scale or respiratory complications were detected between the 3 groups at 3-month follow-up. CONCLUSION Adding IEMT to SST was an effective, feasible, and safe approach that improved respiratory muscle strength. Both IEMT and NMES were associated with improvement in pharyngeal swallowing security signs at the end of the intervention, but the effect did not persist at 3-month follow-up and no differences in respiratory complications were detected between treatment groups and controls.
Collapse
Affiliation(s)
- Anna Guillén-Solà
- 1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain.,2 Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain.,3 Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Monique Messagi Sartor
- 1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Neus Bofill Soler
- 1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Esther Duarte
- 1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Mª Camelia Barrera
- 1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Ester Marco
- 1 Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar/Hospital de l'Esperança), Barcelona, Catalonia, Spain.,2 Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain.,3 Department of Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
| |
Collapse
|
56
|
King SN, Dunlap NE, Tennant PA, Pitts T. Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer. Dysphagia 2016; 31:339-51. [PMID: 27098922 PMCID: PMC5340192 DOI: 10.1007/s00455-016-9710-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
Abstract
Oncologic treatments, such as curative radiotherapy and chemoradiation, for head and neck cancer can cause long-term swallowing impairments (dysphagia) that negatively impact quality of life. Radiation-induced dysphagia comprised a broad spectrum of structural, mechanical, and neurologic deficits. An understanding of the biomolecular effects of radiation on the time course of wound healing and underlying morphological tissue responses that precede radiation damage will improve options available for dysphagia treatment. The goal of this review is to discuss the pathophysiology of radiation-induced injury and elucidate areas that need further exploration.
Collapse
Affiliation(s)
- Suzanne N King
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, 511 South Floyd St MDR 616, Louisville, KY, 40202, USA
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, USA
| | - Paul A Tennant
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, USA
| | - Teresa Pitts
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, 511 South Floyd St MDR 616, Louisville, KY, 40202, USA.
| |
Collapse
|
57
|
Park JS, Oh DH, Chang MY. Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial. Gerodontology 2016; 34:121-128. [DOI: 10.1111/ger.12234] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ji-Su Park
- Department of Rehabilitation Science; Graduate School of Inje University; Gimhae Korea
| | - Dong-Hwan Oh
- Department of Occupational Therapy; Kyungdong University; Wonju Korea
| | - Moon-Young Chang
- Department of Occupational Therapy; College of Biomedical Science and Engineering; Inje University; Gimhae Korea
| |
Collapse
|
58
|
Scarponi L, Mozzanica F, De Cristofaro V, Ginocchio D, Pizzorni N, Bottero A, Schindler A. Neuromuscular Electrical Stimulation for Treatment-Refractory Chronic Dysphagia in Tube-Fed Patients: A Prospective Case Series. Folia Phoniatr Logop 2016; 67:308-14. [PMID: 27160206 DOI: 10.1159/000443499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the role of neuromuscular electrical stimulation (NMES) in tube-fed patients with severe and chronic dysphagia refractory to traditional swallowing therapy (TT). PATIENTS AND METHODS A total of 11 consecutive dysphagic patients with tube-dependent nutrition and who had not responded to 6 months of TT were enrolled. Each patient received NMES for 30 min and TT for 30 min, twice a day, 5 days per week for 4 weeks. In order to evaluate the swallowing impairment, each patient underwent a fiberoptic endoscopic examination of swallowing immediately before the beginning of the treatment, after 2 weeks and after 4 weeks. RESULTS All enrolled patients managed to complete the swallowing treatment protocol for at least 2 weeks. After the 4-week treatment, 6 of 11 enrolled patients passed to a total oral diet with single or multiple consistencies despite specific food limitations or special preparation or compensation. Five patients, all affected by the most severe form of dysphagia, maintained tube-dependent nutrition. CONCLUSION NMES as adjunctive treatment to TT may offer a new possibility for the management of tube-fed patients who are refractory to TT.
Collapse
Affiliation(s)
- Letizia Scarponi
- Phoniatric Unit, Department of Biomedical and Clinical Sciences x2018;L. Sacco', University of Milan, Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
59
|
Park JS, Oh DH, Hwang NK, Lee JH. Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: a randomised controlled trial. J Oral Rehabil 2016; 43:426-34. [DOI: 10.1111/joor.12390] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J.-S. Park
- Department of Rehabilitation Science; Graduate School; Inje University; Gimhae Korea
| | - D.-H. Oh
- Department of Occupational Therapy; Kyungdong University; Gangwon-do; Seoul Korea
| | - N.-K. Hwang
- Department of Occupational Therapy; Seoul North Municipal Hospital; Seoul Korea
| | - J.-H. Lee
- Department of Physical Therapy; College of Nursing and Healthcare Sciences; Dong-Eui University; Busan Korea
| |
Collapse
|
60
|
Cugy E, Leroi AM, Kerouac-Laplante J, Dehail P, Joseph PA, Gerardin E, Marie JP, Verin É. Effect of submental sensitive transcutaneous electrical stimulation on virtual lesions of the oropharyngeal cortex. Ann Phys Rehabil Med 2016; 59:94-9. [PMID: 26717886 DOI: 10.1016/j.rehab.2015.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/18/2015] [Accepted: 10/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effect of submental sensitive transcutaneous electrical stimulation (SSTES) on pharyngeal cortical representation after the creation of an oropharyngeal cortical virtual lesion in healthy subjects. METHODS Motor-evoked potential amplitude of the mylohyoid muscles was measured with transcranial magnetic stimulation (TMS), the oropharyngeal cortex was mapped by cartography, and videofluoroscopic parameters of swallowing function were measured before and after SSTES (at the end of SSTES [0 min] and at 30 and 60 min), after the creation of a cortical virtual lesion (repetitive TMS, 1 Hz, 20 min on the dominant swallowing hemisphere). RESULTS Nine subjects completed the study. After 20 min of SSTES, motor-evoked potential amplitude increased (P<0.05), as did swallow reaction time after repetitive TMS, as seen on videofluoroscopy, which was reversed after electrical stimulation. On cortical mapping, the number of points with a cortical response increased in the dominant lesioned hemisphere (P<0.05), remaining constant at 60 min (P<0.05). CONCLUSION SSTES may be effective for producing cortical plasticity for mylohyoid muscles and reverses oropharyngeal cortical inhibition in healthy subjects. It could be a simple non-invasive way to treat post-stroke dysphagia.
Collapse
Affiliation(s)
- Emmanuelle Cugy
- Service de MPR, centre hospitalier Arcachon, 33260 La Teste de Buch, France; Service de MPR, CHU de Bordeaux, 33076 Bordeaux, France; EA 4136, université de Bordeaux, 33000 Bordeaux, France
| | - Anne-Marie Leroi
- Service de physiologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | | | - Patrick Dehail
- Service de MPR, CHU de Bordeaux, 33076 Bordeaux, France; EA 4136, université de Bordeaux, 33000 Bordeaux, France
| | - Pierre-Alain Joseph
- Service de MPR, CHU de Bordeaux, 33076 Bordeaux, France; EA 4136, université de Bordeaux, 33000 Bordeaux, France
| | | | - Jean-Paul Marie
- EA 3830, université de Rouen, 76000 Rouen, France; Service de chirurgie cervicofaciale, CHU de Rouen, 76031 Rouen, France
| | - Éric Verin
- Service de physiologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; EA 3830, université de Rouen, 76000 Rouen, France; Pôle 3R, CHU de Rouen, 76031 Rouen, France.
| |
Collapse
|
61
|
Crary MA. Treatment for Adults. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
62
|
Barikroo A, Berretin-Felix G, Carnaby G, Crary M. Effect of transcutaneous electrical stimulation amplitude on timing of swallow pressure peaks between healthy young and older adults. Gerodontology 2015; 34:24-32. [PMID: 26694095 DOI: 10.1111/ger.12221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study compared the effect of transcutaneous electrical stimulation (TES) amplitude on timing of lingual-palatal and pharyngeal peak pressures during swallowing in healthy younger and older adults. BACKGROUND Transcutaneous electrical stimulation amplitude is one parameter that may have different impacts on the neuromotor system and swallowing physiology. One aspect of swallowing physiology influenced by age is the timing of swallowing events. However, the effect of varying TES amplitudes on timing of swallowing physiology is poorly understood, especially in older adults. MATERIALS AND METHODS Thirty-four adults (20 younger and 14 older) swallowed 10 ml of nectar-thick liquid under three TES conditions: no stimulation, low-amplitude stimulation and high-amplitude stimulation. TES was delivered by surface electrodes on the anterior neck. Timing of pressure peaks for lingual-palatal contacts and pharyngeal pressures were measured under each condition. RESULTS A significant age × stimulation amplitude interaction was identified for the base of tongue (BOT) [F(2,62) = 5.087, p < 0.009] and the hypopharynx (HYPO) [F(2,62) = 3.277, p < 0.044]. At the BOT, low-amplitude TES resulted in slower swallows in the younger adults compared with no TES. In older adults, low-amplitude TES resulted in faster swallows compared with high-amplitude TES. At the HYPO, no significant differences were identified in pressure timing across the three TES amplitudes in both age groups. In each case, low-amplitude TES resulted in faster swallows in older adults compared with younger adults. CONCLUSIONS Transcutaneous electrical stimulation influences pharyngeal pressure timing differently in young and old people, which questions the appropriateness of using a 'one-size-fits-all' TES amplitude for rehabilitating people with dysphagia.
Collapse
Affiliation(s)
- Ali Barikroo
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, USA
| | - Giedré Berretin-Felix
- Speech Pathology/Audiology Department, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | - Giselle Carnaby
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| | - Michael Crary
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
63
|
Santos JKDO, Gama ACC, Silvério KCA, Oliveira NFCD. Uso da eletroestimulação na clínica fonoaudiológica: uma revisão integrativa da literatura. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517518114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo: Este trabalho tem como objetivo apresentar revisão integrativa de literatura sobre a aplicabilidade e o resultado do uso da eletroestimulação na prática clínica fonoaudiológica. Foram seguidos os preceitos do Cochrane Handbook, que envolveu a formulação da questão a ser investigada, localização e seleção dos estudos e avaliação crítica dos artigos. Foram utilizadas as bases de dados Medical Literature Analysis and Retrieval Sistem on-line (Medline), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed e Web of Science/ISI. Os descritores utilizados foram: "estimulação elétrica nervosa transcutânea", "estimulação elétrica", "disfagia", "transtornos de deglutição", "disfonia", "distúrbios da voz", "treinamento da voz" e "terapia por estimulação elétrica" em inglês, português e espanhol e suas combinações, no período entre 2003 e 2013. Os estudos analisados demonstraram que a eletroestimulação traz benefícios na reabilitação de pacientes na clínica fonoaudiológica, mas a metodologia utilizada nos estudos foi divergente e a população estudada muito heterogênea o que dificulta sua utilização clínica pelos profissionais da área. A eletroestimulação traz benefícios na reabilitação fonoaudiológica, porém novos estudos devem ser realizados utilizando uma amostra mais homogênea e descrevendo metodologia e técnicas fonoaudiológicas utilizadas nos procedimentos, a fim de comprovar seus resultados e viabilizar seu uso pelos profissionais da área.
Collapse
|
64
|
Kim SH, Oh BM, Han TR, Jeong HJ, Sim YJ. Different Movement of Hyolaryngeal Structures by Various Application of Electrical Stimulation in Normal Individuals. Ann Rehabil Med 2015; 39:535-44. [PMID: 26361589 PMCID: PMC4564700 DOI: 10.5535/arm.2015.39.4.535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/03/2015] [Indexed: 12/02/2022] Open
Abstract
Objective To identify the differences in the movement of the hyoid bone and the vocal cord with and without electrical stimulation in normal subjects. Methods Two-dimensional motion analysis using a videofluoroscopic swallowing study with and without electrical stimulation was performed. Surface electrical stimulation was applied during swallowing using electrodes placed at three different locations on each subject. All subjects were analyzed three times using the following electrode placements: with one pair of electrodes on the suprahyoid muscles and a second pair on the infrahyoid muscles (SI); with placement of the electrode pairs on only the infrahyoid muscles (IO); and with the electrode pairs placed vertically on the suprahyoid and infrahyoid muscles (SIV). Results The main outcomes of this study demonstrated an initial downward displacement as well as different movements of the hyoid bone with the three electrode placements used for electrical stimulation. The initial positions of the hyoid bone with the SI and IO placements resulted in an inferior and anterior displaced position. During swallowing, the hyoid bone moved in a more superior and less anterior direction, resulting in almost the same peak position compared with no electrical stimulation. Conclusion These results demonstrate that electrical stimulation caused an initial depression of the hyoid bone, which had nearly the same peak position during swallowing. Electrical stimulation during swallowing was not dependent on the position of the electrode on the neck, such as on the infrahyoid or on both the suprahyoid and infrahyoid muscles.
Collapse
Affiliation(s)
- Sae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Byung-Mo Oh
- Department of Physical Medicine and Rehabilitation, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Ryun Han
- Department of Physical Medicine and Rehabilitation, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Joong Jeong
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Young Joo Sim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
65
|
Anderson C, Macrae P, Taylor-Kamara I, Serel S, Vose A, Humbert IA. The perturbation paradigm modulates error-based learning in a highly automated task: outcomes in swallowing kinematics. J Appl Physiol (1985) 2015; 119:334-41. [PMID: 26023226 PMCID: PMC4538282 DOI: 10.1152/japplphysiol.00155.2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/23/2015] [Indexed: 02/06/2023] Open
Abstract
Traditional motor learning studies focus on highly goal-oriented, volitional tasks that often do not readily generalize to real-world movements. The goal of this study was to investigate how different perturbation paradigms alter error-based learning outcomes in a highly automated task. Swallowing was perturbed with neck surface electrical stimulation that opposes hyo-laryngeal elevation in 25 healthy adults (30 swallows: 10 preperturbation, 10 perturbation, and 10 postperturbation). The four study conditions were gradual-masked, gradual-unmasked, abrupt-masked, and abrupt-unmasked. Gradual perturbations increasingly intensified overtime, while abrupt perturbations were sustained at the same high intensity. The masked conditions reduced cues about the presence/absence of the perturbation (pre- and postperturbation periods had low stimulation), but unmasked conditions did not (pre- and postperturbation periods had no stimulation). Only hyo-laryngeal range of motion measures had significant outcomes; no timing measure demonstrated learning. Systematic-error reduction occurred only during the abrupt-masked and abrupt-unmasked perturbations. Only the abrupt-masked perturbation caused aftereffects. In this highly automated task, gradual perturbations did not induce learning similarly to findings of some volitional, goal-oriented adaptation task studies. Furthermore, our subtle and brief adjustment of the stimulation paradigm (masked vs. unmasked) determined whether aftereffects were present. This suggests that, in the unmasked group, sensory predictions of a motor plan were quickly and efficiently modified to disengage error-based learning behaviors.
Collapse
Affiliation(s)
- C Anderson
- Swallowing Neurophysiology Laboratory, Department of Physical, Medicine, and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - P Macrae
- Swallowing Neurophysiology Laboratory, Department of Physical, Medicine, and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - I Taylor-Kamara
- Swallowing Neurophysiology Laboratory, Department of Physical, Medicine, and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - S Serel
- Swallowing Neurophysiology Laboratory, Department of Physical, Medicine, and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - A Vose
- Swallowing Neurophysiology Laboratory, Department of Physical, Medicine, and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - I A Humbert
- Swallowing Neurophysiology Laboratory, Department of Physical, Medicine, and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
66
|
Lee JH, Kim SB, Lee KW, Lee SJ, Lee JU. Effect of Repetitive Transcranial Magnetic Stimulation According to the Stimulation Site in Stroke Patients With Dysphagia. Ann Rehabil Med 2015; 39:432-9. [PMID: 26161350 PMCID: PMC4496515 DOI: 10.5535/arm.2015.39.3.432] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/27/2014] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) according to the stimulation site in subacute stroke patients with dysphagia. Methods This study was designed as a matched comparative study. Twenty-four patients who had dysphagia after ischemic stroke were recruited, and they were divided into two groups after matching for age and stroke lesion. The patients in group A received rTMS over the brain cortex where motor evoked potential (MEP) was obtained from the suprahyoid muscle. Group B received rTMS over the brain cortex where MEP was obtained from the abductor pollicis brevis muscle. rTMS was performed at 110% of MEP threshold, 10 Hz frequency for 10 seconds, and then repeated every minute for 10 minutes. Dysphagia status was measured by the Functional Dysphagia Scale (FDS), the Penetration-Aspiration Scale (PAS), and the Dysphagia Outcome and Severity Scale (DOSS) using the results of a videofluoroscopic swallowing study. These evaluations were measured before, immediately, and 4 weeks after rTMS. Results Group A showed significant improvement compared to group B in the DOSS score immediately and 4 weeks after rTMS. There were no significant differences in the changes of FDS and PAS scores between groups A and B immediately and 4 weeks after rTMS. Conclusion rTMS over a hot spot for the suprahyoid muscle caused more improvement in swallowing function when compared to that over the interconnected site.
Collapse
Affiliation(s)
- Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Sang Beom Kim
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| | - Jae Uk Lee
- Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea
| |
Collapse
|
67
|
Effect of Electrical Stimulation of the Suprahyoid Muscles in Brain-Injured Patients with Dysphagia. Dysphagia 2015; 30:423-9. [DOI: 10.1007/s00455-015-9617-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
|
68
|
Lee HY, Hong JS, Lee KC, Shin YK, Cho SR. Changes in hyolaryngeal movement and swallowing function after neuromuscular electrical stimulation in patients with Dysphagia. Ann Rehabil Med 2015; 39:199-209. [PMID: 25932416 PMCID: PMC4414966 DOI: 10.5535/arm.2015.39.2.199] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/26/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate immediate changes in hyolaryngeal movement and swallowing function after a cycle of neuromuscular electrical stimulation (NMES) on both submental and throat regions and submental placement alone in patients with dysphagia. METHODS Fifteen patients with dysphagia were recruited. First, videofluoroscopic swallowing study (VFSS) was performed before NMES. All patients thereafter received a cycle of NMES by 2 methods of electrode placement: 1) both submental and throat regions and 2) submental placement alone concomitant with VFSS. The Penetration-Aspiration Score (PAS) and the NIH-Swallowing Safety Scale (NIH-SSS) were measured for swallowing function. RESULTS During swallowing, hyolaryngeal descent significantly occurred by NMES on both submental and throat regions, and anterior displacement of hyolaryngeal complex was significant on submental placement alone. NMES on submental placement alone did not change the PAS and NIH-SSS. However, NMES on both submental and throat regions significantly reduced the NIH-SSS, although it did not change the PAS. Patients with no brainstem lesion and with dysphagia duration of <3 months showed significantly improved the NIH-SSS. CONCLUSION Immediate hyolaryngeal movement was paradoxically depressed after NMES on both submental and throat regions with significant reductions in the NIH-SSS but not the PAS, suggesting improvement in pharyngeal peristalsis and cricopharyngeal functions at the esophageal entry rather than decreased aspiration and penetration. The results also suggested that patients with dysphagia should be carefully screened when determining motor-level NMES.
Collapse
Affiliation(s)
- Hoo Young Lee
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Seoul, Korea. ; Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Seong Hong
- Department of Rehabilitation Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kil Chan Lee
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon-Kyum Shin
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Rae Cho
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea. ; Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. ; Avison Biomedical Research Center, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
69
|
Abstract
PURPOSE OF REVIEW To assess current information regarding the physiological effects of transcutaneous electrical stimulation (TES) on the neck and current evidence regarding the clinical effects of adding TES to dysphagia rehabilitation. RECENT FINDINGS Physiological studies have demonstrated that when electrical stimulation is applied on the throat it will lower the hyo-laryngeal complex and resist elevation needed for airway protection during swallowing. Submental TES has not been found to effectively elevate the hyo-laryngeal complex. Recent controlled clinical trials have had mixed results. Most indicate that TES is beneficial in the treatment of dysphagia; however, studies differ on whether these effects are greater than, equal to, or less than traditional therapy alone for the rehabilitation of swallowing. SUMMARY Currently TES for dysphagia is one of several tools available to the clinician for the rehabilitation of dysphagia. The two controlled clinical trials demonstrate that use of TES in dysphagia therapy is equivalent to traditional dysphagia therapy and of greater benefit only on one of several measures in one study. TES should be used only in patients who can overcome the resistive lowering of the hyo-laryngeal complex induced by TES which could place severely affected patients at greater risk of penetration.
Collapse
|
70
|
Humbert IA, Christopherson H, Lokhande A. Surface electrical stimulation perturbation context determines the presence of error reduction in swallowing hyolaryngeal kinematics. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 24:72-80. [PMID: 25412425 PMCID: PMC4689231 DOI: 10.1044/2014_ajslp-14-0045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/25/2014] [Accepted: 11/02/2014] [Indexed: 05/20/2023]
Abstract
PURPOSE Error-based learning (EBL) involves gradually reducing movement errors caused by a perturbation. When the perturbation has been unexpectedly removed, exaggerated movements occur in the opposite direction of a perturbation effect, known as aftereffects. Our goal was to determine whether the perturbation type impacts error reduction or aftereffects in swallowing hyolaryngeal kinematics. METHOD We perturbed peak hyolaryngeal elevation during swallowing in 16 healthy adults with surface electrical stimulation (SES) in 2 different ways during videofluoroscopy: intermittent SES (I-SES) was applied only during swallowing, and continuous SES (C-SES) was applied during swallowing and during interswallow intervals. In C-SES and I-SES, the onset and offset of the perturbation were unmasked. RESULTS Only the C-SES perturbation caused error reduction (gradually increasing peak elevation). Aftereffects were absent in both perturbations, unlike findings from our previous study with masked perturbation. Furthermore, the duration of laryngeal vestibule closure (dLVC) increased during the I-SES perturbation but was unchanged during C-SES perturbation. CONCLUSION EBL of swallowing airway protection events was strongly influenced by the context of the perturbation. These findings also elucidate how the relationship among critical swallowing airway protection events (hyoid peak, laryngeal peak, and dLVC) can be modified during EBL.
Collapse
|
71
|
Tippett DC. Clinical Challenges in the Evaluation and Treatment of Individuals with Poststroke Dysphagia. Top Stroke Rehabil 2015; 18:120-33. [DOI: 10.1310/tsr1802-120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
72
|
Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation. Curr Opin Otolaryngol Head Neck Surg 2014; 22:172-80. [PMID: 24675153 DOI: 10.1097/moo.0000000000000055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review recent literature depicting a shift in dysphagia rehabilitation in adults. Distinguishing rehabilitation from compensation in dysphagia management, a review of basic exercise principles is followed by description of recent publications depicting exercise-based therapies. Subsequently, transcutaneous electrical stimulation (TES) is reviewed as it may contribute to exercise-based dysphagia rehabilitation in adults. RECENT FINDINGS Surveys have documented extensive variability in the clinical application of dysphagia therapy techniques. Despite this variability, two trends are emerging in dysphagia rehabilitation research: documentation of physiologic and functional changes within the swallowing mechanism subsequent to therapy; and prophylactic exercise-based therapies. In addition, extensive efforts have emerged describing the potential application of TES in dysphagia rehabilitation. Though results of these efforts are conflicted, TES may serve a useful role as an adjunct to well developed exercise-based rehabilitation for dysphagia. SUMMARY The focus of dysphagia rehabilitation in adults is changing. Current efforts indicate that exercise-based therapies should incorporate multiple principles of exercise physiology and document physiologic change within the impaired swallowing mechanism. TES may function as an adjunctive modality; however, current practices should be evaluated to develop additional parameters of stimulation that are focused toward specific dysphagia impairments.
Collapse
|
73
|
Berretin-Felix G, Sia I, Barikroo A, Carnaby GD, Crary MA. Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults. Gerodontology 2014; 33:348-55. [PMID: 25393704 DOI: 10.1111/ger.12166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study compared the immediate impact of different transcutaneous electrical stimulation (TES) amplitudes on physiological swallowing effort in healthy older adults versus young adults. BACKGROUND Swallowing physiology changes with age. Reduced physiological swallowing effort in older adults including lower lingua-palatal and pharyngeal pressures may increase risk for swallowing dysfunction (i.e. dysphagia). Transcutaneous electrical stimulation (TES) has been advocated as an adjunctive modality to enhance outcomes in exercise-based therapy for individuals with dysphagia. However, significant variation in how TES is applied during therapy remains and the physiological swallowing response to TES is poorly studied, especially in older adults. MATERIALS AND METHODS Physiological change in swallowing associated with no stimulation, sensory stimulation and motor stimulation was compared in 20 young adults versus 14 older adults. Lingua-palatal and pharyngeal manometric pressures assessed physiological swallowing effort. RESULTS Multivariate analyses identified interactions between age and stimulation amplitude on lingual and pharyngeal functions. Motor stimulation reduced anterior tongue pressure in both age groups but selectively reduced posterior lingua-palatal pressures in young adults only. Sensory stimulation increased base of tongue (BOT) pressures in older adults but decreased BOT pressures in young adults. Motor stimulation increased hypopharyngeal pressures in both groups. CONCLUSION Age and TES level interact in determining immediate physiological responses on swallow performance. A one-size-fit-all approach to TES in dysphagia rehabilitation may be misdirected.
Collapse
Affiliation(s)
- Giédre Berretin-Felix
- Speech Pathology/Audiology Department, Bauru Dental School, University of São Paulo, São Paulo, Brazil
| | - Isaac Sia
- Swallow Research Laboratory, Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Ali Barikroo
- Swallow Research Laboratory, Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Giselle D Carnaby
- Swallow Research Laboratory, Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Michael A Crary
- Swallow Research Laboratory, Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| |
Collapse
|
74
|
Vose A, Nonnenmacher J, Singer ML, González-Fernández M. Dysphagia Management in Acute and Sub-acute Stroke. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014; 2:197-206. [PMID: 26484001 DOI: 10.1007/s40141-014-0061-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Swallowing dysfunction is common after stroke. More than 50% of the 665 thousand stroke survivors will experience dysphagia acutely of which approximately 80 thousand will experience persistent dysphagia at 6 months. The physiologic impairments that result in post-stroke dysphagia are varied. This review focuses primarily on well-established dysphagia treatments in the context of the physiologic impairments they treat. Traditional dysphagia therapies including volume and texture modifications, strategies such as chin tuck, head tilt, head turn, effortful swallow, supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver and exercises such as the Shaker exercise and Masako (tongue hold) maneuver are discussed. Other more recent treatment interventions are discussed in the context of the evidence available.
Collapse
Affiliation(s)
- Alicia Vose
- Johns Hopkins University School of Medicine Department of Physical Medicine and Rehabilitation
| | - Jodi Nonnenmacher
- Johns Hopkins University School of Medicine Department of Physical Medicine and Rehabilitation
| | - Michele L Singer
- Johns Hopkins University School of Medicine Department of Physical Medicine and Rehabilitation
| | | |
Collapse
|
75
|
Johnson DN, Herring HJ, Daniels SK. Dysphagia Management in Stroke Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0059-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
76
|
Toyama K, Matsumoto S, Kurasawa M, Setoguchi H, Noma T, Takenaka K, Soeda A, Shimodozono M, Kawahira K. Novel neuromuscular electrical stimulation system for treatment of dysphagia after brain injury. Neurol Med Chir (Tokyo) 2014; 54:521-8. [PMID: 24670314 PMCID: PMC4533457 DOI: 10.2176/nmc.oa.2013-0341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to compare the effects of a novel neuromuscular electrical stimulation (NMES) to the effects of conventional treatment in patients with dysphagia after brain injury. In total, 26 patients were non-randomly divided into an experimental group (n = 12) and a control group (n = 14). The experimental group received NMES intervention followed by conventional treatment, including thermal-tactile stimulation with intensive repetition of a dry-swallow task. The control group received conventional treatment without NMES. NMES at a fixed pulse duration of 50 μs and a frequency of 50 Hz was delivered over the skin areas above the motor point of the target muscles, i.e., the bilateral geniohyoid, mylohyoid/anterior belly of the digastric, and thyrohyoid muscles, using a high-voltage pulsed-current device. The two groups received 40-min treatments once a day, 5 days per week, for 8 weeks. Outcome, assessed before and 8 weeks after treatment, was evaluated with regard to the videofluoroscopic dysphagia scale (VDS), the anterior and superior displacement of the hyoid bone and larynx, and the functional oral intake scale. Both groups exhibited improvement, but the experimental group exhibited more significant improvement in the displacement of the hyoid bone and larynx, VDS-total score, and VDS-pharyngeal score than the control group did. The results suggest that NMES combined with conventional treatment is superior to conventional treatment alone in patients with dysphagia following treatment for brain injury. Further investigations are necessary to examine the effects of NMES in patients with more varied types of diseases.
Collapse
Affiliation(s)
- Keiichi Toyama
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital
| | | | | | | | | | | | | | | | | |
Collapse
|
77
|
Humbert IA, McLaren DG. Differential psychophysiological interactions of insular subdivisions during varied oropharyngeal swallowing tasks. Physiol Rep 2014; 2:e00239. [PMID: 24760502 PMCID: PMC4002228 DOI: 10.1002/phy2.239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract The insula is a highly integrated cortical region both anatomically and functionally. It has been shown to have cognitive, social-emotional, gustatory, and sensorimotor functions. Insular involvement in both normal and abnormal swallowing behavior is well established, yet its functional connectivity is unclear. Studies of context-dependent connectivity, or the connectivity during different task conditions, have the potential to reveal information about synaptic function of the insula. The goal of this study was to examine the functional connectivity of specific insular regions (ventral anterior, dorsal anterior, and posterior) with distant cortical regions during four swallowing conditions (water, sour, e-stim, and visual biofeedback) using generalized psychophysiological interactions (gPPI). In 19 healthy adults, we found that the visual biofeedback condition was associated with the most and strongest increases in functional connectivity. The posterior insula/rolandic operculum regions had the largest clusters of increases in functional connectivity, but the ventral anterior insula was functionally connected to a more diverse array of cortical regions. Also, laterality assessments showed left lateralized increases in swallowing functional connectivity. Our results are aligned with reports about the insula's interconnectivity and extensive involvement in multisensory and cognitive tasks.
Collapse
Affiliation(s)
- Ianessa A Humbert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
78
|
Miller S, Kühn D, Jungheim M, Schwemmle C, Ptok M. [Neuromuscular electric stimulation therapy in otorhinolaryngology]. HNO 2014; 62:131-8; quiz 139-40. [PMID: 24549514 DOI: 10.1007/s00106-013-2810-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Animal experiments have shown that after specific nerve traumatization, neuromuscular electrostimulation (NMES) can promote nerve regeneration and reduce synkinesia without negatively interfering with normal regeneration processes. NMES is used routinely in physical rehabilitation medicine. METHODS This systematic literature search in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the DAHTA database, the Health Technology Assessment Database and MEDLINE or PubMed considered studies on the use of NMES in otorhinolaryngology that have been published in German or English. RESULTS The search identified 180 studies. These were evaluated and relevant studies were included in the further evaluation. DISCUSSION In the fields of otorhinolaryngology and phoniatry/paediatric audiology, clinical studies investigating the effects of NMES on facial and laryngeal paresis, as well as dysphonia and dysphagia have been carried out. The evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis.
Collapse
Affiliation(s)
- S Miller
- Klinik für Phoniatrie und Pädaudiologie, MHH. OE 6510, 30623, Hannover, Deutschland
| | | | | | | | | |
Collapse
|
79
|
Poorjavad M, Talebian Moghadam S, Nakhostin Ansari N, Daemi M. Surface electrical stimulation for treating swallowing disorders after stroke: a review of the stimulation intensity levels and the electrode placements. Stroke Res Treat 2014; 2014:918057. [PMID: 24804147 PMCID: PMC3996303 DOI: 10.1155/2014/918057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/25/2014] [Accepted: 03/05/2014] [Indexed: 02/08/2023] Open
Abstract
Neuromuscular electrical stimulation (NMES) for treating dysphagia is a relatively new therapeutic method. There is a paucity of evidence about the use of NMES in patients with dysphagia caused by stroke. The present review aimed to introduce and discuss studies that have evaluated the efficacy of this method amongst dysphagic patients following stroke with emphasis on the intensity of stimulation (sensory or motor level) and the method of electrode placement on the neck. The majority of the reviewed studies describe some positive effects of the NMES on the neck musculature in the swallowing performance of poststroke dysphagic patients, especially when the intensity of the stimulus is adjusted at the sensory level or when the motor electrical stimulation is applied on the infrahyoid muscles during swallowing.
Collapse
Affiliation(s)
- Marziyeh Poorjavad
- 1Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Enghelab Street, Tehran, Iran
- *Marziyeh Poorjavad:
| | - Saeed Talebian Moghadam
- 2Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- 2Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Daemi
- 3Department of Speech Therapy, School of Rehabilitation, Hamedan University of Medical Sciences, Hamedan, Iran
| |
Collapse
|
80
|
Miller S, Jungheim M, Kühn D, Ptok M. Electrical stimulation in treatment of pharyngolaryngeal dysfunctions. Folia Phoniatr Logop 2013; 65:154-68. [PMID: 24356211 DOI: 10.1159/000355562] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neuromuscular electrical stimulation (NMES) has been proposed in the treatment of laryngopharyngeal dysfunctions (dysphonia, dyspnoea, dysphagia) for more than 40 years. Several studies have investigated possible therapeutic effects. Some researchers described favourable results, whereas others did not find relevant benefits. This article aims to review available studies to give an overview regarding the current state of knowledge. METHODS We conducted a selective literature search using PubMed. RESULTS In total, 356 papers were identified: 6 case reports, 11 reviews, 43 prospective clinical trials and 3 retrospective trials were found. CONCLUSION Due to different stimulation protocols, electrode positioning and various underlying pathological conditions, summarizing the present studies appears to be difficult. However, there is evidence that NMES is a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. Nevertheless, more empirical data is needed to fully understand the benefits provided by NMES. Further research suggestions are put forward.
Collapse
Affiliation(s)
- Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hanover Medical School, Hanover, Germany
| | | | | | | |
Collapse
|
81
|
Macrae P, Humbert I. Exploiting Experience-Dependent Plasticity in Dysphagia Rehabilitation: Current Evidence and Future Directions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
82
|
Rofes L, Arreola V, López I, Martin A, Sebastián M, Ciurana A, Clavé P. Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction. Neurogastroenterol Motil 2013; 25:888-e701. [PMID: 23937476 DOI: 10.1111/nmo.12211] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/20/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic poststroke oropharyngeal dysfunction (OD) is a common condition, leading to severe complications, including death. Treatments for chronic poststroke OD are scarce. The aim of our study was to assess and compare the efficacy and safety of treatment with surface electrical stimulation (e-stim) at sensory and motor intensities in patients with chronic poststroke OD. METHODS Twenty chronic poststroke patients with OD were randomly assigned to (i) sensory e-stim (treatment intensity: 75% of motor threshold) or (ii) motor e-stim (treatment intensity: motor threshold). Patients were treated during 10 days, 1 h/day. Videofluoroscopy was performed at the beginning and end of the study to assess signs of impaired efficacy and safety of swallow and timing of swallow response. KEY RESULTS Patients presented advanced age (74.95 ± 2.18), 75% were men. The mean days poststroke was 336.26 ± 89.6. After sensory stimulation, the number of unsafe swallows was reduced by 66.7% (p < 0.001), the laryngeal vestibule closure time by 22.94% (p = 0.027) and maximal vertical hyoid extension time by 18.6% (p = 0.036). After motor stimulation, the number of unsafe swallows was reduced by 62.5% (p = 0.002), the laryngeal vestibule closure time by 38.26% (p = 0.009) and maximal vertical hyoid extension time by 24.8% (p = 0.008). Moreover, the motor stimulus reduced the pharyngeal residue by 66.7% (p = 0.002), the upper esophageal sphincter opening time by 39.39% (p = 0.009), and increased bolus propulsion force by 211.1% (p = 0.008). No serious adverse events were detected during the treatment. CONCLUSIONS & INFERENCES Surface e-stim is a safe and effective treatment for chronic poststroke dysphagic patients.
Collapse
Affiliation(s)
- L Rofes
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
83
|
Abstract
The number of oral cavity and oropharyngeal cancer survivors is rising. By 2030, oropharyngeal cancers are projected to account for almost half of all head and neck cancers. Normal speech, swallowing, and respiration can be disrupted by adverse effects of tumor and cancer therapy. This review summarizes clinically distinct functional outcomes of patients with oral cavity and oropharyngeal cancers, methods of pretreatment functional assessments, strategies to reduce or prevent functional complications, and posttreatment rehabilitation considerations.
Collapse
Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology & Audiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
| | | |
Collapse
|
84
|
Nam HS, Beom J, Oh BM, Han TR. Kinematic effects of hyolaryngeal electrical stimulation therapy on hyoid excursion and laryngeal elevation. Dysphagia 2013; 28:548-56. [PMID: 23605128 DOI: 10.1007/s00455-013-9465-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to assess the effect of repeated sessions of electrical stimulation therapy (EST) on the neck muscles with respect to the stimulation site by using quantitative kinematic analysis of videofluoroscopic swallowing studies (VFSS) in dysphagia patients with acquired brain injury. We analyzed 50 patients in a tertiary hospital who were randomly assigned into two different treatment groups. One group received EST on the suprahyoid muscle only (SM), and the other group received stimulation with one pair of electrodes on the suprahyoid muscle and the other pair on the infrahyoid muscle (SI). All patients received 10-15 sessions of EST over 2-3 weeks. The VFSS was carried out before and after the treatment. Temporal and spatial parameters of the hyoid excursion and laryngeal elevation during swallowing were analyzed by two-dimensional motion analysis. The SM group (n = 25) revealed a significant increase in maximal anterior hyoid excursion distance (mean ± SEM = 1.56 ± 0.52 mm, p = 0.008) and velocity (8.76 ± 3.42 mm/s, p = 0.017), but there was no significant increase laryngeal elevation. The SI group (n = 25), however, showed a significant increase in maximal superior excursion distance (2.09 ± 0.78 mm, p = 0.013) and maximal absolute excursion distance (2.20 ± 0.82 mm, p = 0.013) of laryngeal elevation, but no significant increase in hyoid excursion. There were no significant differences between the two groups with respect to changes in maximal anterior hyoid excursion distance (p = 0.130) and velocity (p = 0.254), and maximal distance of superior laryngeal elevation (p = 0.525). EST on the suprahyoid muscle induced an increase in anterior hyoid excursion, and infrahyoid stimulation caused an increase in superior laryngeal elevation. Hyolaryngeal structural movements were increased in different aspects according to the stimulation sites. Targeted electrical stimulation based on pathophysiology is necessary.
Collapse
Affiliation(s)
- Hyung Seok Nam
- Department of Rehabilitation Medicine, Seoul National University College of Medicine , 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea,
| | | | | | | |
Collapse
|
85
|
Baijens LWJ, Speyer R, Passos VL, Pilz W, van der Kruis J, Haarmans S, Desjardins-Rombouts C. Surface electrical stimulation in dysphagic parkinson patients: A randomized clinical trial. Laryngoscope 2013; 123:E38-44. [DOI: 10.1002/lary.24119] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Laura W. J. Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery; Maastricht University Medical Center; Maastricht
| | - Renée Speyer
- School of Public Health, Tropical Medicine and Rehabilitation, James Cook University; Townsville Australia
| | | | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery; Maastricht University Medical Center; Maastricht
| | | | - Saskia Haarmans
- Department of Internal Medicine; Diakonessen Hospital; Utrecht The Netherlands
| | | |
Collapse
|
86
|
|
87
|
Connor NP, Russell JA, Jackson MA, Kletzien H, Wang H, Schaser AJ, Leverson GE, Zealear DL. Tongue muscle plasticity following hypoglossal nerve stimulation in aged rats. Muscle Nerve 2012; 47:230-40. [PMID: 23169566 DOI: 10.1002/mus.23499] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2012] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Age-related decreases in tongue muscle mass and strength have been reported. It may be possible to prevent age-related tongue muscle changes using neuromuscular electrical stimulation (NMES). Our hypothesis was that alterations in muscle contractile properties and myosin heavy chain composition would be found after NMES. METHODS Fifty-four young, middle-aged, and old 344/Brown Norway rats were included in this study. Twenty-four rats underwent bilateral electrical stimulation of the hypoglossal nerves for 8 weeks and were compared with control or sham rats. Muscle contractile properties and myosin heavy chain (MHC) in the genioglossus (GG), styloglossus (SG), and hyoglossus (HG) muscles were examined. RESULTS Compared with unstimulated control rats, we found reduced muscle fatigue, increased contraction and half-decay times, and increased twitch and tetanic tension. Increased type I MHC was found, except for in GG in old and middle-aged rats. CONCLUSION Transitions in tongue muscle contractile properties and phenotype were found after NMES.
Collapse
Affiliation(s)
- Nadine P Connor
- Department of Surgery, Otolaryngology-Head and Neck Surgery, 600 Highland Avenue, Room K4/711, University of Wisconsin, Madison, Wisconsin 53792, USA.
| | | | | | | | | | | | | | | |
Collapse
|
88
|
Archer SK, Garrod R, Hart N, Miller S. Dysphagia in Duchenne Muscular Dystrophy Assessed Objectively by Surface Electromyography. Dysphagia 2012. [DOI: 10.1007/s00455-012-9429-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
89
|
Gokce SM, Gokce HS, Gorgulu S, Karacay S, Akca E, Olmez H. Relationship between Class III malocclusion and hyoid bone displacement during swallowing: a cine-magnetic resonance imaging study. Korean J Orthod 2012; 42:190-200. [PMID: 23112950 PMCID: PMC3481984 DOI: 10.4041/kjod.2012.42.4.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/01/2012] [Accepted: 03/05/2012] [Indexed: 11/25/2022] Open
Abstract
Objective The displacement of the hyoid bone (HB) is a critical biomechanical component of the swallowing function. The aim of this study was to evaluate the swallowing-induced vertical and horizontal displacements of the HB in subjects with 2 different magnitudes of skeletal Class III malocclusion, by means of real-time, balanced turbo-field-echo (B-TFE) cine-magnetic resonance imaging. Methods The study population comprised 19 patients with mild skeletal Class III malocclusion, 16 with severe skeletal Class III malocclusion, and 20 with a skeletal Class I relationship. Before the commencement of the study, all subjects underwent cephalometric analysis to identify the nature of skeletal malformations. B-TFE images were obtained for the 4 consecutive stages of deglutition as each patient swallowed 10 mL of water, and the vertical and horizontal displacements of the HB were measured at each stage. Results At all stages of swallowing, the vertical position of the HB in the severe Class III malocclusion group was significantly lower than those in the mild Class III and Class I malocclusion groups. Similarly, the horizontal displacement of the HB was found to be significantly associated with the severity of malocclusion, i.e., the degree of Class III malocclusion, while the amount of anterior displacement of the HB decreased with an increase in the severity of the Class III deformity. Conclusions Our findings indicate the existence of a relationship between the magnitude of Class III malocclusion and HB displacement during swallowing.
Collapse
Affiliation(s)
- Sila Mermut Gokce
- Department of Orthodontics, Dental Science Center, Gulhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
90
|
Shune S, Moon JB. Neuromuscular Electrical Stimulation in Dysphagia Management: Clinician Use and Perceived Barriers. ACTA ACUST UNITED AC 2012. [DOI: 10.1044/cicsd_39_f_55] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
91
|
Human hyolaryngeal movements show adaptive motor learning during swallowing. Dysphagia 2012; 28:139-45. [PMID: 22926828 DOI: 10.1007/s00455-012-9422-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
Abstract
The hyoid bone and larynx elevate to protect the airway during swallowing. However, it is unknown whether hyolaryngeal movements during swallowing can adjust and adapt to predict the presence of a persistent perturbation in a feed-forward manner (adaptive motor learning). We investigated adaptive motor learning in nine healthy adults. Electrical stimulation was administered to the anterior neck to reduce hyolaryngeal elevation, requiring more strength to swallow during the perturbation period of this study. We assessed peak hyoid bone and laryngeal movements using videofluoroscopy across thirty-five 5-ml water swallows. Evidence of adaptive motor learning of hyolaryngeal movements was found when (1) participants showed systematic gradual increases in elevation against the force of electrical stimulation and (2) hyolaryngeal elevation overshot the baseline (preperturbation) range of motion, showing behavioral aftereffects, when the perturbation was unexpectedly removed. Hyolaryngeal kinematics demonstrates adaptive, error-reducing movements in the presence of changing and unexpected demands. This is significant because individuals with dysphagia often aspirate due to disordered hyolaryngeal movements. Thus, if rapid motor learning is accessible during swallowing in healthy adults, patients may be taught to predict the presence of perturbations and reduce errors in swallowing before they occur.
Collapse
|
92
|
The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness. Eur Arch Otorhinolaryngol 2012; 270:805-15. [PMID: 22865104 DOI: 10.1007/s00405-012-2114-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
Abstract
This prospective, open study was carried out in order to assess changes in the swallowing and dietary status after injection of Botulinum toxin A (BoNT-A) into the upper esophageal sphincter (UES) in a series of patients with cricopharyngeus (CP) muscle dysfunction associated with pharyngo-laryngeal weakness during at least 1 year follow-up after treatment. Patients who had a cricopharyngeus (CP) muscle dysfunction associated with pharyngo-laryngeal weakness and who were at risk for aspiration were included in the study. The upper border of the cricoid cartilage was identified and the CP muscle localized using a standard electromyogram (EMG). The dose of BoNT-A was determined depending on the results of EMG performed just before the injection. Outcomes were assessed by the penetration-aspiration scale (PAS), the level of residue in the pyriform sinus and the National Institute of Health-Swallow Safety Scale (NIH-SSS) on a video fluoroscopic swallowing (VFSS) assessment, the patient's subjective impressions of their ability to swallow by the Deglutition Handicap Index (DHI), and changes in dietary status by the Functional Oral Intake Scale. Eleven patients underwent the complete assessment of swallowing function at 1, 3, 6, and 12 months. After the first set of treatment, seven patients had a good response and four did not respond. A significant decrease in the PAS score (p = 0.03), the amount of residue (p = 0.04) and the NIH-SSS score (p = 0.03) was observed 3 months after the injection in comparison with the first VFSS before the treatment. A relapse of dysphagia occurred in 3 out of the 11 treated patients; at 3 and 4 months for 2 patients with a Wallenberg syndrome, and at 11 months for a patient with cranial nerve paralysis after a surgery for a glomus tumor. Two of them underwent a second injection. One patient had a good response and remained stable for at least 1 year. The second did not respond either to the second injection or to a myotomy of the cricopharyngeal muscle. The third one is waiting for further surgery (myotomy). Therefore, at the end of the study and after a follow-up of at least 12 months, 5 patients out of the 11 enrolled had a good result. Percutaneous injection of BoNT-A into the UES can be a useful solution to improve cricopharyngeal dysfunction, despite the underlying pharyngo-laryngeal weakness.
Collapse
|
93
|
Humbert IA, Michou E, MacRae PR, Crujido L. Electrical stimulation and swallowing: how much do we know? Semin Speech Lang 2012; 33:203-16. [PMID: 22851342 DOI: 10.1055/s-0032-1320040] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Consequences of dysphagia substantially reduce quality of life, increase the risk of medical complications and mortality, and pose a substantial cost to healthcare systems. As a result, it is of no wonder that the clinical and scientific communities are showing interest in new avenues for dysphagia rehabilitation. Electrical stimulation (e-stim) for the treatment of swallowing impairments is among the most studied swallowing interventions in the published literature, yet many unanswered questions about its efficacy remain. In the meantime, many speech-language pathologists who treat dysphagia are attending educational and training sessions to obtain certifications to use this technique. Here, we review the values and limitations of the published literature on the topic of e-stim for swallowing to assist clinicians in decision making in their clinical practice. The discussion provides a review of swallowing anatomy and physiology, the fundamentals of e-stim, and information essential for the readers' independent critique of these studies--all of which are crucial for evaluating the possible effects of e-stim.
Collapse
Affiliation(s)
- Ianessa A Humbert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland 21231, USA.
| | | | | | | |
Collapse
|
94
|
|
95
|
Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulmonol 2012; 47:321-37. [PMID: 22009835 DOI: 10.1002/ppul.21576] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 08/11/2011] [Indexed: 11/08/2022]
Abstract
Aspiration is a significant cause of respiratory morbidity and sometimes mortality in children. It occurs when airway protective reflexes fail, especially, when dysphagia is also present. Clinical symptoms and physical findings of aspiration can be nonspecific. Advances in technology can lead to early diagnosis of dysphagia and aspiration, and, new therapeutic advances can significantly improve outcome and prognosis. This report first reviews the anatomy and physiology involved in the normal process of swallowing. Next, the protective reflexes that help to prevent aspiration are discussed followed by the pathophysiologic events that occur after an aspiration event. Various disease processes that can result in dysphagia and aspiration in children are discussed. Finally, the various methods for diagnosis and treatment of dysphagia in children are reviewed.
Collapse
Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center, LeBonheur Children's Hospital, St. Jude Children's Research Hospital, Memphis, Tennessee 38103, USA.
| | | |
Collapse
|
96
|
Park JW, Kim Y, Oh JC, Lee HJ. Effortful Swallowing Training Combined with Electrical Stimulation in Post-Stroke Dysphagia: A Randomized Controlled Study. Dysphagia 2012; 27:521-7. [DOI: 10.1007/s00455-012-9403-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/27/2012] [Indexed: 11/29/2022]
|
97
|
Humbert IA, Lokhande A, Christopherson H, German R, Stone A. Adaptation of swallowing hyo-laryngeal kinematics is distinct in oral vs. pharyngeal sensory processing. J Appl Physiol (1985) 2012; 112:1698-705. [PMID: 22403349 DOI: 10.1152/japplphysiol.01534.2011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Before a bolus is pushed into the pharynx, oral sensory processing is critical for planning movements of the subsequent pharyngeal swallow, including hyoid bone and laryngeal (hyo-laryngeal) kinematics. However, oral and pharyngeal sensory processing for hyo-laryngeal kinematics is not fully understood. In 11 healthy adults, we examined changes in kinematics with sensory adaptation, sensitivity shifting, with oropharyngeal swallows vs. pharyngeal swallows (no oral processing), and with various bolus volumes and tastes. Only pharyngeal swallows showed sensory adaptation (gradual changes in kinematics with repeated exposure to the same bolus). Conversely, only oropharyngeal swallows distinguished volume differences, whereas pharyngeal swallows did not. No taste effects were observed for either swallow type. The hyo-laryngeal kinematics were very similar between oropharyngeal swallows and pharyngeal swallows with a comparable bolus. Sensitivity shifting (changing sensory threshold for a small bolus when it immediately follows several very large boluses) was not observed in pharyngeal or oropharyngeal swallowing. These findings indicate that once oral sensory processing has set a motor program for a specific kind of bolus (i.e., 5 ml water), hyo-laryngeal movements are already highly standardized and optimized, showing no shifting or adaptation regardless of repeated exposure (sensory adaptation) or previous sensory experiences (sensitivity shifting). Also, the oral cavity is highly specialized for differentiating certain properties of a bolus (volume) that might require a specific motor plan to ensure swallowing safety, whereas the pharyngeal cavity does not make the same distinctions. Pharyngeal sensory processing might not be able to adjust motor plans created by the oral cavity once the swallow has already been triggered.
Collapse
Affiliation(s)
- Ianessa A Humbert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
| | | | | | | | | |
Collapse
|
98
|
Heck FM, Doeltgen SH, Huckabee ML. Effects of submental neuromuscular electrical stimulation on pharyngeal pressure generation. Arch Phys Med Rehabil 2012; 93:2000-7. [PMID: 22497988 DOI: 10.1016/j.apmr.2012.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/30/2012] [Accepted: 02/16/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the immediate and late effects of submental event-related neuromuscular electrical stimulation (NMES) on pharyngeal pressure generation during noneffortful and effortful saliva swallows. DESIGN Before-after trial. SETTING Swallowing rehabilitation research laboratory. PARTICIPANTS Sex-matched (N=20) healthy research volunteers. INTERVENTIONS Participants received 80Hz NMES of 4-second duration to floor of mouth muscles that was time-locked to 60 volitional saliva swallows. MAIN OUTCOME MEASURES Manometry measures of peak pressures and duration of pressure events in the oropharynx, hypopharynx, and the upper esophageal sphincter (UES) were derived during execution of noneffortful and effortful saliva swallows. Measures were taken at baseline, during stimulation, and at 5-, 30-, and 60-minutes poststimulation. RESULTS Baseline pharyngeal and UES pressures did not differ between stimulated and nonstimulated swallows. At 5- and 30-minutes poststimulation, peak pressure decreased at the hypopharyngeal and at the UES sensor during noneffortful swallows. The effect lasted up to an hour only in the hypopharynx. No changes in duration of pressure events were observed. CONCLUSIONS Using this treatment paradigm, decreased peak amplitude in the hypopharynx up to an hour after treatment indicates a potential risk of decreased bolus flow associated with NMES. On the other hand, decreased UES relaxation pressure may facilitate bolus transit into the esophagus.
Collapse
Affiliation(s)
- Frauke M Heck
- Department of Communication Disorders, University of Canterbury, Van der Veer Institute for Parkinson's and Brain Research, Christchurch, New Zealand.
| | | | | |
Collapse
|
99
|
Lowell SY, Kelley RT, Colton RH, Smith PB, Portnoy JE. Position of the hyoid and larynx in people with muscle tension dysphonia. Laryngoscope 2012; 122:370-7. [DOI: 10.1002/lary.22482] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/21/2011] [Accepted: 11/04/2011] [Indexed: 11/11/2022]
|
100
|
Baijens LWJ, Speyer R, Passos VL, Pilz W, Roodenburg N, Clavé P. The effect of surface electrical stimulation on swallowing in dysphagic Parkinson patients. Dysphagia 2012; 27:528-37. [PMID: 22237722 PMCID: PMC3528961 DOI: 10.1007/s00455-011-9387-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 12/14/2011] [Indexed: 11/24/2022]
Abstract
Surface electrical stimulation has been applied on a large scale to treat oropharyngeal dysphagia. Patients suffering from oropharyngeal dysphagia in the presence of Parkinson's disease have been treated with surface electrical stimulation. Because of controversial reports on this treatment, a pilot study was set up. This study describes the effects of a single session of surface electrical stimulation using different electrode positions in ten patients with idiopathic Parkinson's disease (median Hoehn and Yahr score: II) and oropharyngeal dysphagia compared to ten age- and gender-matched healthy control subjects during videofluoroscopy of swallowing. Three different electrode positions were applied in random order per subject. For each electrode position, the electrical current was respectively turned "on" and "off" in random order. Temporal, spatial, and visuoperceptual variables were scored by experienced raters who were blinded to the group, electrode position, and status (on/off) of the electrical current. Interrater and interrater reliabilities were calculated. Only a few significant effects of a single session of surface electrical stimulation using different electrode positions in dysphagic Parkinson patients could be observed in this study. Furthermore, significant results for temporal and spatial variables were found regardless of the status of the electrical current in both groups suggesting placebo effects. Following adjustment for electrical current status as well as electrode positions (both not significant, P > 0.05) in the statistical model, significant group differences between Parkinson patients and healthy control subjects emerged. Further studies are necessary to evaluate the potential therapeutic effect and mechanism of electrical stimulation in dysphagic patients with Parkinson's disease.
Collapse
Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|