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Dodderi T, Muthukumar V, Hedge PS, Rai SPV, Moolambally SR, Balasubramanium RK, Kothari M. A Survey of Speech-Language Pathologists' Applications of Motor Learning Principles in Dysphagia Therapy in Adults in India. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3745-3762. [PMID: 37672783 DOI: 10.1044/2023_jslhr-23-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE In the study, we investigated whether speech-language pathologists (SLPs) in India use practice and feedback conditions of motor learning principles (MLPs), including biofeedback, in dysphagia therapy in adults using a problem-solution approach. METHOD Based on a literature review and clinical experience, we developed and validated a hypothetical case involving an adult with dysphagia (representing the problem) and a purpose-built 22-item questionnaire (representing the solution). We distributed the questionnaire electronically by sending an e-mail to 2,069 SLPs and also published a flyer on the dysphagia special interest group of India. RESULTS A total of 107 SLPs anonymously submitted their responses. In practice conditions, most of the SLPs reported following massed over distributed, small over large, blocked over random, whole over part, variable over constant, and internal over external practice strategies. In feedback conditions, most of the participants reported using knowledge of results over performance, high over low, immediate over delayed, and self over therapist feedback strategies. Lastly, more than two thirds of SLPs did not use biofeedback devices for dysphagia therapy. CONCLUSION The findings from our study indicate that SLPs in India do not adhere uniformly to the recommended practices of MLPs for dysphagia therapy in adults.
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Affiliation(s)
- Thejaswi Dodderi
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Varsha Muthukumar
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | | | - Santosh P V Rai
- Department of Radio Diagnosis and Imaging, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sheetal Raj Moolambally
- Department of General Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Mohit Kothari
- Hammel Neurorehabilitation Center and University Research Clinic, Department of Clinical Medicine, Aarhus University, Denmark
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Litwin T, Dusek P, Antos A, Członkowska A, Bembenek J. Tackling the neurological manifestations in Wilson's disease - currently available treatment options. Expert Rev Neurother 2023; 23:1249-1259. [PMID: 37842984 DOI: 10.1080/14737175.2023.2268841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Wilson's disease (WD) is a potentially treatable, inherited disorder resulting from impaired copper metabolism. Pathological copper accumulation causes a range of symptoms, most commonly hepatic and a wide spectrum of neurological symptoms including tremor, dystonia, chorea, parkinsonism, dysphagia, dysarthria, gait and posture disturbances. To reduce copper overload, anti-copper drugs are used that improve liver function and neurological symptoms in up to 85% of patients. However, in some WD patients, treatment introduction leads to neurological deterioration, and in others, neurological symptoms persist with no improvement or improvement only after several years of treatment, severely affecting the patient's quality of life. AREAS COVERED This review appraises the evidence on various pharmacological and non-pharmacological therapies, neurosurgical procedures and liver transplantation for the management of neurological WD symptoms. The authors also discuss the neurological symptoms of WD, causes of deterioration and present symptomatic treatment options. EXPERT OPINION Based on case and series reports, current recommendations and expert opinion, WD treatment is focused mainly on drugs leading to negative copper body metabolism (chelators or zinc salts) and copper-restricted diet. Treatment of WD neurological symptoms should follow general recommendations of symptomatic treatment. Patients should be always considered individually, especially in the case of severe, disabling neurological symptoms.
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Affiliation(s)
- Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Agnieszka Antos
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jan Bembenek
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Matos KC, de Oliveira VF, de Oliveira PLC, Carvalho FA, de Mesquita MRM, da Silva Queiroz CG, Marques LM, Lima DLN, Carvalho FMM, Braga-Neto P. Combined conventional speech therapy and functional electrical stimulation in acute stroke patients with dyphagia: a randomized controlled trial. BMC Neurol 2022; 22:231. [PMID: 35733098 PMCID: PMC9215026 DOI: 10.1186/s12883-022-02753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is the main cause of oropharyngeal neurogenic dysphagia. Electrostimulation has been used as a therapeutic tool in these cases. However, there are few studies that prove its effectiveness. We evaluated the effect of functional electrostimulation as a complement to conventional speech therapy in patients with dysphagia after a stroke in a stroke unit. METHODS We performed a clinical, randomized, and controlled trial divided into intervention group (IG) (n = 16) and control group (CG) (n = 17). All patients were treated with conventional speech therapy, and the IG also was submitted to the functional electrotherapy. Primary outcomes were Functional Oral Ingestion Scale (FOIS) and Swallowing videoendoscopy (FEES). The degree of dysphagia was scored in functional, mild, moderate and severe dysphagia according to FEES procedure. Dysphagia Risk Evaluation Protocol (DREP) was considered a secondary outcome. RESULTS There was a significant difference regarding FOIS scores after 5 days of intervention in groups. Both groups also showed a tendency to improve dysphagia levels measured by FEES, although not statistically significant. Improvements on oral feeding was seen in both groups. No significant differences between groups before and after the intervention were detected by DREP scores. Electrical stimulation did not show additional benefits beyond conventional therapy when comparing outcomes between groups. CONCLUSION Conventional speech therapy improved oral ingestion even regardless the use of electrostimulation in a stroke unit. TRIAL REGISTRATION This research was registered in ClinicalTrials.gov (Identifier: NCT03649295 ) in 28/08/2018 and in the Brazilian Registry of Clinical Trials (ReBEC) (Register Number: RBR-56QK5J), approval date: 18/12/2018. HGF Ethics Committee Approval Number: N. 2.388.931.
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Affiliation(s)
- Klayne Cunha Matos
- Speech Therapy Service, Hospital Geral de Fortaleza, Fortaleza, Brazil.,Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | | | | | | | - Levi Mota Marques
- Otorhinolaryngology Service, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | | | - Fernanda Martins Maia Carvalho
- Medical Sciences Post-Graduation Program, Universidade de Fortaleza, Fortaleza, Brazil.,Neurology Department, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil. .,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.
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Andrade PA, Frič M, Otčenášek Z. Assessment of Changes in Laryngeal Configuration and Voice Parameters Among Different Frequencies of Neuromuscular Electrical Stimulation (NMES) and Cumulative Effects of NMES in a Normophonic Subject: A Pilot Study. J Voice 2021:S0892-1997(21)00114-4. [PMID: 34045154 DOI: 10.1016/j.jvoice.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) is a complementary resource to voice therapy that can be used for the treatment of hypofunctional voice disorders. Although positive clinical studies have been reported, neutral and even potentially harmful effects of NMES are also described in the literature. Furthermore, in the studies examined by the authors, the use of different methods of NMES have been identified, which further contributes to the inconsistent results found among studies. Moreover, limited rationale is provided for the chosen NMES parameters such as electrode placement, frequency of NMES and length of treatment. The aims of this pilot study were to investigate the a) impact of different frequencies of NMES on glottal configuration and vocal fold vibration patterns and b) changes in laryngeal configuration and vocal output across 12 minutes of NMES. METHOD Three experiments were carried out looking at changes in laryngeal configuration and voice output using different imaging techniques (fibreoptic nasolaryngoscopy and high-speed video), acoustical analysis (F0, formant analysis, SPL, CPPS and LHSR values), electroglottography (EGG) and Relative Fundamental Frequency (RFF) analyses. Glottal parameters and acoustical measures were recorded before, during, and after stimulation. Data was collected at rest and during phonation. RESULTS Overall the results showed global changes in laryngeal configuration from normal to hyperfunctional (ie, increased RFF, SPL, CQ, and stiffness). Changes were more pronounced for lower frequencies of NMES and were significant within less than three minutes of application. CONCLUSION NMES is an effective resource for the activation of intrinsic laryngeal muscles producing significant levels of adduction within few minutes of application. Lower NMES frequencies produced greater muscle activation when compared to higher frequencies.
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Affiliation(s)
- Pedro Amarante Andrade
- Music and Dance Faculty, Academy of Performing Arts in Prague, Musical Acoustics Research Centre, Prague, Czechia.
| | - Marek Frič
- Music and Dance Faculty, Academy of Performing Arts in Prague, Musical Acoustics Research Centre, Prague, Czechia.
| | - Zdeněk Otčenášek
- Music and Dance Faculty, Academy of Performing Arts in Prague, Musical Acoustics Research Centre, Prague, Czechia.
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Treatment for Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Clinical Effects and Safety of Electroacupuncture for the Treatment of Poststroke Dysphagia: A Comprehensive Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:1560978. [PMID: 33062000 PMCID: PMC7533748 DOI: 10.1155/2020/1560978] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/26/2020] [Accepted: 09/15/2020] [Indexed: 12/01/2022]
Abstract
Objectives Electroacupuncture (EA), an extension of acupuncture, which is based on traditional acupuncture combined with modern electrotherapy, is commonly used for poststroke dysphagia (PSD) in clinical treatment and research. However, there is still a lack of sufficient evidence to recommend the routine use of EA for PSD. The aim of this study was to assess the efficacy and safety of EA in the treatment of PSD. Methods Randomized controlled trials (RCTs) evaluating the effects of EA on PSD were identified through a comprehensive literature search of the PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, and VIP databases from their inception to July 2020. The quality assessment of the included trials was performed based on the guidance of the Cochrane Reviewers' Handbook, and meta-analysis (MA) was performed by using the RevMan 5.3 software. Results Sixteen trials were identified, and these included 1,216 patients with PSD. The results demonstrated that EA in combination with swallowing rehabilitation training (SRT) was significantly superior to SRT alone with regard to effective rate (OR 5.40, 95% CI [3.78, 7.72], P < 0.00001, water swallow test (WST) (MD −0.78, 95% CI [−1.07, −0.50], P < 0.00001), the video fluoroscopic swallowing study (VFSS) (MD 1.47, 95% CI [1.11, 1.84], P < 0.00001), the Ichiro Fujishima Rating Scale (IFRS) (MD 1.94, 95% CI [1.67, 2.22], P < 0.00001), and the incidence of aspiration pneumonia (IAP) (OR 0.20, 95% CI [0.06, 0.61], P=0.005). Conclusions The results showed that EA was better than the control treatment in terms of the effective rate, WST, VFSS, IFRS, and IAP of dysphagia after stroke. Strict evaluation standards and high-quality RCT designs are necessary for further exploration.
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Transcutaneous Electrical Neuromuscular Stimulation (TENS) Along with Traditional Dysphagia Therapy in Patients with Posterior Stroke: A Case Study. Indian J Otolaryngol Head Neck Surg 2020; 72:279-283. [PMID: 32728535 DOI: 10.1007/s12070-019-01714-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022] Open
Abstract
Swallowing is a complicated, multilevel and neuromuscular physiological function. Transcutaneous neuromuscular electrical stimulation is a relatively new therapeutic intervention for the treatment of swallowing disorders. The aim was to administer and focus on pre and post therapy effects of traditional dysphagia therapy and electrical stimulation (TENS) in 2 participants with posterior stroke. Electrical current along with traditional dysphagia therapy on regular intervals with adequate current levels post stroke. These cumulative therapeutic strategies helped in improving the swallowing mechanism. TENS is one of the new therapeutic technique that has greater advantage along with traditional dysphagia therapy, which promises a lot of scope in cases with acute cerebrovascular accidents.
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8
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Serel Arslan S, Azola A, Sunday K, Vose A, Plowman E, Tabor L, Singer M, Robison R, Humbert IA. Effects of Submental Surface Electrical Stimulation on Swallowing Kinematics in Healthy Adults: An Error-Based Learning Paradigm. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1375-1384. [PMID: 30076418 PMCID: PMC6436455 DOI: 10.1044/2018_ajslp-17-0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Hyoid bone and laryngeal approximation aid airway protection (laryngeal vestibule closure) while moving toward their peak superior and anterior positions during swallowing. Submental surface electrical stimulation (SES) is a therapeutic technique that targets the muscles that move the hyoid bone during swallowing. It is unknown whether submental SES only increases peak hyoid bone swallowing positions but not peak laryngeal swallowing positions, which could require faster or greater laryngeal movement to achieve adequate laryngeal vestibule closure. METHOD We examined the effects of submental SES on hyo-laryngeal kinematics in 30 healthy adults who swallowed 50 times using an error-based learning paradigm. RESULTS Submental SES did not alter any hyo-laryngeal swallowing kinematic. However, submental SES significantly changed the starting position of the hyoid bone just prior to the swallow onset (more anterior; p = .003). On average, submental SES immediately prior to swallow onset can position the hyoid approximately 20% closer to its peak swallowing point. CONCLUSIONS These findings indicate that electrical stimulation of the agonists for hyoid movement might not alter swallowing outcomes tested in this study. However, submental SES could have clinical utility by minimizing swallowing impairments related to reduced hyoid swallowing range of motion in individuals with dysphagia.
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Affiliation(s)
| | - Alba Azola
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD
| | - Kirstyn Sunday
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Alicia Vose
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Emily Plowman
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Lauren Tabor
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Michele Singer
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
| | - Raele Robison
- Swallowing Systems Core, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
- Department of Physical Therapy, University of Florida, Gainesville
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9
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The Value of Adding Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) to Traditional Therapy for Poststroke Dysphagia. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Electrical stimulation therapy for dysphagia: a follow-up survey of USA dysphagia practitioners. Int J Rehabil Res 2018; 40:360-365. [PMID: 28704266 DOI: 10.1097/mrr.0000000000000241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare current application, practice patterns, clinical outcomes, and professional attitudes of dysphagia practitioners regarding electrical stimulation (e-stim) therapy with similar data obtained in 2005. A web-based survey was posted on the American Speech-Language-Hearing Association Special Interest Group 13 webpage for 1 month. A total of 271 survey responses were analyzed and descriptively compared with the archived responses from the 2005 survey. Results suggested that e-stim application increased by 47% among dysphagia practitioners over the last 10 years. The frequency of weekly e-stim therapy sessions decreased while the reported total number of treatment sessions increased between the two surveys. Advancement in oral diet was the most commonly reported improvement in both surveys. Overall, reported satisfaction levels of clinicians and patients regarding e-stim therapy decreased. Still, the majority of e-stim practitioners continue to recommend this treatment modality to other dysphagia practitioners. Results from the novel items in the current survey suggested that motor level e-stim (e.g. higher amplitude) is most commonly used during dysphagia therapy with no preferred electrode placement. Furthermore, the majority of clinicians reported high levels of self-confidence regarding their ability to perform e-stim. The results of this survey highlight ongoing changes in application, practice patterns, clinical outcomes, and professional attitudes associated with e-stim therapy among dysphagia practitioners.
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Conde MDCM, Siqueira LTD, Vendramini JE, Brasolotto AG, Guirro RRDJ, Silverio KCA. Transcutaneous Electrical Nerve Stimulation (TENS) and Laryngeal Manual Therapy (LMT): Immediate Effects in Women With Dysphonia. J Voice 2018; 32:385.e17-385.e25. [DOI: 10.1016/j.jvoice.2017.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022]
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Członkowska A, Litwin T, Chabik G. Wilson disease: neurologic features. HANDBOOK OF CLINICAL NEUROLOGY 2018; 142:101-119. [PMID: 28433096 DOI: 10.1016/b978-0-444-63625-6.00010-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Wilson disease (WD) is a neurodegenerative disorder, which presents as a spectrum of neurologic manifestations that includes tremor, bradykinesia, rigidity, dystonia, chorea, dysarthria, and dysphagia, together with a combination of neurologic symptoms that can easily lead to misdiagnosis. An early diagnosis of WD, and appropriate anticopper treatment, usually leads to a marked improvement in patient health. Conversely, delayed diagnosis can result in persistent pathology, which, left untreated, can ultimately prove lethal. The aim of this chapter is to present a detailed description of the neurologic features of WD, including their evaluation, together with relevant ophthalmologic examinations, brain neuroimaging, and other laboratory measurements that show the extent of the involvement of the nervous system.
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Affiliation(s)
- Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland.
| | - Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Grzegorz Chabik
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Hutcheson KA, Barrow MP, Plowman EK, Lai SY, Fuller CD, Barringer DA, Eapen G, Wang Y, Hubbard R, Jimenez SK, Little LG, Lewin JS. Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series. Laryngoscope 2017; 128:1044-1051. [PMID: 28833185 DOI: 10.1002/lary.26845] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/15/2017] [Accepted: 07/13/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE/HYPOTHESIS Expiratory muscle strength training (EMST) is a simple, inexpensive, device-driven exercise therapy. Therapeutic potential of EMST was examined among head and neck cancer survivors with chronic radiation-associated aspiration. STUDY DESIGN Retrospective case series. METHODS Maximum expiratory pressures (MEPs) were examined among n = 64 radiation-associated aspirators (per penetration-aspiration scale score ≥ 6 on modified barium swallow). Pre-post EMST outcomes were examined in a nested subgroup of patients (n = 26) who enrolled in 8 weeks of EMST (25 repetitions, 5 days/week, 75% load). Nonparametric analyses examined effects of EMST on the primary endpoint MEPs. Secondary measures included swallowing safety (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]), perceived dysphagia (M.D. Anderson Dysphagia Inventory [MDADI]), and diet (performance status scale for head and neck cancer patients [PSSHN]). RESULTS Compared to sex-matched published normative data, MEPs were reduced in 91% (58 of 64) of aspirators (mean ± standard deviation: 89 ± 37). Twenty-six patients enrolled in EMST and three patients withdrew. MEPs improved on average 57% (87 ± 29 to 137 ± 44 cm H2 O, P < 0.001) among 23 who completed EMST. Swallowing safety (per DIGEST) improved significantly (P = 0.03). Composite MDADI scores improved post-EMST (pre-EMST: 59.9 ± 17.1, post-EMST: 62.7 ± 13.9, P = 0.13). PSSHN diet scores did not significantly change. CONCLUSION MEPs were reduced in chronic radiation-associated aspirators relative to normative data, suggesting that expiratory strengthening could be a novel therapeutic target to improve airway protection in this population. Similar to findings in neurogenic populations, these data also suggest improved expiratory pressure-generating capabilities after EMST and translation to functional improvements in swallowing safety in chronic radiation-associated aspirators. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1044-1051, 2018.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martha P Barrow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emily K Plowman
- Department of Speech, Language, and Hearing Sciences, The University of Florida, Gainesville, Florida, U.S.A
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Denise A Barringer
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yiqun Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel Hubbard
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah K Jimenez
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Leila G Little
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Affiliation(s)
- Lori Burkhead Morgan
- Department of Neurology, Medical College of Georgia at Augusta University Augusta, GA
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15
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Litwin T, Dušek P, Członkowska A. Symptomatic treatment of neurologic symptoms in Wilson disease. HANDBOOK OF CLINICAL NEUROLOGY 2017; 142:211-223. [PMID: 28433105 DOI: 10.1016/b978-0-444-63625-6.00018-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Wilson disease (WD) is a potentially treatable neurodegenerative disorder. In the majority of cases, treatment with drugs that induce a negative copper balance (usually chelators or zinc salts) leads to improvements in liver function and neurologic signs. However, some patients show severe neurologic symptoms at diagnosis, such as tremor, dystonia, parkinsonism, and chorea. In this patient group, some neurologic deficits may persist despite adequate treatment, and further neurologic deterioration may be observed after treatment initiation. Such patients may require additional treatment to alleviate neurologic symptoms. Apart from general recommendations for WD anticopper treatment, there are currently no guidelines for managing neurologic symptoms in WD. The aim of this chapter is to summarize possible treatments of neurologic symptoms in WD based on the presently available medical literature.
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Affiliation(s)
- Tomasz Litwin
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic; Institute of Neuroradiology, University Medicine Goettingen, Goettingen, Germany
| | - Anna Członkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
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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.
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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
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Litwin T, Dusek P, Czlonkowska A. Neurological manifestations in Wilson’s disease –possible treatment options for symptoms. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1188003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Tomasz Litwin
- II Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
| | - Petr Dusek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Prague, Czech Republic
- Institute of Neuroradiology, University Medicine Goettingen, Goettingen, Germany
| | - Anna Czlonkowska
- II Department of Neurology, Institute Psychiatry and Neurology, Warsaw, Poland
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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]
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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.
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Terré R, Mearin F. A randomized controlled study of neuromuscular electrical stimulation in oropharyngeal dysphagia secondary to acquired brain injury. Eur J Neurol 2015; 22:687-e44. [DOI: 10.1111/ene.12631] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/27/2014] [Indexed: 01/25/2023]
Affiliation(s)
- R. Terré
- Functional Digestion Rehabilitation Unit; Institut Guttmann; Neurorehabilitation Hospital; Barcelona Spain
- Institut Guttmann; Institut Universitari de Neurorehabilitació; Bellaterra (Cerdanyola del Vallès) Spain
- Universitat Autònoma de Barcelona; Bellaterra (Cerdanyola del Vallès) Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol; Badalona Barcelona Spain
| | - F. Mearin
- Functional Digestion Rehabilitation Unit; Institut Guttmann; Neurorehabilitation Hospital; Barcelona Spain
- Institut Guttmann; Institut Universitari de Neurorehabilitació; Bellaterra (Cerdanyola del Vallès) Spain
- Universitat Autònoma de Barcelona; Bellaterra (Cerdanyola del Vallès) Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol; Badalona Barcelona Spain
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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.
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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
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Lee KW, Kim SB, Lee JH, Lee SJ, Ri JW, Park JG. The effect of early neuromuscular electrical stimulation therapy in acute/subacute ischemic stroke patients with Dysphagia. Ann Rehabil Med 2014; 38:153-9. [PMID: 24855608 PMCID: PMC4026600 DOI: 10.5535/arm.2014.38.2.153] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/09/2013] [Indexed: 01/25/2023] Open
Abstract
Objective To compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS). Methods Fifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one patients received NMES combined with TDT (NMES/TDT group) and 26 patients received TDT only (TDT group). Electrical stimulation with a maximal tolerable intensity was applied on both suprahyoid muscles for 30 minutes, 5 days per week during 3 weeks. The swallowing function was evaluated at baseline and 3, 6, and 12 weeks after baseline. Outcomes of the VFSS were assessed using the Functional Oral Intake Scale (FOIS). Results The mean ages were 63.5±11.4 years in the NMES/TDT group and 66.7±9.5 years in the TDT group. Both groups showed a significant improvement on the FOIS after treatment. The FOIS score was significantly more improved at 3 and 6 weeks after baseline in the NMES/TDT group than in the TDT group (p<0.05). Conclusion An early application of NMES combined with TDT showed a positive effect in acute/subacute ischemic stroke patients with dysphagia. These results indicated that the early application of NMES could be used as a supplementary treatment of TDT to help rehabilitate acute/subacute dysphagic stroke patients by improving their swallowing coordination.
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Affiliation(s)
- Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan; Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Sang Beom Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan; Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan; Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan; Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Jae Won Ri
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan; Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
| | - Jin Gee Park
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan; Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Korea
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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.
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Affiliation(s)
- Keiichi Toyama
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital
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Neuromuscular electrical stimulation of the cricothyroid muscle in patients with suspected superior laryngeal nerve weakness. J Voice 2013; 28:216-25. [PMID: 24315659 DOI: 10.1016/j.jvoice.2013.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 09/09/2013] [Indexed: 11/23/2022]
Abstract
In this retrospective case study, we report the apparent clinical effectiveness of neuromuscular electrical stimulation (NMES) in combination with voice therapy (VT) for rehabilitating dysphonia secondary to suspected superior laryngeal nerve (SLN) weakness in two female patients. Both patients failed or plateaued with traditional VT but had significant improvement with the addition of NMES of the cricothyroid muscle and SLN using a VitalStim unit. Stimulation was provided simultaneously with voice exercises based on musical phonatory tasks. Both acoustic analysis and endoscopic evaluation demonstrated important improvements after treatment. In the first patient, the major change was obtained within the primo passaggio region; specifically, a decrease in voice breaks was demonstrated. In the second patient, an improvement in voice quality (less breathiness) and vocal range were the most important findings. Additionally, each patient reported a significant improvement in their voice complaints. Neuromuscular laryngeal electrical stimulation in combination with vocal exercises might be a useful tool to improve voice quality in patients with SLN injury.
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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.
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Affiliation(s)
- L Rofes
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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Beom J, Han TR. Treatment of dysphagia in patients with brain disorders. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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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]
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Lee SY, Yang HE, Yang HS, Lee SH, Jeung HW, Park YO. Neuromuscular Electrical Stimulation Therapy for Dysphagia Caused by Wilson's Disease. Ann Rehabil Med 2012; 36:409-13. [PMID: 22837979 PMCID: PMC3400883 DOI: 10.5535/arm.2012.36.3.409] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 09/19/2011] [Indexed: 11/09/2022] Open
Abstract
Wilson's disease is an autosomal recessive disorder of abnormal copper metabolism. Although dysphagia is a common complaint of patients with Wilson's disease and pneumonia is an important cause of death in these patients, management of swallowing function has rarely been reported in the context of Wilson's disease. Hence, we report a case of Wilson's disease presenting with dysphagia. A 33-year-old man visited our hospital with a complaint of difficulty in swallowing, since about last 7 years and which had worsened since the last 2-3 months. He was diagnosed with Wilson's disease about 13 years ago. On the initial VFSS, reduced hyoid bone movement, impaired epiglottic movement and moderate amount of residue in the valleculae during the pharyngeal phase were noted. After 10 sessions of neuromuscular electrical stimulation for 1 hour per day, decreased amount of residue was observed in the valleculae during the pharyngeal phase on the follow-up VFSS.
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Affiliation(s)
- Seon Yeong Lee
- Department of Physical Medicine & Rehabilitation, Seoul Veterans Hospital, Seoul 134-791, Korea
| | - Hea Eun Yang
- Department of Physical Medicine & Rehabilitation, Seoul Veterans Hospital, Seoul 134-791, Korea
| | - Hee Seung Yang
- Department of Physical Medicine & Rehabilitation, Seoul Veterans Hospital, Seoul 134-791, Korea
| | - Seung Hwa Lee
- Department of Physical Medicine & Rehabilitation, Seoul Veterans Hospital, Seoul 134-791, Korea
| | | | - Young Ok Park
- Korea Tourism College Eldercare Center, Icheon 467-745, Korea
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Xia W, Zheng C, Lei Q, Tang Z, Hua Q, Zhang Y, Zhu S. Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training. ACTA ACUST UNITED AC 2011; 31:73-76. [DOI: 10.1007/s11596-011-0153-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Indexed: 10/18/2022]
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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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McMicken BL, Muzzy CL, Calahan S. Retrospective ratings of 100 first time-documented stroke patients on the Functional Oral Intake Scale. Disabil Rehabil 2010; 32:1163-72. [PMID: 20078206 DOI: 10.3109/09638280903437238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study investigated whether patients originally evaluated on the swallowing portion of the Functional Assessment Measure (SFAM), an instrument that when used independently of the Functional Assessment Measure (FAM) has questionable reliability and validity, would demonstrate clinically and statistically significant gains if measured on an instrument such as the Functional Oral Intake Scale (FOIS), which is valid and reliable. Second, this study questioned how easily the FOIS could be adopted at Rancho Los Amigos National Rehabilitation Center (RLANRC), a rehabilitation facility currently utilising the Functional Independence Measure and the SFAM. Additionally, this research addressed inter-rater reliability, the relationship between the SFAM and FOIS at admission and at discharge, and the clinical and statistical difference in ratings between the two scales. METHOD Treatment was given at RLANRC in Downey, California. Subjects for this study consisted of 100 first time-documented acute stroke patients with swallowing disorders. Inter-item correlation, intraclass correlation coefficients and Spearman Rho Correlations were used to establish inter-rater reliability, and descriptive statistics, Spearman Rho Correlations and the Wilcoxon Signed Ranks Test were used to explore relationships between the two scales. RESULTS It was found that there was high inter-rater reliability, strong significant relationships between the SFAM and FOIS at admission and discharge, and statistically significant differences and clinical change in scores between admission and discharge on the FOIS. CONCLUSION The FOIS is a valid and reliable instrument that is similar in design to the SFAM and requires minimal training for implementation. The transition from the SFAM to the FOIS will provide RLANRC with a reliable and valid assessment protocol.
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Affiliation(s)
- Betty L McMicken
- Department of Communicative Disorders, California State University, Long Beach, CA 90840, USA.
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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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Carnaby-Mann GD, Crary MA. McNeill Dysphagia Therapy Program: A Case-Control Study. Arch Phys Med Rehabil 2010; 91:743-9. [DOI: 10.1016/j.apmr.2010.01.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 11/16/2009] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
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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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Carnaby-Mann GD, Crary MA. Adjunctive neuromuscular electrical stimulation for treatment-refractory dysphagia. Ann Otol Rhinol Laryngol 2008; 117:279-87. [PMID: 18478837 DOI: 10.1177/000348940811700407] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Neuromuscular electrical stimulation (NMES) has been proposed as an adjunctive modality for the treatment of swallowing disorders. We present data from a prospective case series to define and measure effects of a systematic therapy for chronic pharyngeal dysphagia using adjunctive NMES. METHODS Six adult patients with pharyngeal dysphagia received 15 sessions of a standardized protocol of swallowing exercises with adjunctive NMES. The patients completed clinical and instrumental baseline, posttreatment, and 6-month follow-up evaluations. Outcome measures included the proportion of patients who improved in clinical swallowing ability, functional oral intake, and change in body weight; patient perception of swallowing ability; and changes in kinematic aspects of swallowing. RESULTS Significant change was demonstrated for clinical swallowing ability (p < .042), functional oral intake (p < .02), weight gain (p < .026), and patient perception of swallowing ability (p < .043). Hyoid and laryngeal elevation during swallowing demonstrated bolus-specific patterns of change. No patient experienced a treatment-related or swallowing-related complication. Patients (4 of 5) who were followed out to 6 months after treatment maintained functional gains. CONCLUSIONS A systematic therapy for chronic pharyngeal dysphagia using adjunctive NMES produced improvement in clinical swallowing ability and functional oral intake without significant weight loss or complications.
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Affiliation(s)
- Giselle D Carnaby-Mann
- Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, 101 S Newell Dr, PO Box 100175, Gainesville, FL 32610, USA
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