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Fowler LP, Awan SN, Gorham-Rowan M, Morris R. Investigation of Fatigue, Delayed-Onset Muscle Soreness, and Spectral-Based Cepstral Measurements in Healthy Speakers after Neuromuscular Electrical Stimulation. Ann Otol Rhinol Laryngol 2011; 120:641-50. [DOI: 10.1177/000348941112001003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We observed whether 30 minutes of neuromuscular electrical stimulation applied to the necks of healthy speakers would result in significant acoustic changes and perceptions of fatigue and/or delayed-onset muscle soreness (DOMS). Methods: Twelve participants were assigned to experimental (n = 6; 3 male and 3 female) and control groups (n = 6; 3 male and 3 female). Neuromuscular electrical stimulation was applied to the anterior neck in the experimental group only. All participants produced 3 trials of the vowel / a/ and the Rainbow Passage before and after completing a 30-minute phonation protocol. Recorded samples were analyzed for measures of the cepstral peak prominence, the ratio of low- to high-frequency spectral energy, and their respective standard deviations. Perceptions of fatigue and DOMS were rated on visual analog scales before, 5 minutes after, and 24 hours after completion of the phonation protocol. Results: Statistically significant acoustic findings reflecting reduced relative sound pressure level, increased high-frequency noise, and phonatory instability were observed in the experimental group. In addition, reports of fatigue and DOMS were also reported by some participants. Conclusions: A 30-minute dosage may be too high for some people experiencing neuromuscular electrical stimulation for the first time.
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102
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Humbert IA, Joel S. Tactile, gustatory, and visual biofeedback stimuli modulate neural substrates of deglutition. Neuroimage 2011; 59:1485-90. [PMID: 21872665 DOI: 10.1016/j.neuroimage.2011.08.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 08/08/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022] Open
Abstract
It has been well established that swallowing kinematics are modified with different forms of exogenous and endogenous input, however the underlying neural substrates associated with these effects are largely unknown. Our objective was to determine whether the swallowing BOLD response is modulated with heightened sensory modalities (taste, cutaneous electrical stimulation, and visual biofeedback) compared to water ingestion (control) in healthy adults across the age span. Habituation and sensitization were also examined for each sensory condition. Our principal findings are that each sensory swallowing condition activated components of the swallowing cortical network, plus regions associated with the particular sensory modality (i.e. primarily frontal motor planning and integration areas with visual condition). Overall, the insula was most commonly active among the sensory modalities. We also discuss gradual increases and decreases in BOLD signal with repeated exposures for each condition. We conclude that both stimulus- and intention-based inputs have unique cortical swallowing networks relative to their modality. This scientific contribution advances our understanding of the mechanisms of normal swallowing cortical control and has the potential to impact clinical uses of these modalities in treatments for neurogenic dysphagia.
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Affiliation(s)
- Ianessa A Humbert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 98 North Broadway, Suite 403, Baltimore, MD 21231, USA.
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103
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Beom J, Kim SJ, Han TR. Electrical Stimulation of the Suprahyoid Muscles in Brain-injured Patients with Dysphagia: A Pilot Study. Ann Rehabil Med 2011; 35:322-7. [PMID: 22506140 PMCID: PMC3309209 DOI: 10.5535/arm.2011.35.3.322] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 12/27/2010] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the therapeutic effects of repetitive electrical stimulation of the suprahyoid muscles in brain-injured patients with dysphagia. METHOD Twenty-eight brain-injured patients who showed reduced laryngeal elevation and supraglottic penetration or subglottic aspiration during a videofluoroscopic swallowing study (VFSS) were selected. The patients received either conventional dysphagia management (CDM) or CDM with repetitive electrical stimulation of the suprahyoid muscles (ESSM) for 4 weeks. The videofluoroscopic dysphagia scale (VDS) using the VFSS and American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) swallowing scale (ASHA level) was used to determine swallowing function before and after treatment. RESULTS VDS scores decreased from 29.8 to 17.9 in the ESSM group, and from 29.2 to 16.6 in the CDM group. However, there was no significant difference between the groups (p=0.796). Six patients (85.7%) in the ESSM group and 14 patients (66.7%) in the CDM group showed improvement according to the ASHA level with no significant difference between the ESSM and CDM groups (p=0.633). CONCLUSION Although repetitive neuromuscular electrical stimulation of the suprahyoid muscles did not further improve the swallowing function of dysphagia patients with reduced laryngeal elevation, more patients in the ESSM group showed improvement in the ASHA level than those in the CDM group. Further studies with concurrent controls and a larger sample group are required to fully establish the effects of repetitive neuromuscular electrical stimulation of the suprahyoid muscles in dysphagia patients.
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Affiliation(s)
- Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul 110-744, Korea
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104
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Yamamura K, Kitagawa J, Kurose M, Sugino S, Takatsuji H, Mostafeezur RM, Zakir HM, Yamada Y. Neural mechanisms of swallowing and effects of taste and other stimuli on swallow initiation. Biol Pharm Bull 2011; 33:1786-90. [PMID: 21048300 DOI: 10.1248/bpb.33.1786] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Swallowing involves several motor processes such as bolus formation and intraoral transport of a food bolus (oral stage) and a series of visceral events that occur in a relatively fixed timed sequence but are to some degree modifiable (pharyngeal stage or swallow reflex). Reflecting the progressive aging of society, patients with swallowing disorders (i.e., dysphagia) are increasing. Therefore, there is expanding social demand for the development of better rehabilitation treatment of dysphagic patients. To date, many dysphagia diets have been developed and are available commercially to help bring back the pleasure of mealtimes to dysphagia patients. Texture modification of food to make the food bolus easier to swallow with less risk of aspiration is one of the important elements in dysphagia diets from the viewpoint of safety assurance. However, for the further development of dysphagia diets, new attempts based on new concepts are needed. One of the possible approaches is to develop dysphagia diets that facilitate swallow initiation. For this approach, an understanding of the mechanisms of swallow initiation and identification of factors that facilitate or suppress swallow initiation are important. In this review, we first summarize the neural mechanisms of swallowing and effects of taste and other inputs on swallow initiation based on data mainly obtained from experimental animals. Then we introduce a recently established technique for eliciting swallowing using electrical stimulation in humans and our ongoing studies using this technique.
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Affiliation(s)
- Kensuke Yamamura
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University Graduate School of Medical and Dental Sciences, 2–5274 Gakkocho-dori, Chuo-ku, Niigata 951–8514, Japan.
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105
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Kagaya H, Baba M, Saitoh E, Okada S, Yokoyama M, Muraoka Y. Hyoid Bone and Larynx Movements During Electrical Stimulation of Motor Points in Laryngeal Elevation Muscles: A Preliminary Study. Neuromodulation 2011; 14:278-83; discussion 283. [DOI: 10.1111/j.1525-1403.2011.00331.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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106
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An Exploratory Study of Voice Change Associated With Healthy Speakers After Transcutaneous Electrical Stimulation to Laryngeal Muscles. J Voice 2011; 25:54-61. [DOI: 10.1016/j.jvoice.2009.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 07/21/2009] [Indexed: 11/22/2022]
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107
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Langdon C, Blacker D. Dysphagia in stroke: a new solution. Stroke Res Treat 2010; 2010. [PMID: 20721336 PMCID: PMC2915662 DOI: 10.4061/2010/570403] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 05/17/2010] [Accepted: 05/30/2010] [Indexed: 11/27/2022] Open
Abstract
Dysphagia is extremely common following stroke, affecting 13%–94% of acute stroke sufferers. It is associated with respiratory complications, increased risk of aspiration pneumonia, nutritional compromise and dehydration, and detracts from quality of life. While many stroke survivors experience a rapid return to normal swallowing function, this does not always happen. Current dysphagia treatment in Australia focuses upon prevention of aspiration via diet and fluid modifications, compensatory manoeuvres and positional changes, and exercises to rehabilitate paretic muscles. This article discusses a newer adjunctive treatment modality, neuromuscular electrical stimulation (NMES), and reviews the available literature on its efficacy as a therapy for dysphagia with particular emphasis on its use as a treatment for dysphagia in stroke.
There is a good theoretical basis to support the use of NMES as an adjunctive therapy in dysphagia and there would appear to be a great need for further well-designed studies to accurately determine the safety and efficacy of this technique.
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Affiliation(s)
- Claire Langdon
- Speech Pathology Department and Department of Neurology, Sir Charles Gairdner Hospital, Hospital Avenue Nedlands Western Australia 6009, Australia
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108
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Doeltgen SH, Dalrymple-Alford J, Ridding MC, Huckabee ML. Differential Effects of Neuromuscular Electrical Stimulation Parameters on Submental Motor-Evoked Potentials. Neurorehabil Neural Repair 2010; 24:519-27. [DOI: 10.1177/1545968309360417] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Neuromuscular electrical stimulation (NMES) of the muscles underlying the pharynx and faucial pillars affects the excitability of corticobulbar projections in a frequency- and duration-specific manner. The anterior hyomandibular (submental) muscles are primary targets for the clinical application of NMES to improve disordered swallowing, but the optimal NMES parameters for this application are unknown. Objective. To determine the influence of NMES parameters on the excitability of corticobulbar projections to the submental musculature. Methods. Transcranial magnetic stimulation (TMS) was used in event-related protocols, triggered by either volitional contraction of the submental muscles or pharyngeal swallowing, to assess corticobulbar excitability prior to, immediately following, and 30, 60, and 90 minutes post-NMES in 25 healthy volunteers. In the first 2 experiments, 4 stimulus frequencies (5, 20, 40, and 80 Hz) and 3 NMES dosages, manipulated through stimulus train durations or number of repetitions, were evaluated. The optimal excitatory NMES triggered by volitional swallowing (event-related NMES) was then replicated in a new sample and contrasted with non-event-related NMES (either discrete events or continuously for 1 hour). Results. It was found that 80Hz NMES increased motor-evoked potential (MEP) amplitude at 30 minutes and 60 minutes poststimulation only after 60 repetitions of 4-s event-related NMES trains. Non-event-related and continuous NMES did not affect MEP amplitudes. No changes in MEP onset latencies were observed. Conclusions. Changes in corticobulbar excitability induced by NMES of the submental muscle group are frequency and dose dependent and only occur after NMES triggered by volitional swallowing. Underlying neural mechanisms are discussed.
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Affiliation(s)
- Sebastian H. Doeltgen
- University of Canterbury, Christchurch, New Zealand, , Van der Veer Institute for Parkinson's and Brain Research, Christchurch, New Zealand
| | - John Dalrymple-Alford
- University of Canterbury, Christchurch, New Zealand, Van der Veer Institute for Parkinson's and Brain Research, Christchurch, New Zealand
| | - Michael C. Ridding
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Maggie-Lee Huckabee
- University of Canterbury, Christchurch, New Zealand, Van der Veer Institute for Parkinson's and Brain Research, Christchurch, New Zealand
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109
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Clark H, Lazarus C, Arvedson J, Schooling T, Frymark T. Evidence-based systematic review: effects of neuromuscular electrical stimulation on swallowing and neural activation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2009; 18:361-375. [PMID: 19726568 DOI: 10.1044/1058-0360(2009/08-0088)] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To systematically review the literature examining the effects of neuromuscular electrical stimulation (NMES) on swallowing and neural activation. The review was conducted as part of a series examining the effects of oral motor exercises (OMEs) on speech, swallowing, and neural activation. METHOD A systematic search was conducted to identify relevant studies published in peer-reviewed journals from 1960 to 2007. All studies meeting the exclusion/inclusion criteria were appraised for quality and categorized as efficacy or exploratory research based on predetermined criteria. RESULTS Out of 899 citations initially identified for the broad review of OMEs, 14 articles relating to NMES qualified for inclusion. Most of the studies (10/14) were considered exploratory research, and many had significant methodological limitations. CONCLUSIONS This systematic review reveals that surface NMES to the neck has been most extensively studied with promising findings, yet high-quality controlled trials are needed to provide evidence of efficacy. Surface NMES to the palate, faucial pillars, and pharynx has been explored in Phase I research, but no evidence of efficacy is currently available. Intramuscular NMES has been investigated in a single Phase I exploratory study. Additional research is needed to document the effects of such protocols on swallowing performance.
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110
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Kim SJ, Han TR. Effect of Surface Electrical Stimulation of Suprahyoid Muscles on Hyolaryngeal Movement. Neuromodulation 2009; 12:134-40. [DOI: 10.1111/j.1525-1403.2009.00200.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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111
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Effortful Swallowing Training Coupled with Electrical Stimulation Leads to an Increase in Hyoid Elevation During Swallowing. Dysphagia 2009; 24:296-301. [DOI: 10.1007/s00455-008-9205-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 12/11/2008] [Indexed: 10/21/2022]
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112
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Abstract
The neurobiological study of swallowing and its dysfunction, defined as dysphagia, has evolved over two centuries beginning with electrical stimulation applied directly to the central nervous system, and then followed by systematic investigations that have used lesioning, transmagnetic stimulation, magnetoencephalography, and functional magnetic resonance imaging. The field has evolved from mapping the central neural pathway and peripheral nerves, to defining the importance of specific regions of the lower brain stem in terms of interneurons that provide sequential control for multiple muscles in the most complex reflex elicited by the nervous system, the pharyngeal phase of swallowing. The field is now emerging into defining how the higher cortical regions interact with this brain stem control and is providing a broader perspective of how the intact nervous system functions to control the three phases of swallowing (i.e., oral, pharyngeal, and esophageal). Much of the present interest focuses on how to retrain a damaged nervous system using a variety of stimulus techniques, which follow fundamentals in rehabilitation of the nervous system.
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Affiliation(s)
- Arthur J Miller
- Division of Orthodontics, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, California 94143-0438, USA.
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113
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Abstract
Patients who have cancers of the oral cavity, pharynx, or larynx may be treated with surgery, radiotherapy, chemotherapy, or a combination of these modalities. Each treatment type may have a negative impact on posttreatment swallowing function; these effects are presented in this article. A number of rehabilitative procedures are available to the clinician to reduce or eliminate swallowing disorders in patients treated for cancer of the head and neck. The various procedures-including postures, maneuvers, modifications to bolus volume and viscosity, range-of-motion exercises, and strengthening exercises-and their efficacy in patients treated for head and neck cancer are discussed.
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Affiliation(s)
- Barbara R Pauloski
- Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Suite 3-331, Evanston, IL 60208-3540, USA.
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114
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Morello SL, Ducharme NG, Hackett RP, Warnick LD, Mitchell LM, Soderholm LV. Activity of selected rostral and caudal hyoid muscles in clinically normal horses during strenuous exercise. Am J Vet Res 2008; 69:682-9. [DOI: 10.2460/ajvr.69.5.682] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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115
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116
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Abstract
OBJECTIVES/HYPOTHESIS Closure of the true and false vocal folds is a normal part of airway protection during swallowing. Individuals with reduced or delayed true vocal fold closure can be at risk for aspiration and may benefit from intervention to ameliorate the problem. Surface electrical stimulation is currently used during therapy for dysphagia, despite limited knowledge of its physiological effects. DESIGN Prospective single effects study. METHODS The immediate physiological effect of surface stimulation on true vocal fold angle was examined at rest in 27 healthy adults using 10 different electrode placements on the submental and neck regions. Fiberoptic nasolaryngoscopic recordings during passive inspiration were used to measure change in true vocal fold angle with stimulation. RESULTS Vocal fold angles changed only to a small extent during two electrode placements (P < or = .05). When two sets of electrodes were placed vertically on the neck, the mean true vocal fold abduction was 2.4 degrees; while horizontal placements of electrodes in the submental region produced a mean adduction of 2.8 degrees (P = .03). CONCLUSIONS Surface electrical stimulation to the submental and neck regions does not produce immediate true vocal fold adduction adequate for airway protection during swallowing, and one position may produce a slight increase in true vocal fold opening.
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117
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Robbins J, Butler SG, Daniels SK, Diez Gross R, Langmore S, Lazarus CL, Martin-Harris B, McCabe D, Musson N, Rosenbek J. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2008; 51:S276-S300. [PMID: 18230851 DOI: 10.1044/1092-4388(2008/021)] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE This review presents the state of swallowing rehabilitation science as it relates to evidence for neural plastic changes in the brain. The case is made for essential collaboration between clinical and basic scientists to expand the positive influences of dysphagia rehabilitation in synergy with growth in technology and knowledge. The intent is to stimulate thought and propose potential research directions. METHOD A working group of experts in swallowing and dysphagia reviews 10 principles of neural plasticity and integrates these advancing neural plastic concepts with swallowing and clinical dysphagia literature for translation into treatment paradigms. In this context, dysphagia refers to disordered swallowing associated with central and peripheral sensorimotor deficits associated with stroke, neurodegenerative disease, tumors of the head and neck, infection, or trauma. RESULTS AND CONCLUSIONS The optimal treatment parameters emerging from increased understanding of neural plastic principles and concepts will contribute to evidence-based practice. Integrating these principles will improve dysphagia rehabilitation directions, strategies, and outcomes. A strategic plan is discussed, including several experimental paradigms for the translation of these principles and concepts of neural plasticity into the clinical science of rehabilitation for oropharyngeal swallowing disorders, ultimately providing the evidence to substantiate their translation into clinical practice.
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Affiliation(s)
- Joanne Robbins
- University of Wisconsin and William S. Middleton VA Hospital, Geriatric Research Education and Clinical Center, Madison, WI, USA.
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118
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Crary MA, Carnaby-Mann GD, Faunce A. Electrical Stimulation Therapy for Dysphagia: Descriptive Results of Two Surveys. Dysphagia 2007; 22:165-73. [PMID: 17318684 DOI: 10.1007/s00455-006-9068-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 09/12/2006] [Indexed: 10/23/2022]
Abstract
Given the paucity of objective information on neuromuscular electrical stimulation approaches to dysphagia therapy, and the expanding utilization of this clinical approach, we designed and conducted two surveys to gather large-scale information regarding reported practice patterns, outcomes, complications, and professional perceptions associated with electrical stimulation approaches to dysphagia therapy. Self-administered questionnaires were mailed to 1000 randomly selected speech-language pathologists in each of two groups: (1) clinicians who had completed a formal electrical stimulation training course and were actively using these techniques, and (2) clinicians who were members of Special Interest Division 13 of the American Speech-Language and Hearing Association. Survey responses were anonymous and no incentive to respond was included. Acceptable response rates were achieved for both surveys (47% and 48%). Both groups of respondents were demographically similar and reported similar practice patterns. Stroke was the most common etiology of dysphagia treated with this approach. The majority of respondents identified no specific dysphagia criteria for application of electrical stimulation, used varied behavioral treatment methods, and did not follow patients beyond therapy. Clinicians reported positive outcomes with no treatment-related complications. Satisfaction with this approach was reported to be high among patients and professionals. Clinicians who did not report using these techniques indicated that they were waiting for more objective information on clinical outcomes and safety. Results of these surveys form an initial description of practice patterns and outcomes associated with electrical stimulation approaches to dysphagia therapy.
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Affiliation(s)
- Michael A Crary
- Department of Communicative Disorders, College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, Florida 32610, USA.
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