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Lim J, Hyun SE, Kim H, Ryu JS. Residual effect of sequential 4-channel neuromuscular electrical stimulation evaluated by high-resolution manometry. Biomed Eng Online 2024; 23:70. [PMID: 39049019 PMCID: PMC11270850 DOI: 10.1186/s12938-024-01269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND High-resolution manometry (HRM) can quantify swallowing pathophysiology to evaluate the status of the pharynx. Sequential 4-channel neuromuscular electrical stimulation (NMES) was recently developed based on the normal contractile sequences of swallowing-related muscles. This study aimed to examine the effects of sequential 4-channel NMES for compensatory application during swallowing and to observe the residual effects after the application of NMES using HRM. RESULTS Sequential 4-channel NMES significantly improved the HRM parameters, with respect to the maximal pressure and area of the velopharynx (VP), maximal pressure and area of the mesopharynx (MP), and upper esophageal sphincter (UES) activation and nadir duration. Furthermore, the improvement in the pressure and area variables of the VP and MP showed a tendency to maintain even when measured after NMES, but there are no significant differences. CONCLUSIONS The present study suggests that the sequential 4-channel NMES application of the suprahyoid and infrahyoid muscles during swallowing improves the pressure, area, and time variables of the oropharynx, as measured by HRM, and it is likely that the effects may persist even after stimulation. Trial Registration Clinicaltrials.gov, registration number: NCT02718963 (initial release: 03/20/2016, actual study completion date: 06/24/2016, last release: 10/20/2020).
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Affiliation(s)
- Jiwoon Lim
- Department of Rehabilitation Medicine, Korea University Ansan Hospital, Ansan-Si, South Korea
| | - Sung Eun Hyun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hayoung Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-707, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-707, South Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Darwish M, El-Tamawy MS, Mahmoud A, Ali AS, Khalifa HA. The impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2108. [PMID: 38970291 DOI: 10.1002/pri.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/21/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Dysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients. METHODS A single-blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65 years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40 min/session, 1 session/day, and 5 days/week for 4 weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4 weeks of intervention for both groups. RESULTS Before treatment, all patients were susceptible to pneumonia after two and 4 weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p < 0.05) and a statistically significant increase in incidence of SAP after 2 weeks of intervention only in the control group (p < 0.05). The results also showed a significant negative correlation between GUSS score and SAP (r = - 0.3662, p = 0.0018) IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.
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Affiliation(s)
- Moshera Darwish
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Aya Mahmoud
- Department of Physical Therapy for Neurology, Kasr El-Aini hospitals, Cairo University, Cairo, Egypt
| | - Ahmed S Ali
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Al-Qurayyat, Saudi Arabia
| | - Heba A Khalifa
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Al-Qurayyat, Saudi Arabia
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Eskildsen SJ, Hansen CA, Kallemose T, Curtis DJ, Wessel I, Poulsen I. Factors Associated With Time to Decannulation in Patients With Tracheostomy Following Severe Traumatic Brain Injury. Respir Care 2024; 69:566-574. [PMID: 38649274 PMCID: PMC11147609 DOI: 10.4187/respcare.11376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Prolonged tracheal tube placement following severe traumatic brain injury (TBI) can cause serious complications. Safe removal requires sufficient ability for independent breathing and airway protection. Thus, identifying important factors for time to removal of the tracheal tube (decannulation) is essential for safe and efficient weaning. This study aimed to identify significant factors for time to decannulation in a Danish population of subjects with tracheostomy after TBI. METHODS This was a retrospective register-based cohort study. Subjects with moderate and severe TBI and a tracheal tube were selected from the Danish Head Trauma Database between 2011-2021. Time to decannulation was calculated as time from injury to decannulation. Associations between selected explanatory variables representing demographic and clinical characteristics and time to decannulation were analyzed using linear regression models. RESULTS A total 324 subjects were included with a median of 44 d to decannulation. Primary analysis found that an improvement in swallowing ability during the initial 4 weeks of rehabilitation was associated with an 8.2 d reduction in time to decannulation (95% CI -12.3 to -4.2, P < .001). Change in overall sensorimotor ability reduced time to decannulation by 0.94 (95% CI -0.78 to -0.10, P = .03) d. Change in cognitive abilities from rehab admission to 4-week follow-up did not significantly affect the number of days to decannulation (P = .66). Secondary analysis showed pneumonia was associated with the largest estimated increase of 24.4 (95% CI 15.9-32.9, P < .001) d and that increased cognitive functioning at rehabilitation admission was associated with a significant reduction in time to decannulation. CONCLUSIONS This study found that a change in swallowing ability is a potentially significant factor for reducing time to decannulation. Identifying factors that could explain differences in time to decannulation is essential for patient outcomes, especially if these factors are modifiable and could be targeted in rehabilitation and treatment.
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Affiliation(s)
- Signe J Eskildsen
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and Aarhus University, Health, Department of Public Health, Aarhus, Denmark.
| | - Carrinna A Hansen
- Department of Orthopaedic Surgery, Zealand University Hospital, University of Copenhagen, Koege, Denmark; and University of Southern Denmark, the Faculty of Health Sciences, Department of Regional Health Research, Odense, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Derek J Curtis
- Department of Pediatric Rehabilitation, Children's Therapy Center, The Child and Youth Administration, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; and Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital, Denmark; and Aarhus University, Health, Department of Public Health, Aarhus, Denmark
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Molfenter SM, Jones-Rastelli RB, Balou M. Radiographic Magnification on Videofluoroscopy: An Important Variable to Consider for Scaled Analyses of Swallowing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:126-131. [PMID: 37889234 DOI: 10.1044/2023_jslhr-23-00430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE Traditionally, kinematic measures on videofluoroscopy require the use of an external scalar (such as a penny) to transform pixels to absolute distances. Videofluoroscopy is subject to image magnification based on the distance of the feature of interest to the X-ray source. However, the impact of the position/location of the external scalar on swallowing measures is unknown. Our goal was to systematically investigate the accuracy of various common external scalar locations in lateral and anterior-posterior (A-P) view. METHOD U.S. pennies were taped to a styrofoam head in three positions (on the left and right lateral neck and in midline submentally). Locations were measured to ensure equal left and right, as well as midline, placement. A metal screwdriver (6 mm in diameter) was inserted into the premanufactured hole that is centrally located at the bottom of the styrofoam head. The head was centered on a medical tray and placed in the middle of a Siemens Alpha C-arm Fluoroscope field. ImageJ was used to measure penny length in pixels (three locations) in both lateral and A-P views. Penny length was known (19.05 mm), and, therefore, used to derive screwdriver size (for each location) for comparison to the actual screwdriver size. RESULTS All scalars overestimated the screwdriver size ranging from 6.55 to 7.87 mm, representing a 9%-31% inflation. Scalars closer to the X-ray source had the largest magnification. CONCLUSIONS Our results confirm that image magnification of external scalars is a significant source of variability that is currently unaccounted for in the swallowing literature. Recommendations for future research design/measurement methods are provided.
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Affiliation(s)
- Sonja M Molfenter
- Department of Communicative Sciences and Disorders, New York University Steinhardt, New York City
- Rusk Rehabilitation, NYU Langone Health, New York City
| | | | - Matina Balou
- Department of Otolaryngology-Head & Neck Surgery, NYU Langone Health, New York City
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Leydon C, Mital K, DoCarmo J, Gaffney A, Ullucci P. The Impact of Vocal Task on Voice Acoustics, Effort and Discomfort Following Submandibular Neuromuscular Electrical Stimulation in Healthy Adults. J Voice 2023; 37:700-706. [PMID: 34116890 DOI: 10.1016/j.jvoice.2021.04.025] [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: 01/25/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) offers a potential adjuvant to traditional voice therapy for individuals with dysphonia. The type of vocal task to implement in conjunction with electrical stimulation to achieve maximal therapeutic benefit is unknown. The purpose of this study was to elucidate the impact of tasks on voice outcomes. METHODS Nineteen vocally-healthy adult females, between 23 and 27 years of age (Ave: 23.8, SD: 1.13), participated in the study. 15 participants completed all three 30-minute sessions, and four completed at least one session. NMES was paired with three different voice conditions: high-pitched hum, low-pitched hum, and comfortable-pitched hum. Acoustic (average fundamental frequency and loudness; perturbation (jitter, shimmer, noise to harmonic ratio); Cepstral Spectral Index of Dysphonia; pitch range), perceived phonatory effort, and discomfort (delayed onset muscle soreness) measures were compared across conditions. RESULTS Eight participants experienced discomfort following NMES. Three participants withdrew from the study due to discomfort, and one withdrew due to an unrelated oral surgery. NMES paired with high-pitch humming resulted in increased average fundamental frequency during sustained phonation and reading tasks, and increased Cepstral Spectral Index of Dysphonia during sustained phonation. Low-pitch humming resulted in a decreased noise to harmonic ratio. No statistically significant changes in perceived phonatory effort were noted. CONCLUSION Almost half of the participants reported temporary discomfort. Task-specific differences in some outcomes were noted indicating that the nature of voice task performed with NMES must be considered when examining the impact of NMES on voice. Vocal tasks can impact discomfort and acoustic vocal outcomes of NMES.
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Affiliation(s)
- Ciara Leydon
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut.
| | - Kaitlyn Mital
- Department of Physical Therapy and Human Movement, Sacred Heart University, Fairfield, Connecticut; The Spine and Health Center of Closter, Cloister, NJ
| | - Julie DoCarmo
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut; Yale New Haven Hospital, Milford, CT
| | - Annelise Gaffney
- Department of Communication Disorders, Sacred Heart University, Fairfield, Connecticut; AMN Healthcare/ClubStaffing, Kauai, HI
| | - Paul Ullucci
- Department of Physical Therapy and Human Movement, Sacred Heart University, Fairfield, Connecticut; College of Health & Wellness, Johnson & Wales University, Providence, RI
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Lim J, Lee JC, Jang EG, Choi SY, Seo KH, Lee SY, Park D, Oh BM, Seo HG, Ryu JS. Kinematic mechanism of the rehabilitative effect of 4-channel NMES: post-hoc analysis of a prospective randomized controlled study. Sci Rep 2023; 13:13445. [PMID: 37596323 PMCID: PMC10439227 DOI: 10.1038/s41598-023-40359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
The sequential 4-channel neuromuscular electrical stimulation (NMES), based on the normal contractile sequences of swallowing-related muscles, is a new rehabilitative treatment. The objective of this study was to explore the mechanism of the rehabilitative effect of the 4-channel NMES using kinematic analysis of videofluoroscopic swallowing study (VFSS) data. For this post-hoc analysis, we included a subset of participants from the prospective randomized controlled study on the clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES. Seventeen subjects (11 and six in the 4- and 2-channel NMES groups, respectively) were eligible for the kinematic analysis of VFSS data. The hyoid bone movement was analyzed by evaluating the distance and time parameters with four peak points (A, B, C, D). The 4-channel NMES group showed significant improvement in vertical distances (A-C), horizontal distance (A-B, A-C), time interval (A-B-C) and total time, compared with their pretreatment data. The 2-channel NMES group showed significant improvements in time interval (A-B); however, the Euclidean distance (A-D) and mean velocity of the Euclidean distance (A-C) were significantly decreased. When the two groups were directly compared, the 4-channel group showed significantly greater improvement in horizontal distance (A-B), Euclidean distance (A-D), time interval (A-B-C), and mean velocity the Euclidean distance (A-D). The results in this study suggest that the sequential 4-channel NMES might lead to the physiologic circular movement of the hyoid bone during swallowing, and therefore be an effective treatment for dysphagia.Trial registration: Clinicaltrials.gov, registration number: NCT03670498.
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Affiliation(s)
- Jiwoon Lim
- Department of Rehabilitation Medicine, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Jun Chang Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Eun Gyeong Jang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Sun Young Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Kyoung-Ho Seo
- Department of Rehabilitation Medicine, Seongnam Citizen's Medical Center, Seongnam-si, South Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, South Korea
| | - Donghwi Park
- Department of Rehabilitation Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, South Korea.
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Chesney N, Khwaounjoo P, Huckabee ML, Cakmak YO. Non-Contact Assessment of Swallowing Dysfunction Using Smartphone Captured Skin Displacements. SENSORS (BASEL, SWITZERLAND) 2023; 23:5392. [PMID: 37420560 DOI: 10.3390/s23125392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/09/2023]
Abstract
Early and accurate dysphagia diagnosis is essential for reducing the risk of associated co-morbidities and mortalities. Barriers to current evaluation methods may alter the effectiveness of identifying at-risk patients. This preliminary study evaluates the feasibility of using iPhone X-captured videos of swallowing as a non-contact dysphagia screening tool. Video recordings of the anterior and lateral necks were captured simultaneously with videofluoroscopy in dysphagic patients. Videos were analyzed using an image registration algorithm (phase-based Savitzky-Golay gradient correlation (P-SG-GC)) to determine skin displacements over hyolaryngeal regions. Biomechanical swallowing parameters of hyolaryngeal displacement and velocity were also measured. Swallowing safety and efficiency were assessed by the Penetration Aspiration Scale (PAS), Residue Severity Ratings (RSR), and the Normalized Residue Ratio Scale (NRRS). Anterior hyoid excursion and horizontal skin displacements were strongly correlated with swallows of a 20 mL bolus (rs = 0.67). Skin displacements of the neck were moderately to very strongly correlated with scores on the PAS (rs = 0.80), NRRS (rs = 0.41-0.62), and RSR (rs = 0.33). This is the first study to utilize smartphone technology and image registration methods to produce skin displacements indicating post-swallow residual and penetration-aspiration. Enhancing screening methods provides a greater chance of detecting dysphagia, reducing the risk of negative health impacts.
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Affiliation(s)
- Nikyta Chesney
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch 8140, New Zealand
| | - Prashanna Khwaounjoo
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Maggie-Lee Huckabee
- Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch 8140, New Zealand
| | - Yusuf Ozgur Cakmak
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Centre for Bioengineering and Nanotechnology, University of Otago, Dunedin 9054, New Zealand
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Safi M. Assessing Discomfort Levels During Facial Neuromuscular Electrical Stimulation Using Discomfort Level Scale: A Preliminary Study. Indian J Otolaryngol Head Neck Surg 2022; 74:5275-5279. [PMID: 36742910 PMCID: PMC9895512 DOI: 10.1007/s12070-020-02173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
The primary aim of the current study was to evaluate discomfort levels of facial NMES in healthy volunteers. Eight participants completed the Discomfort Level Scale (DLS) following each motor level facial neuromuscular electrical stimulation (NMES) session. Each participant completed 12 sessions of facial NMES for a total of 96 NMES treatments. Pearson product-moment correlation coefficient demonstrated a significant correlation between the facial NMES intensity level and DLS (p < 0.001). This study demonstrated that the DLS is a useful tool to check for discomfort levels in patients who receive facial NMES. Further, this study provides strong support for the tolerability of facial NMES.
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Affiliation(s)
- Mohammed Safi
- Speech Language Pathology, United Arab Emirates University, Al Ain, UAE
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Safi MF, Martin S, Gray L, Ludlow CL. Healthy Volunteers Immediately Adapt to Submental Stimulation During Swallowing. Neuromodulation 2022; 25:1141-1149. [PMID: 34590756 PMCID: PMC8964837 DOI: 10.1111/ner.13537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Transcutaneous stimulation above and below the hyoid is used to assist patients with swallowing disorders (dysphagia) but has shown different effects. Previously, infrahyoid transcutaneous stimulation lowered the hyoid and larynx resisting swallowing movement while suprahyoid stimulation had no effects on hyolaryngeal movement either at rest or during swallowing. More recently, large submental electrodes, covering the submental region, are used for swallowing therapy in combination with resistance therapy. To gain insight into the effects of these electrodes on movement during swallowing, we studied healthy volunteers using videofluoroscopy (VF). We hypothesized that submental electrical stimulation might elevate the hyoid but not the larynx increasing vestibular opening potentially reducing swallowing safety. MATERIALS AND METHODS While undergoing VF, seven healthy volunteers (mean age 51, 5 males) swallowed 5 mL of liquid barium on at least ten trials randomly ordered across three conditions: stimulation at rest, swallowing without stimulation, and swallowing with stimulation. RESULTS During stimulation at rest, significant (one tailed p < 0.05) anterior movement occurred in the hyoid and larynx, no superior hyoid and laryngeal movement and an increase in the distance between the hyoid and larynx. When comparing swallowing with and without submental stimulation, during stimulation volunteers significantly reduced anterior hyoid motion (p = 0.028) and increased hyoid elevation (p = 0.043) without changing anterior or superior laryngeal movement or the distance between the hyoid and larynx. CONCLUSIONS The healthy volunteers immediately corrected for the effects of submental stimulation by reducing hyoid anterior motion and increasing superior hyoid motion without changing laryngeal motion to prevent increased vestibule opening with stimulation. This suggests that healthy volunteers had an internal schema for swallowing movement patterning with feedforward correction for the effects of stimulation.
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Affiliation(s)
- Mohammed F Safi
- Laryngeal and Speech Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
| | - Sandra Martin
- Laryngeal and Speech Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Lincoln Gray
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - Christy L Ludlow
- Laryngeal and Speech Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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Hwang NK, Park JS, Choi JB, Jung YJ. Effect of Peripheral Magnetic Stimulation for Dysphagia Rehabilitation: A Systematic Review. Nutrients 2022; 14:3514. [PMID: 36079772 PMCID: PMC9460190 DOI: 10.3390/nu14173514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
Recently, a therapeutic method to stimulate the suprahyoid muscle using peripheral magnetic stimulation for dysphagia rehabilitation has been reported. However, clinical evidence, application protocol, and intervention method remain unclear. Therefore, a systematic review of the published literature is needed. The objective of this study was to systematically review clinical studies of peripheral magnetic stimulation applied for rehabilitation of dysphagia. Issues to be considered in future studies are also suggested. This systematic review performed a literature search of four databases (Medline, Embase, CINAHL, and Web of Science) to identify relevant studies published on the application of repetitive peripheral magnetic stimulation (rPMS) for swallowing-related muscles between 2010 and 2022. Seven studies were reviewed. Randomized controlled trials and one-group pre-post, case study designs were included. In the included studies, rPMS was applied to strengthen the submental suprahyoid muscles. The intervention regime varied. The rPMS was applied at a frequency of 30 Hz for 2 s. Rest time ranged from 8 s to 27-28 s. The number of intervention sessions ranged from 2-3 to 30. The intensity ranged from pain-inducing minimum intensity (90% of maximum stimulus output) to non-painful intensity (70-80% of maximum intensity). The rPMS on the suprahyoid muscles had positive effects on physiological changes in the swallowing function, such as displacement of the hyoid bone, muscle strength (cervical flexor, jaw-opening force), swallowing safety, swallowing performance, and swallowing-related quality of life. Participants also reported little pain and adverse reactions during rPMS. Although rPMS is a therapeutic option that can help improve the swallowing function as a non-invasive stimulation method in the rehabilitation of dysphagia, clinical evidence is needed for the development of clear stimulation protocols and guidelines.
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Affiliation(s)
- Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul 02062, Korea
| | - Ji-Su Park
- Research Institute for Korean Medicine, Pusan National University, Yangsan 50612, Korea
| | - Jong-Bae Choi
- Department of Occupational Therapy, Sangji University, Wonju 26339, Korea
| | - Young-Jin Jung
- School of Healthcare and Biomedical Engineering, Chonnam National University, Yeosu 59626, Korea
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Doan TN, Ho WC, Wang LH, Chang FC, Tran TTQ, Chou LW. Therapeutic Effect and Optimal Electrode Placement of Transcutaneous Neuromuscular Electrical Stimulation in Patients with Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Life (Basel) 2022; 12:life12060875. [PMID: 35743906 PMCID: PMC9225155 DOI: 10.3390/life12060875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/29/2022] Open
Abstract
Background: To date, there is no conclusive evidence that transcutaneous neuromuscular electrical stimulation (TNMES) benefits patients with post-stroke dysphagia (PSD). In addition, the optimal TNMES electrode placement has not been well-established. This systematic review and meta-analysis were conducted to investigate these two research gaps. Methods: Five major databases were systematically searched for randomized controlled trials (RCTs) through January 2022. Effect sizes were computed using Hedges’ g statistic, which were then entered into the random-effects model to obtain pooled effect estimates. Results: Twenty-four RCTs met the eligibility criteria. On the improvement of swallowing function, TNMES alone was not superior to conventional swallowing therapies (CSTs); combined therapy of TNMES and CSTs significantly surpassed CSTs alone (standardized mean difference (SMD) = 0.91, 95% confidence interval (95% CI): 0.68 to 1.14, p < 0.0001; I2 = 63%). Moreover, significant pooled effect sizes were observed in subgroups with horizontal electrode placement above the hyoid bone (SMD = 0.94, 95% CI: 0.72 to 1.16; I2 = 0%) and horizontal electrode placement just above and below the hyoid bone (SMD = 0.87, 95% CI: 0.59 to 1.14; I2 = 0%). The largest pooled effect size was observed in the subgroup that individualized electrode placement according to dysphagia evaluation (SMD = 1.65, 95% CI: 0.38 to 2.91; I2 = 90%). Conclusion: TNMES should be used in combination with CSTs for PSD. Horizontal electrode placement should target suprahyoid muscles or both suprahyoid and thyrohyoid muscles.
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Affiliation(s)
- Thanh-Nhan Doan
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (T.-N.D.); (W.-C.H.)
- Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Quang Nam 560000, Vietnam
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung 406040, Taiwan; (T.-N.D.); (W.-C.H.)
| | - Liang-Hui Wang
- Department of Speech Language Pathology and Auditory, HungKuang University, Taichung 433304, Taiwan;
- Ph.D. Program for Aging, China Medical University, Taichung 404332, Taiwan;
| | - Fei-Chun Chang
- Ph.D. Program for Aging, China Medical University, Taichung 404332, Taiwan;
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
| | - Trang Thi Quynh Tran
- Faculty of Rehabilitation, University of Medicine and Pharmacy, Hue University, Thành phố Huế 530000, Vietnam;
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413505, Taiwan
- Correspondence: or
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Takahashi N, Barikroo A, Crary MA, Dungan S, Carnaby GD. Transcutaneous Electrical Stimulation as a Resistance Force in Lingual Exercise: A Preliminary Proof-of-Concept Study. J Oral Rehabil 2022; 49:712-719. [PMID: 35397191 DOI: 10.1111/joor.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited knowledge exists regarding whether transcutaneous electrical stimulation (TES) based exercise can improve the lingual pressure generation. OBJECTIVES To compare the effect of submental TES with two different pulse durations (PD) coupled with isometric lingual exercises on lingual pressure measures. METHODS Twenty-eight healthy volunteers were divided into two submental TES groups: short PD (300 μs) and long PD (700 μs). The Iowa Oral Performance Instrument (IOPI) was used for lingual pressure measurements and exercise. In total, participants attended six exercise sessions three days per week for two consecutive weeks. Maximum and swallowing lingual pressures were measured one hour following each exercise session and three days after the final session to assess any detraining effect. Data were analyzed using repeated measure ANOVA. RESULTS Mean maximum lingual pressure change was significantly greater in TES with short PD versus the long PD condition following the first week of exercise. Following the two-week exercise, a significant increase was found in mean maximum lingual pressure for short and long PD conditions compared with the baseline. However, no significant difference was found between PD conditions for maximum lingual pressure. Likewise, no significant differences in swallowing lingual pressure were found compared with the baseline or across the two TES conditions. CONCLUSION Although short PD induced greater gain in maximum lingual pressure than the long PD after week 1, the enhanced effect faded after week 2, leading to a comparable increase in maximum lingual pressure for both groups. However, increased gain in maximum lingual pressure was not transferred to lingual pressure during swallowing.
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Affiliation(s)
- Noriaki Takahashi
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University, Tama Oral Rehabilitation Clinic, Tokyo, Japan
| | - Ali Barikroo
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, OH, USA
| | | | | | - Giselle D Carnaby
- School of Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
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Ogura M, Matsumoto S, Ohama R, Ohama Y, Arima H, Takenaka K, Toyama K, Ikegami T, Shimodozono M. Immediate Effects of Electrical Stimulation on Oropharyngeal Structure and Laryngeal Vestibular Closure: A Pilot Study in Healthy Subjects. Prog Rehabil Med 2022; 7:20220033. [PMID: 35860706 PMCID: PMC9262636 DOI: 10.2490/prm.20220033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michihiro Ogura
- Department of Rehabilitation, Kagoshima University Hospital, Kagoshima, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation and Physical Medicine, Mito Clinical Education and Training Center, Tsukuba University Hospital, Mito-kyodo Hospital, Mito, Japan
| | - Rintaro Ohama
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yumi Ohama
- Neurosurgery Center, Ichikikushikino Medical Association, Kagoshima, Japan
| | - Haruka Arima
- Department of Rehabilitation, Kagoshima University Hospital, Kagoshima, Japan
| | - Keita Takenaka
- Department of Rehabilitation, Tarumizu Municipal Medical Center, Tarumizu Chuo Hospital, Kagoshima, Japan
| | - Keiichi Toyama
- Department of Speech Language-Hearing Therapy, Faculty of Allied Health Sciences, Yamato University, Osaka, Japan
| | | | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Mayerl CJ, Steer KE, Chava AM, Bond LE, Edmonds CE, Gould FDH, Hieronymous TL, Vinyard CJ, German RZ. Anatomical and physiological variation of the hyoid musculature during swallowing in infant pigs. J Exp Biol 2021; 224:jeb243075. [PMID: 34734633 PMCID: PMC10659033 DOI: 10.1242/jeb.243075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
The function of a muscle is impacted by its line of action, activity timing and contractile characteristics when active, all of which have the potential to vary within a behavior. One function of the hyoid musculature is to move the hyoid bone during swallowing, yet we have little insight into how their lines of action and contractile characteristics might change during a swallow. We used an infant pig model to quantify the contractile characteristics of four hyoid muscles during a swallow using synchronized electromyography, fluoromicrometry and high-speed biplanar videofluoroscopy. We also estimated muscle line of action during a swallow using contrast-enhanced CT-scanned muscles animated to move with the hyoid bone and found that as the hyoid elevated, the line of action of the muscles attached to it became greater in depression. We also found that muscles acted eccentrically and concentrically, which was correlated with hyoid movement. This work contributes to our understanding of how the musculature powering feeding functions during swallowing.
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Affiliation(s)
- Christopher J. Mayerl
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Kendall E. Steer
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Almasi M. Chava
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Laura E. Bond
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Chloe E. Edmonds
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Francois D. H. Gould
- Department of Cell Biology and Neuroscience, Rowan School of Osteopathic Medicine, Stratford, NJ 08084, USA
| | - Tobin L. Hieronymous
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Christopher J. Vinyard
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
| | - Rebecca Z. German
- NEOMED Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44, PO Box 95, Rootstown, OH 44272, USA
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15
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Nagashima Y, Kagaya H, Toda F, Aoyagi Y, Shibata S, Saitoh E, Abe K, Nakayama E, Ueda K. Effect of electromyography-triggered peripheral magnetic stimulation on voluntary swallow in healthy humans. J Oral Rehabil 2021; 48:1354-1362. [PMID: 34499762 DOI: 10.1111/joor.13256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 07/24/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electrical stimulation therapy is effective for patients with dysphagia. However, because of the pain, strong stimulation cannot be applied. Although magnetic stimulation induces less pain, there are no reports on magnetic stimulation being synchronised with a swallowing reflex. OBJECTIVE This study aimed to determine whether it is possible to induce magnetic stimulation during a voluntary swallowing using electromyography (EMG)-triggered peripheral magnetic stimulation and to evaluate its effect on healthy individuals. METHODS A total of 20 healthy adults in seated position were instructed to swallow saliva and 10 ml of barium under videofluoroscopy. For concomitant use of magnetic stimulation, a magnetic stimulus for suprahyoid muscles at 30 Hz frequency was applied for 2 s when the EMG level in the sternohyoid muscle exceeded the threshold. During the voluntary swallowing, the movement of the hyoid bone and opening width of the upper oesophageal sphincter (UES) were measured. Furthermore, pressure topography was evaluated in 6 subjects using high-resolution manometry. RESULTS The magnetic stimulation significantly extended the movement time of the hyoid bone (p < 0.001). During liquid deglutition, significant increases were observed in the anterior maximum movement distance of the hyoid bone (p < 0.05), opening width of the UES (p < 0.001) and anterior movement distance of the hyoid bone at the maximum UES opening (p < 0.01). In the pressure topography, the maximum pressure immediately after UES closure significantly decreased with magnetic stimulation (p < 0.05). CONCLUSION EMG-triggered peripheral magnetic stimulation made it possible to apply magnetic stimulation during a voluntary swallowing.
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Affiliation(s)
- Yuki Nagashima
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.,Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Fumi Toda
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kimiko Abe
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo, Japan
| | - Enri Nakayama
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo, Japan
| | - Koichiro Ueda
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo, Japan
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Lee SY, Park D, Jang J, Jang EG, Lee JC, Park Y, Cho S, Kim WS, Park J, Kim BR, Seo KH, Park S, Ryu JS. Compensatory Effects of Sequential 4-Channel Neuromuscular Electrical Stimulation for the Treatment of Acute, Subacute, and Chronic Dysphagia in a Prospective, Double-Blinded Randomized Clinical Trial. Neurorehabil Neural Repair 2021; 35:801-811. [PMID: 34218702 DOI: 10.1177/15459683211029891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The precise mechanism of 2-channel neuromuscular electrical stimulation (NMES) treatment is unknown, and controversy remains over its efficacy. The sequential 4-channel NMES was newly developed based on normal contractile sequences of swallowing-related muscles. Objective. To assess the clinical efficacy of sequential 4-channel NMES during swallowing. Methods. In this prospective RCT, 52 inpatients with dysphagia (acute, subacute, and chronic state) after stroke, brain tumor, or encephalitis were enrolled. Participants who underwent a videofluoroscopic swallowing study (VFSS) and clinical evaluation were enrolled and were randomly assigned to the 4-channel NMES or sham group. The 4-channel NMES and sham groups swallowed thin and honey-like fluids under NMES (sequential stimulation on suprahyoid and infrahyoid) and sham stimulation, respectively. The procedures were evaluated with the VFSS. Pre- and post-treatment evaluations were performed with the videofluoroscopic dysphagia scale (VDS), penetration-aspiration scale (PAS), Likert scale, and kinematic analysis. Results. The 4-channel NMES group showed significantly greater improvements than the sham group with respect to oral VDS, pharyngeal VDS, total VDS, and PAS (P < .05). Furthermore, the Likert scale for satisfaction, easiness, and discomfort for swallowing showed favorable results for the 4-channel NMES group (P < .05). In the kinematic analysis, the peak speed point, distance, and velocity of hyoid movement were significantly greater in the 4-channel NMES group (P < .05). Conclusions. Sequential 4-channel NMES activating the suprahyoid, thyrohyoid, and other infrahyoid muscles during swallowing showed significant clinical improvement with respect to VDS, PAS, and kinematic analysis. Therefore, sequential 4-channel NMES is a potential new functional electrical stimulation system for the treatment of dysphagia.
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Affiliation(s)
- So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, South Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Joonyoung Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Gyeong Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jun Chang Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yulhyun Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seon Cho
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jihong Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, South Korea
| | - Kyoung-Ho Seo
- Department of Rehabilitation Medicine, Seongnam Citizen's Medical Center, Seongnam, South Korea
| | - Sungwon Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Seo KH, Jang J, Jang EG, Park Y, Lee SY, Kim BR, Park D, Park S, Hwang H, Kim NH, Oh BM, Seo HG, Lee JC, Ryu JS. Clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES for the treatment of dysphagia in a prospective double-blind randomized controlled study. J Neuroeng Rehabil 2021; 18:90. [PMID: 34059092 PMCID: PMC8165767 DOI: 10.1186/s12984-021-00884-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Background To date, conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles. Objective To evaluate and compare the rehabilitative effectiveness of the sequential 4-channel NMES with that of conventional 2-channel NMES. Methods In this prospective randomized case–control study, 26 subjects with dysphagia were enrolled. All participants received 2- or 4-channel NMES for 2–3 weeks (minimal session: 7 times, treatment duration: 300–800 min). Twelve subjects in the 4-channel NMES group and eleven subjects in the 2-channel NMES group completed the intervention. Initial and follow-up evaluations were performed using the videofluoroscopic dysphagia scale (VDS), the penetration-aspiration scale (PAS), the MD Anderson dysphagia inventory (MDADI), the functional oral intake scale (FOIS), and the Likert scale. Results The sequential 4-channel NMES group experienced significant improvement in their VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical subsets) scores, based on their pretreatment data. VDS (oral, pharyngeal, and total) and MDADI (emotional and physical subsets) scores, but not PAS and FOIS scores, significantly improved in the 2-channel NMES group posttreatment. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS scores. Conclusions The sequential 4-channel NMES, through its activation of the suprahyoid and thyrohyoid muscles, and other infrahyoid muscles mimicking physiological activation, may be a new effective treatment for dysphagia. Trial registration: clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00884-6.
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Affiliation(s)
- Kyoung-Ho Seo
- Department of Rehabilitation Medicine, Seongnam Citizen's Medical Center, Seongnam-si, South Korea
| | - Joonyoung Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Eun Gyeong Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Yulhyun Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju-do, South Korea
| | - Bo Ryun Kim
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, South Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
| | - Sungwon Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Hyeoncheol Hwang
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, South Korea
| | - Nam Hun Kim
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jun Chang Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
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18
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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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19
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Effect of Submental Surface Neuromuscular Stimulation on Laryngeal Vestibule Opening in Healthy Volunteers at Rest and During Swallowing. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Hwang JM, Jung H, Kim CH, Lee YS, Lee M, Hwang SY, Kim AR, Park D. Submandibular Push Exercise Using Visual Feedback from a Pressure Sensor in Patients with Swallowing Difficulties: A Pilot Study. Healthcare (Basel) 2021; 9:407. [PMID: 33916285 PMCID: PMC8065833 DOI: 10.3390/healthcare9040407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: We aimed to determine the usefulness and effectiveness of a submandibular push exercise with visual feedback from a pressure sensor in patients with dysphagia through continuous exercise sessions. Methods: Twelve patients with dysphagia of various etiologies were included. A total of five exercise sessions (every 3 or 4 days) over three weeks were conducted. During the submandibular push exercise, patients were instructed to maintain a maximum force for 3 s, repeated for 1 min to measure the number of exercises, the maximum pressure, and the area of the pressure-time graph. We statistically compared the values of each exercise trial. Results: Among the 12 patients, eight completed the exercise sessions. As the number of exercise trials increased, the maximum pressure and the area in the pressure-time graph showed a significant increase compared to the previous attempt (p < 0.05). The maximum pressure and the area of the pressure-time graph improved from the first to the fourth session (p < 0.05). The values were maintained after the fourth session, and there was no significant difference between the fourth and the fifth exercise (p > 0.05). There was no significant difference between successful and non-successful groups, except for the Modified Barthel Index (p < 0.05). Conclusion: Through repetitive exercise training, the submandibular push exercise using visual feedback from a pressure sensor can be applied as an exercise method to strengthen swallowing related muscles, such as the suprahyoid and infrahyoid muscles. However, additional studies including more patients and a long-term study period are warranted to evaluate the effects of the exercise for improvement of dysphagia.
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Affiliation(s)
- Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (J.-M.H.); (H.J.); (C.-H.K.); (Y.-S.L.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Hyunwoo Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (J.-M.H.); (H.J.); (C.-H.K.); (Y.-S.L.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (J.-M.H.); (H.J.); (C.-H.K.); (Y.-S.L.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (J.-M.H.); (H.J.); (C.-H.K.); (Y.-S.L.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Myunghwan Lee
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu 41061, Korea; (M.L.); (S.Y.H.)
| | - Soo Yeon Hwang
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu 41061, Korea; (M.L.); (S.Y.H.)
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (J.-M.H.); (H.J.); (C.-H.K.); (Y.-S.L.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea
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21
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Chang MC, Park S, Cho JY, Lee BJ, Hwang JM, Kim K, Park D. Comparison of three different types of exercises for selective contractions of supra- and infrahyoid muscles. Sci Rep 2021; 11:7131. [PMID: 33785793 PMCID: PMC8010107 DOI: 10.1038/s41598-021-86502-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/16/2021] [Indexed: 01/25/2023] Open
Abstract
Several exercise methods, such as the Shaker exercise, tongue press exercise, chin tuck against resistance (CTAR) exercise, and submandibular push exercise, have been introduced to strengthen the muscles involved in swallowing. In this study, we compared the effectiveness of the CTAR, submandibular push, and Shaker exercises for the induction of selective supra- and infrahyoid muscle contractions using surface electromyography (EMG). This study is a prospective non-randomized controlled study. Twenty-five healthy subjects and 20 patients experiencing swallowing difficulty were enrolled. During the three different types of exercises, the root mean square (RMS) values of the sternocleidomastoid (SCM), suprahyoid (anterior belly of the digastric and mylohyoid muscles), and infrahyoid (sternothyroid and thyrohyoid muscles) muscles were analyzed using surface EMG. Differences in the activity of swallowing muscles among the three different exercises were analyzed using one-way repeated measured analysis of variance. In terms of both the maximum and mean RMS values of the suprahyoid muscle, the submandibular push exercise showed a larger RMS value than the CTAR and Shaker exercises in healthy subjects (p < 0.05). In terms of both the maximum and mean RMS values of the suprahyoid muscle, the Shaker exercise and submandibular push exercise showed a larger RMS value than the CTAR exercise in patients with swallowing difficulty (p < 0.05). The submandibular push exercise may be effective as a swallowing muscle exercise owing to its superiority in inducing selective contractions of the supra- and infrahyoid muscles. The CTAR and Shaker exercises are also effective in this regard.
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Affiliation(s)
- Min Cheol Chang
- Department of Rehabilitation Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Sungwon Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Joo Young Cho
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Byung Joo Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - KwanMyung Kim
- Graduate School of Creative Design Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
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22
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Barikroo A, Clark AL. Effects of Varying Transcutaneous Electrical Stimulation Pulse Duration on Swallowing Kinematics in Healthy Adults. Dysphagia 2021; 37:277-285. [PMID: 33656633 DOI: 10.1007/s00455-021-10276-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Prior research in swallowing physiology has suggested that using submental transcutaneous electrical stimulation (TES) with short pulse duration (PD) (300 μs) may enhance the impact on deep extrinsic tongue muscles, thereby pulling the tongue down during swallowing. However, it was unclear whether that same TES protocol could have a differential impact on hyolaryngeal kinematics and timing. This study aimed to compare the effect of submental TES with varying PDs on anterior and superior hyolaryngeal kinematics and timing both at rest and during swallowing in healthy adults. Twenty-four healthy adults between the ages of 22 and 77 participated in this study. Anterior and superior hyolaryngeal excursion magnitude and duration measures were collected using videofluoroscopic swallowing study. Each subject swallowed three 10 ml pudding trials under three conditions: no TES, TES with short PD (300 μs), and TES with long PD (700 μs). TES was delivered using two-channel surface electrodes in the submental area. In both short and long PD conditions, TES amplitude was gradually increased until participants reached their maximum tolerance level. Videofluoroscopic data were analyzed using VideoPad Video Editor and Image J programs. One-way repeated measure ANOVAs were conducted to identify within-subject effect of TES condition. For hyoid movement, TES with short PD selectively placed the hyoid bone on a more anterior position at rest and reduced anterior hyoid excursion during swallowing compared with the no TES condition. Regarding laryngeal movement, both TES protocols resulted in the larynx taking on a more anterior position at rest and reduced anterior laryngeal excursions during swallowing when compared with the no TES condition. Varying PDs had no significant effect on the superior hyoid and laryngeal movements at rest and during swallowing. Both TES protocols induced shorter hyoid elevation duration during swallowing Findings suggest that though both TES protocols demonstrated a comparable impact on reducing anterior laryngeal excursions, the TES protocol with short PD had an enhanced effect on reducing anterior hyoid excursion during swallowing. This reduced range of motion may result from stimulating the deep submental muscles, which primarily place the hyoid and larynx into a more forward position before swallowing onset. Overall, the TES protocol with short PD may have an increased benefit in facilitating swallowing in patients with dysphagia.
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Affiliation(s)
- Ali Barikroo
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, OH, USA. .,Speech Pathology & Audiology Program, School of Health Sciences, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA.
| | - Alexis L Clark
- Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, OH, USA
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23
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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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24
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Oh DH, Park JS, Kim HJ, Chang MY, Hwang NK. The effect of neuromuscular electrical stimulation with different electrode positions on swallowing in stroke patients with oropharyngeal dysphagia: A randomized trial. J Back Musculoskelet Rehabil 2020; 33:637-644. [PMID: 31594198 DOI: 10.3233/bmr-181133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the effects of neuromuscular electrical stimulation (NMES) on oropharyngeal swallowing function according to 2 types of placement, acting as assistance and as resistance, in stroke patients with dysphagia. METHODS Thirty-eight stroke patients with dysphasia were randomly assigned to the suprahyoid group (SMG), or infrahyoid muscle group (IMG); 26 patients completed the intervention and were included in the analysis. In the SMG, the electrodes were placed on the region between the jaw and the hyoid bone, whereas in the IMG, the electrodes were placed on the region below the hyoid for the targeted infrahyoid muscles. Both groups received NMES for 30 min/d, 5 d/wk, for 4 weeks and conventional dysphagia therapy. Swallowing function was measured using the Videofluoroscopic Dysphagia Scale and Penetration-Aspiration Scale based on videofluoroscopic swallowing study. Oral dietary intake was measured using the Functional Oral Intake Scale. RESULTS Both groups showed significant improvements in oropharyngeal function and level of functional oral intake, but there was no significant difference between the two groups. However, the SMG showed a more reduced penetration-aspiration, compared with the IMG. CONCLUSIONS Altogether, these data demonstrate that 2 types of NMES placements have a similar effect on improving swallowing function and oral diet intake in patients with dysphagia.
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Affiliation(s)
- Dong-Hwan Oh
- Department of Occupational Therapy, Kyung-Dong University, Korea
| | - Ji-Su Park
- Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, DongSeo University, Korea
| | - Hee-Jeong Kim
- Department of Occupational Therapy, Kyung-Dong University, Korea
| | - Moon-Young Chang
- Department of Occupational Therapy, College of Healthcare Medical Science and Engineering, Inje University, Korea
| | - Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Korea
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25
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Costa DR, Santos PSDS, Fischer Rubira CM, Berretin-Felix G. Immediate effect of neuromuscular electrical stimulation on swallowing function in individuals after oral and oropharyngeal cancer therapy. SAGE Open Med 2020; 8:2050312120974152. [PMID: 33403111 PMCID: PMC7739140 DOI: 10.1177/2050312120974152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/26/2020] [Indexed: 02/04/2023] Open
Abstract
Objective To analyze the immediate effect of sensory and motor neuromuscular electrical stimulation, in oral and pharyngeal stages of swallowing, in individuals after oral and oropharyngeal cancer therapy. Methods The study was conducted on 10 individuals (mean age of 58 years) submitted to oral and oropharyngeal cancer therapy. The individuals were submitted to videofluoroscopy, during which they were randomly asked to swallow 5 mL of liquid, honey, and pudding, in three conditions: without stimulation, with sensory neuromuscular electrical stimulation, and with motor neuromuscular electrical stimulation. The degree of swallowing dysfunction was scored (Dysphagia Outcome and Severity Scale), as well as the presence of food stasis (Eisenhuber scale), and measurement of the oral and pharyngeal transit time. The results were statistically analyzed by the Friedman test or analysis of variance for repeated measures. Results The Dysphagia Outcome and Severity Scale revealed improvement for one individual with both sensory and motor stimuli, and worsening in two individuals, being one with motor and one with sensory stimulus. In the Eisenhuber scale, the neuromuscular electrical stimulation changed the presence of residues to variable extents. Concerning the oral and pharyngeal transit time, no difference was observed between the different stimulation levels for the consistencies tested (p > 0.05). Conclusion Both sensory and motor neuromuscular electrical stimulations presented a varied immediate impact on the oral and pharyngeal stages of swallowing in individuals after oral and oropharyngeal cancer therapy. Thus, the results of the immediate effect suggest that the technique is not indicated, evidencing the need of caution in the use of neuromuscular electrical stimulation for the rehabilitation of dysphagia, after HNC treatment.
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Affiliation(s)
- Danila Rodrigues Costa
- Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology of Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Cássia Maria Fischer Rubira
- Department of Surgery, Stomatology, Pathology and Radiology of Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Giédre Berretin-Felix
- Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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26
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Jones CA, Colletti CM, Ding MC. Post-stroke Dysphagia: Recent Insights and Unanswered Questions. Curr Neurol Neurosci Rep 2020; 20:61. [PMID: 33136216 PMCID: PMC7604228 DOI: 10.1007/s11910-020-01081-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? RECENT FINDINGS There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.
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Affiliation(s)
- Corinne A Jones
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA. .,Speech, Language, & Hearing Sciences; Moody College of Communication, The University of Texas, Austin, TX, USA.
| | - Christina M Colletti
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| | - Ming-Chieh Ding
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
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27
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Park S, Cho JY, Lee BJ, Hwang JM, Lee M, Hwang SY, Kim K, Lee KH, Park D. Effect of the submandibular push exercise using visual feedback from pressure sensor: an electromyography study. Sci Rep 2020; 10:11772. [PMID: 32678239 PMCID: PMC7366651 DOI: 10.1038/s41598-020-68738-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022] Open
Abstract
We developed a new exercise method called the submandibular push exercise that can strengthen the suprahyoid muscle by inducing only the motion of the hyoid bone without neck flexion. In this study, we aimed to investigate and compare the muscle activity of the suprahyoid and infrahyoid muscles in the course of performing three different swallowing exercises. Twenty healthy participants and fifteen patients with dysphagia were recruited. Each participant consecutively performed three exercises: Shaker, CTAR, and submandibular push exercises. To investigate muscle activation, surface electromyography was performed on the suprahyoid, infrahyoid, and SCM muscles, during the exercises. Root mean square (RMS) was measured. In healthy participants, the submandibular push exercise showed a significantly higher RMS value in the suprahyoid and infrahyoid muscles than the Shaker and CTAR exercises using repeated ANOVA with Tukey's post hoc test (p < 0.05). In patients with dysphagia, the submandibular push and Shaker exercises showed significantly higher RMS value in the suprahyoid and infrahyoid muscles than the CTAR exercise. However, no significant difference was found between the submandibular push and Shaker exercises. In both healthy and patients with dysphagia, the mean RMS values of the SCM muscles during the submandibular push exercise were significantly lower than those during the Shaker exercise using repeated ANOVA with Tukey's post hoc test (p < 0.05). In conclusion, considering the relatively superior selectiveness in suprahyoid and infrahyoid muscle contraction, the submandibular push exercise using visual feedback from pressure sensor could be an efficient supplementary exercise to the conventional swallowing muscle exercises. However, further studies may be necessary to confirm the improvement in swallowing difficulty.
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Affiliation(s)
- Sungwon Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Joo Young Cho
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Byung Joo Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Myunghwan Lee
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Soo Yeon Hwang
- Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - KwanMyung Kim
- Graduate School of Creative Design Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Ki Hoon Lee
- Mompyeonhan Rehabilitation Clinic, Daegu, Republic of Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
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28
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Transcutaneous Electrical Stimulation and Dysphagia Rehabilitation: A Narrative Review. Rehabil Res Pract 2020; 2020:4865614. [PMID: 32455025 PMCID: PMC7238355 DOI: 10.1155/2020/4865614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/02/2020] [Indexed: 11/17/2022] Open
Abstract
Transcutaneous electrical stimulation (TES) was introduced as a modality for dysphagia rehabilitation more than a decade ago. The underlying premise of this modality is improving the structural movements and enhancing neural activation based on stimulation-induced muscle contractions. However, divisive evidence exists regarding the effectiveness of this treatment modality. This manuscript reviews current evidence regarding the effects of transcutaneous electrical stimulation (TES) on clinical and physiological aspects of swallowing function. Furthermore, this narrative review delineates the knowledge gap in this area and recommends future research roadmap. This review gives a comprehensive picture regarding current knowledge of TES to practicing speech and language pathologists and interested researchers. It highlights the need for more robust studies in this area. It also encourages researchers to focus more on the physiologic studies to understand the physiologic underpinning behind this treatment modality.
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29
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King SN, Shen TY, Musselwhite MN, Huff A, Reed MD, Poliacek I, Howland DR, Dixon W, Morris KF, Bolser DC, Iceman KE, Pitts T. Swallow Motor Pattern Is Modulated by Fixed or Stochastic Alterations in Afferent Feedback. Front Hum Neurosci 2020; 14:112. [PMID: 32327986 PMCID: PMC7160698 DOI: 10.3389/fnhum.2020.00112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Afferent feedback can appreciably alter the pharyngeal phase of swallow. In order to measure the stability of the swallow motor pattern during several types of alterations in afferent feedback, we assessed swallow during a conventional water challenge in four anesthetized cats, and compared that to swallows induced by fixed (20 Hz) and stochastic (1-20Hz) electrical stimulation applied to the superior laryngeal nerve. The swallow motor patterns were evaluated by electromyographic activity (EMG) of eight muscles, based on their functional significance: laryngeal elevators (mylohyoid, geniohyoid, and thyrohyoid); laryngeal adductor (thyroarytenoid); inferior pharyngeal constrictor (thyropharyngeus); upper esophageal sphincter (cricopharyngeus); and inspiratory activity (parasternal and costal diaphragm). Both the fixed and stochastic electrical stimulation paradigms increased activity of the laryngeal elevators, produced short-term facilitation evidenced by increasing swallow durations over the stimulus period, and conversely inhibited swallow-related diaphragm activity. Both the fixed and stochastic stimulus conditions also increased specific EMG amplitudes, which never occurred with the water challenges. Stochastic stimulation increased swallow excitability, as measured by an increase in the number of swallows produced. Consistent with our previous results, changes in the swallow motor pattern for pairs of muscles were only sometimes correlated with each other. We conclude that alterations in afferent feedback produced particular variations of the swallow motor pattern. We hypothesize that specific SLN feedback might modulate the swallow central pattern generator during aberrant feeding conditions (food/liquid entering the airway), which may protect the airway and serve as potentially important clinical diagnostic indicators.
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Affiliation(s)
- Suzanne N King
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY, United States.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Tabitha Y Shen
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - M Nicholas Musselwhite
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Alyssa Huff
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, School of Medicine, University of Louisville, Louisville, KY, United States
| | - Mitchell D Reed
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, School of Medicine, University of Louisville, Louisville, KY, United States
| | - Ivan Poliacek
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States.,Department of Medical Biophysics, Jessenius Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Dena R Howland
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, School of Medicine, University of Louisville, Louisville, KY, United States.,Robley Rex VA Medical Center, Louisville, KY, United States
| | - Warren Dixon
- Department of Mechanical and Aerospace Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, United States
| | - Kendall F Morris
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Donald C Bolser
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Kimberly E Iceman
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, School of Medicine, University of Louisville, Louisville, KY, United States
| | - Teresa Pitts
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, School of Medicine, University of Louisville, Louisville, KY, United States
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30
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Sayaca C. Swallowing dıfficulty and swallowing anxiety in patients with type-II diabetes mellitus. Eur Arch Otorhinolaryngol 2020; 277:2005-2010. [PMID: 32189071 DOI: 10.1007/s00405-020-05902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Type-II Diabetes Mellitus (TII-DM) is the most common endocrine disorder in people who are over 65 years of age. It leads to a decrease in muscle strength and impaired muscle coordination. Ageing and weakness cause swallowing difficulty (SD). OBJECTIVE The aim of this study was to evaluate the relationship between duration of disease, SD and swallowing anxiety (SA) in TII-DM patients. STUDY DESIGN Prospective case-control study. METHODS A total of 103 elderly individuals (74 females and 29 males) participated in this study. Fifty-two elderly patients (aged 70.27 ± 4.65 years) had a TII-DM and the duration of DM was 11.32 ± 10.03 years (minimum: 0-40 years). Fifty-one patients without diabetes mellitus (69.35 ± 3.58 years) were included in the control group. SD was determined using the EAT-10 Questionnaire. SA was evaluated with the Swallowing Anxiety Scale developed in the Turkish population. Handgrip strength was evaluated with a Jamar dynamometer on the dominant side. RESULTS There was a significant difference in SD (p : 0.042), SA (p : 0.001), and handgrip strength (p : 0.039) between groups. There was a relationship between SD and SA in the control and DM groups (r : 0.577; p : 0.000 and r : 0.663; p : 0.000, respectively). There was no relationship between the other parameters (age, SD, SA, and handgrip strength) in the control group (p < 0.05). There was a positive moderate relationship between SA and duration of disease in the TII-DM group (r : 0.472; p : 0.000). There was no relationship between other parameters (age, SD, SA, handgrip strength, and duration of disease) in the DM group (p < 0.05). CONCLUSION In elderly individuals with TII-DM and without DM, there were differences in SD, SA, and handgrip strength. Although there was a relationship between SD and SA in both groups, this relationship was found to be higher in elderly patients with TII-DM. In addition, there was a relationship between the duration of diagnosis and SA. In elderly individuals, evaluating SD with SA was thought to be helpful in the prevention or early rehabilitation of swallowing disorders.
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Affiliation(s)
- Cetin Sayaca
- Faculty of Healthy Science Physical Therapy and Rehabilitation, Uskudar University, Altunizade Mahallesi, Mahir Iz Cad. No:23, 34674, Uskudar, Istanbul, Turkey.
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31
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Woisard V, Costes M, Colineaux H, Lepage B. How a personalised transportable folding device for seating impacts dysphagia. Eur Arch Otorhinolaryngol 2020; 277:179-188. [PMID: 31586257 PMCID: PMC6942592 DOI: 10.1007/s00405-019-05657-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/13/2019] [Indexed: 11/13/2022]
Abstract
PURPOSE A personalised transportable folding device for seating (DATP) on a standard seat was developed by an occupational therapist at the Toulouse University Hospital Centre (patent no. WO 2011121249 A1) based on the hypothesis that the use of a seat to assist with better positioning on any chair during meals modifies the sitting posture and has an impact on cervical statics which increases the amplitude of movements of the axial skeleton (larynx and hyoid bone) and benefits swallowing. The aim of this work is to demonstrate that an improvement in sitting posture with the help of the DATP, through Hyoid bone motion, has an impact on the quality of swallowing in a dysphagic population which benefits from the device in comparison to a dysphagic population which does not benefit from the device after 1 month of care. The secondary endpoints concern the evaluation of the impact on other characteristics of swallowing, posture, the acceptability of the device and the quality of life. METHODOLOGY This is a randomised comparative clinical trial. The blind was not possible for the patients but the examiner who evaluated the outcome criterion was blinded to the group to which the patient belonged. The outcome criterion was the measurement of the hyoid bone movement during swallowing. The other criteria were collected during the videofluoroscopic examination of swallowing and by use of a questionnaire. Fifty-six (56) patients were included: 30 in the group without device (D-) and 26 in the group with the device (D+). All the patients benefited from a training course on seating. Only the D+ patients participated in this course where the use of the device was explained and the device was then kept for use at home for 1 month. RESULTS A significant improvement was noted in the postural criteria before and after use, in favour of a better posture for the two groups (p < 0.001) and more hyoid bone motion in the D+ group. The difference was significant in the bivariate analysis for horizontal movement (p = 0.04). After adjustment of potential factors of confusion, we noted a significant mean difference for the three distances in the D+ group in comparison to the D- group, of + 0.33 (95% CI [+ 0.17; + 0.48]) for horizontal movement, + 0.22 (95% CI [+ 0.03; + 0.40]) for vertical movement and + 0.37 (95% CI = [+ 0.20; + 0.53]) for horizontal movement. However, the other parameters, and notably the other swallowing markers were not significantly modified by the use of the device. CONCLUSION The personalised transportable folding device for seating developed to reduce dysphagia has an action on hyoid bone motion during swallowing. However, this positive effect on an intermediate outcome criterion of the quality of swallowing was not associated with an improvement in swallowing efficiency in the study population. The diversity of diseases with which the patients in this study were afflicted is a factor to be controlled in future studies with this device.
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Affiliation(s)
- Virginie Woisard
- Voice and Deglutition Unit, Otorhinolaryngology Department, Rangueil Larrey University Hospital of Toulouse, 31059, Toulouse Cedex, France.
| | - Mireille Costes
- Voice and Deglutition Unit, Otorhinolaryngology Department, Rangueil Larrey University Hospital of Toulouse, 31059, Toulouse Cedex, France
| | - Hélène Colineaux
- Department of Epidemiology, USMR, 37 Allées Jules Guesde, 31073, Toulouse, France
| | - Benoit Lepage
- Department of Epidemiology, USMR, 37 Allées Jules Guesde, 31073, Toulouse, France
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32
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Huh JW, Park E, Min YS, Kim AR, Yang WJ, Oh HM, Nam TW, Jung TD. Optimal placement of electrodes for treatment of post-stroke dysphagia by neuromuscular electrical stimulation combined with effortful swallowing. Singapore Med J 2019; 61:487-491. [PMID: 31680183 DOI: 10.11622/smedj.2019135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION We aimed to determine the optimal placement of electrodes for neuromuscular electrical stimulation (NMES) for post-stroke dysphagia therapy. METHODS 31 patients with post-stroke dysphagia were randomised to three groups according to NMES electrode placement. In Group A (n = 10), two pairs of electrodes were attached horizontally on the suprahyoid and infrahyoid muscles. In Group B (n = 11), one pair of electrodes was attached horizontally on the suprahyoid muscles while the other was attached vertically on the infrahyoid muscles. In Group C (n = 10), the electrodes were attached vertically, with one pair above the hyoid bone and the other above the cricoid cartilage. All patients received rehabilitation treatment via NMES combined with effortful swallowing training five times weekly for four weeks. The effect of NMES electrode placement was assessed in terms of the Functional Dysphagia Scale (FDS) and Dysphagia Outcome and Severity Scale (DOSS) scores. RESULTS Group A showed significantly greater improvement than Group B in overall FDS (p = 0.009) and pharyngeal-phase FDS (FDS-P; p = 0.005) scores. Group A also showed significant improvement when compared with Group C in overall FDS (p = 0.001) and FDS-P (p = 0.001) scores. CONCLUSION Horizontal placement of the NMES electrodes on the suprahyoid and infrahyoid muscles for the treatment of post-stroke dysphagia by NMES combined with effortful swallowing was more effective than the horizontal and vertical placement of electrodes on the suprahyoid and infrahyoid muscles, respectively, and their vertical placement above the hyoid bone and cricoid cartilage.
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Affiliation(s)
- Jae-Won Huh
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Eunhee Park
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Won-Jong Yang
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Hyun-Min Oh
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Tae-Woo Nam
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
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Feiner M, Gerstenberger C, Mayr W, Hortobagyi D, Gugatschka M. Exploring stimulation patterns for electrical stimulation of the larynx using surface electrodes. Eur Arch Otorhinolaryngol 2019; 276:3153-3158. [DOI: 10.1007/s00405-019-05594-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
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The Effect of Four-Channel Neuromuscular Electrical Stimulation on Swallowing Kinematics and Pressures. Am J Phys Med Rehabil 2019; 98:1051-1059. [DOI: 10.1097/phm.0000000000001241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barikroo A, Hegland K, Carnaby G, Bolser D, Manini T, Crary M. The Effects of Electrical Stimulation Pulse Duration on Lingual Palatal Pressure Measures During Swallowing in Healthy Older Adults. Dysphagia 2019; 34:529-539. [PMID: 30820657 DOI: 10.1007/s00455-019-09991-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 02/23/2019] [Indexed: 11/28/2022]
Abstract
Limited research in swallowing physiology has suggested that the most common existing transcutaneous electrical stimulation (TES) protocol (VitalStim) may not penetrate to layers of tissue to affect deep swallowing muscles. TES amplitude is the primary parameter that determines the depth of electrical current penetration (DECP). Preliminary work suggests that replacing a long-pulse duration with a short-pulse duration can increase maximum amplitude tolerance (MAT) within subjects' comfort level. Increasing MAT may indicate a higher DECP. The current study evaluates this premise in reference to the effects of varying pulse duration on lingual-palatal pressure during swallowing. Thirty healthy older adults (60-70 years of age) participated in this study. Each subject swallowed three trials of 10 mL pudding under three TES conditions: no stimulation, short-pulse duration, and long-pulse duration. TES was delivered using two pairs of surface electrodes on the submental muscles. MAT and perceived discomfort levels were identified separately for short and long-pulse TES conditions. Lingual-palatal peak pressure, pressure integral, and pressure duration were measured under each condition. Two-way repeated measures ANOVAs were conducted to identify within subject effects of TES condition and tongue bulb location. Lingual-palatal pressure and pressure integral were significantly reduced in the short-pulse duration condition. MAT was significantly higher in the short-pulse duration versus the long-pulse duration condition. Furthermore, MAT was significantly correlated with lingual-palatal pressure. Changing pulse duration had no significant impact on tongue pressure duration. Results suggest that a short-pulse duration may penetrate deeper into muscles involved in swallowing. The specific impact is reflected in a reduced upward pressure of the tongue on the palate during swallowing. This 'restrictive' effect of TES on tongue pressure may have the potential to be used during a resistive exercise paradigm for tongue elevation during swallowing.
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Affiliation(s)
- Ali Barikroo
- Speech Pathology and Audiology Program, Swallowing Physiology & Rehabilitation Research Laboratory, School of Health Sciences, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA.
| | - Karen Hegland
- Department of Speech, Language, and Hearing Sciences, Upper Airway Dysfunction Lab, Gainesville, FL, USA
| | - Giselle Carnaby
- Department of Communication Sciences and Disorders, Swallowing Research Laboratory, University of Central Florida, Orlando, USA
| | - Donald Bolser
- Department of Physiological Sciences, University of Florida, Gainesville, USA
| | - Todd Manini
- Institute on Aging and the Department of Aging and Geriatric Research, University of Florida, Gainesville, USA
| | - Michael Crary
- Department of Communication Sciences and Disorders, Swallowing Research Laboratory, University of Central Florida, Orlando, USA
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Costa DR, Silva-Arone MMAD, Rubira CMF, Santos PSDS, Berretin-Felix G. Efeito imediato da estimulação elétrica neuromuscular na deglutição após tratamento do câncer de laringe: relato de caso. Codas 2019; 31:e20180100. [DOI: 10.1590/2317-1782/20182018100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/23/2018] [Indexed: 11/21/2022] Open
Abstract
RESUMO Este trabalho teve por objetivo verificar o efeito imediato da Estimulação Elétrica Neuromuscular (EENM) sensorial e motora, nas fases oral e faríngea da deglutição, em um homem de 64 anos, após tratamento de câncer de laringe. Foi realizado exame de videofluoroscopia durante a deglutição de 5 ml de mel e pudim, em três condições: sem estimulação, com EENM sensorial, com EENM motora, definidas de forma randomizada. Foi classificado o grau da disfunção da deglutição (DOSS), a presença de estase de alimentos (escala de Eisenhuber), de penetração laríngea e aspiração laringotraqueal (PAS), além da medida do tempo de trânsito oral e faríngeo, realizadas por uma avaliadora sem conhecimento sobre o estímulo aplicado. Na escala DOSS, houve melhora com a estimulação sensorial e motora. Na escala PAS, verificou-se melhora, tanto para o estímulo sensorial quanto motor na consistência mel, porém observou-se piora no estímulo motor para a consistência pudim. Houve diminuição dos resíduos em base de língua com estímulo sensorial e motor para as consistências pudim e mel; piora no estímulo motor na parede posterior da faringe para a consistência mel. Em relação ao tempo de trânsito oral e faríngeo, não foi observada diferença entre os níveis de estimulações. Os resultados demonstraram que a EENM em nível sensorial e motor melhorou o grau da disfagia em um indivíduo após o tratamento de câncer de laringe, com maiores benefícios do nível sensorial em relação ao motor no que diz respeito à presença de penetração e resíduos.
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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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Iizuka M, Kobayashi M, Hasegawa Y, Tomita K, Takeshima R, Izumizaki M. A new flexible piezoelectric pressure sensor array for the noninvasive detection of laryngeal movement during swallowing. J Physiol Sci 2018; 68:837-846. [PMID: 29508285 PMCID: PMC10717778 DOI: 10.1007/s12576-018-0601-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/20/2018] [Indexed: 11/29/2022]
Abstract
We tried to develop a new device to detect laryngeal movement noninvasively. We made small piezo pressure sensors (length, 1.5 mm, width, 7.0 mm), and five of these were lined up with 3.0-mm intervals and embedded in the middle of a palm-sized urethane resin sheet. This sheet was lightly attached to the ventral surface of the neck near the laryngeal prominence. The first and second peaks obtained from each sensor should correspond to the period when the larynx moves to the upper and lower positions during swallowing. The mean maximum rising velocities for men and women were about 0.08 and 0.11 m/s, respectively. Similarly, the mean maximum lowering velocities for men and women were about 0.09 and 0.11 m/s, respectively. The swallowing latencies for men and women were about 0.49 and 0.53 s, respectively. In conclusion, we succeeded in developing a new device, which will be useful in evaluating the swallowing function.
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Affiliation(s)
- Makito Iizuka
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Masaaki Kobayashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki, 300-0394, Japan
| | - Yoshimasa Hasegawa
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki, 300-0394, Japan
| | - Reiko Takeshima
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki, 300-0394, Japan
| | - Masahiko Izumizaki
- Department of Physiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
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Meng P, Zhang S, Wang Q, Wang P, Han C, Gao J, Yue S. The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia. J Back Musculoskelet Rehabil 2018; 31:363-370. [PMID: 29278871 DOI: 10.3233/bmr-170788] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess whether the clinical efficacy of a therapeutic protocol using surface neuromuscular electrical stimulation (sNMES) on patients with post-stroke dysphagia (PSD) is superior to that without sNMES, and whether swallowing functional outcome is different with regards to different electrode placement on patients' skin of neck. METHODS Thirty patients with PSD were randomly allocated into treatment group A (TGA), treatment group B (TGB) and control group according to a random number table. The three groups of patients all received traditional dysphagia therapy (TDT) and other general rehabilitation therapy such as physical therapy and occupational therapy as a basic treatment project. Besides this, sNMES treatment was applied on different sites of patients' neck skin in group A and B separately. All the patients received video-fluoroscopic swallowing study (VFSS) pre-treatment and 2 weeks post-treatment, during which the displacement of the hyolaryngeal complex towards the superior and anterior sides while swallowing semi-liquid diet were measured. Outcome of the VFSS was measured using dysphagia outcome and severity scale (DOSS). RESULTS Post-treatment evaluation was carried out using water swallow test (WST), repetitive saliva swallowing test (RSST) and dysphagia outcome and severity scale (DOSS) from the three study groups were all improved (P< 0.05). The results of post-treatment evaluation using WST from TGA and TGB were 2.40 ± 1.26 and 2.10 ± 0.99 respectively, using RSST from TGA and TGB were 5.30 ± 1.89 and 5.20 ± 1.69 respectively, using DOSS from TGA and TGB were 5.20 ± 1.40 and 5.10 ± 1.45 respectively. Compared to control group, the results of post-treatment evaluation using the three scales, there were significant improvement between TGA and TGB (P< 0.05), however, the inter-group differences of TGA and TGB indicated no statistically significant difference (P> 0.05). The post-treatment evaluation of the moving distance of hyoid bone towards anterior side in swallowing was significantly improved as compared to TGB (-8.40 ± 7.48, t=-3.552, P= 0.006), and was statistically significant as compared to the control group (P> 0.05). CONCLUSIONS Swallowing function in the patients with PSD was significantly improved using TDT combined with NMES. Stimulating electrodes placed at the suprahyoid region or on both suprahyoid and infrahyoid regions resulted in no difference of effect. However, NMES on suprahyoid region could further improve the moving distance of hyoid bone anteriorly.
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Affiliation(s)
- Pingping Meng
- Department of Physical Medicine and Rehabiliation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuchao Zhang
- Department of Blood Transfusion, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qiang Wang
- Department of Physical Medicine and Rehabiliation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Peipei Wang
- Department of Physical Medicine and Rehabiliation, Qingdao City Central Hospital, Qingdao, Shandong, China
| | - Chao Han
- Department of Physical Medicine and Rehabiliation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jinghui Gao
- Department of Physical Medicine and Rehabiliation, Qilu Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Shouwei Yue
- Department of Physical Medicine and Rehabiliation, Qilu Hospital Affiliated to Shandong University, Jinan, Shandong, China
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"Hidden in Plain Sight": A Descriptive Review of Laryngeal Vestibule Closure. Dysphagia 2018; 34:281-289. [PMID: 30062547 DOI: 10.1007/s00455-018-9928-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
A major emphasis in the evaluation of swallowing is to identify physiological abnormalities in swallowing that contribute to or explain unsafe swallowing (i.e., ingested material enters the trachea; post-swallow residue in the pharynx). Impairments in laryngeal vestibule closure are widely recognized as one of the major causes of unsafe swallowing, as it is the primary mechanism and first line of defense for preventing material from penetrating the airway during swallowing. However, this complex mechanism is often overlooked and understudied in swallowing research and dysphagia management. The purpose of this review is to promote a better understanding of the mechanism of laryngeal vestibule closure. We discuss where gaps in research exist and propose future directions for incorporating laryngeal vestibule closure as a primary outcome measure in swallowing research. Additionally, we propose that an increased knowledge of the mechanism of laryngeal vestibule closure will increase diagnostic accuracy and optimize dysphagia management for patients with dysphagia.
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Park JS, Oh DH, Hwang NK, Lee JH. Effects of neuromuscular electrical stimulation in patients with Parkinson’s disease and dysphagia: A randomized, single-blind, placebo-controlled trial. NeuroRehabilitation 2018; 42:457-463. [DOI: 10.3233/nre-172306] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ji-Su Park
- Department of Rehabilitation Science, Graduate School, Inje University, Gimhae, Republic of Korea
| | - Dong-Hwan Oh
- Department of Occupational Therapy, Kyung-dong University, Wonju, Republic of Korea
| | - Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul, Republic of Korea
| | - Jung-Hoon Lee
- Department of Physical Therapy, College of Nursing, Healthcare Sciences and Human Ecology, Dong-Eui University, Busan, Republic of Korea
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Kagaya H, Ogawa M, Mori S, Aoyagi Y, Shibata S, Inamoto Y, Mori H, Saitoh E. Hyoid Bone Movement at Rest by Peripheral Magnetic Stimulation of Suprahyoid Muscles in Normal Individuals. Neuromodulation 2018; 22:593-596. [DOI: 10.1111/ner.12777] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/03/2018] [Accepted: 02/13/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of MedicineFujita Health UniversityToyoake Aichi Japan
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of MedicineFujita Health UniversityToyoake Aichi Japan
| | - Shino Mori
- Department of Rehabilitation Medicine I, School of MedicineFujita Health UniversityToyoake Aichi Japan
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine I, School of MedicineFujita Health UniversityToyoake Aichi Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of MedicineFujita Health UniversityToyoake Aichi Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health SciencesFujita Health UniversityToyoake Aichi Japan
| | | | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of MedicineFujita Health UniversityToyoake Aichi Japan
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43
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Effect of Neuromuscular Electrical Stimulation on Labial and Lingual Weakness. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barikroo A, Carnaby G, Bolser D, Rozensky R, Crary M. Transcutaneous electrical stimulation on the anterior neck region: The impact of pulse duration and frequency on maximum amplitude tolerance and perceived discomfort. J Oral Rehabil 2018; 45:436-441. [PMID: 29574920 DOI: 10.1111/joor.12625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
Maximum amplitude tolerance (MAT) has been known as a primary factor determining the depth of electrical current penetration. However, the effect of varying transcutaneous electrical stimulation (TES) parameters on MAT and discomfort level is poorly understood. Furthermore, limited information exists regarding the biopsychological factors that may impact MAT and discomfort. The primary aims of this study were to compare the effects TES protocol with varying levels of pulse duration (300 μs vs 700 μs) and frequency (30 Hz vs 80 Hz) on the MAT and discomfort in healthy older adults. The exploratory aim of this study was to examine relationships between submental adipose tissue thickness, pain sensitivity and gender with MAT and discomfort. Twenty-four healthy older adults participated in this study. Transcutaneous electrical stimulation was delivered to the submental region. Maximum amplitude tolerance and discomfort were measured for each condition. Furthermore, submental adipose tissue thickness and pain sensitivity were measured for each subject. Maximum amplitude tolerance was significantly increased for the TES protocols with short-pulse duration [F (3, 69) = 38.695, P < .0001]. Discomfort was similar across different TES protocols. Submental adipose tissue thickness (r = .30, P < .003) and pain sensitivity (r = -.43, P < .0001) were related to MAT. Pain sensitivity rating was also related to discomfort (r = .45, P < .0001). In conclusion, using TES protocols with short-pulse duration may increase the MAT. Higher amplitude stimulation may increase the impact on deep swallowing muscles. In addition, submental adipose tissue thickness and pain sensitivity are potential biopsychological factors that may affect MAT and discomfort.
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Affiliation(s)
- Ali Barikroo
- Swallowing Physiology and Rehabilitation Research Laboratory, Department of Speech Pathology and Audiology, Kent State University, Kent, OH, USA
| | - Giselle Carnaby
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| | - Donald Bolser
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Ronald Rozensky
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael Crary
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
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Natour YS, Darawsheh WB, Bashiti S, Wari M, Taha J, Odeh T. A study of VHI scores and acoustic features in street vendors as occupational voice users. JOURNAL OF COMMUNICATION DISORDERS 2018; 71:11-21. [PMID: 29223491 DOI: 10.1016/j.jcomdis.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 10/29/2017] [Accepted: 12/03/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE to investigate acoustic features of phonation and perception of voice handicap in street vendors. METHODS Eighty-eight participants (44 street vendors, 44 controls) were recruited. The mean age of the group was 38.9±16.0 years (range: 20-78 years). Scores of the Arabic version of the Voice Handicap Index (VHI-Arab) were used for analysis. Acoustic measures of fundamental frequency (F0), jitter, shimmer, and signal-to-noise ratio (SNR) were also analyzed. RESULTS Analysis showed a significant difference between street vendors and controls in the total score of the VHI-Arab (p<0.001) as well as scores of all three VHI-Arab subsections: functional (p<0.001), physical (p<0.001), and emotional (p=0.025). Weak correlations were found among all of the VHI scores and acoustic measures (-0.219≤ r≤0.355), except for SNR where a moderate negative correlations were found (r=-0.555; -0.4) between the VHI (physical and total) scores and SNR values. Significant differences also were found in F0, jitter, and SNR among specific subgroups of street vendors when stratified by weekly hours worked (p<0.05), and in jitter (p=0.39) when stratified by educational level. CONCLUSIONS Perception of voice handicap and a possible effect on vocal quality in street vendors were noted. The effect of factors, namely work hours and educational level, on voice quality should be further studied.
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Affiliation(s)
- Yaser S Natour
- Department of Hearing and Speech Sciences, School of Rehabilitation Sciences, The University of Jordan, Jordan
| | - Wesam B Darawsheh
- Department of Occupational Therapy, School of Rehabilitation Sciences, The University of Jordan, Jordan.
| | - Sara Bashiti
- The Faculty of Pharmacy, Nursing and Allied Health Professions, Speech Language Pathology and Audiology Department, Birzeit University, Palestine
| | - Majd Wari
- The Faculty of Pharmacy, Nursing and Allied Health Professions, Speech Language Pathology and Audiology Department, Birzeit University, Palestine
| | - Juhayna Taha
- The Faculty of Pharmacy, Nursing and Allied Health Professions, Speech Language Pathology and Audiology Department, Birzeit University, Palestine
| | - Thair Odeh
- The Faculty of Pharmacy, Nursing and Allied Health Professions, Speech Language Pathology and Audiology Department, Birzeit University, Palestine
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Prosiegel M, Weber S. Vorstellung verschiedener Therapiekonzepte. DYSPHAGIE 2018:215-229. [DOI: 10.1007/978-3-662-56132-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Choi JB, Shim SH, Yang JE, Kim HD, Lee DH, Park JS. Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia. NeuroRehabilitation 2017; 41:753-757. [DOI: 10.3233/nre-172145] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jong-Bae Choi
- Department of Occupational Therapy, Kyung Hee Medical Center, Republic of Korea
| | - Sun-Hwa Shim
- Department of Occupational Therapy, Korea Children’s Developmental Center, Republic of Korea
| | - Jong-Eun Yang
- Department of Occupational Therapy, Bethesda Hospital, Republic of Korea
| | - Hyun-Dong Kim
- Department of Physical Medicine and Rehabilitation, Busan Paik Hospital of Inje University, Busan, Republic of Korea
| | - Doo-Ho Lee
- Department of Rehabilitation Science, Graduate School of Inje University, Republic of Korea
| | - Ji-Su Park
- Department of Rehabilitation Science, Graduate School of Inje University, Republic of Korea
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Yamazaki Y, Tohara H, Hara K, Nakane A, Wakasugi Y, Yamaguchi K, Minakuchi S. Excessive anterior cervical muscle tone affects hyoid bone kinetics during swallowing in adults. Clin Interv Aging 2017; 12:1903-1910. [PMID: 29184396 PMCID: PMC5685148 DOI: 10.2147/cia.s143175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to determine whether excessive neck muscle tone affects hyoid bone kinetics during swallowing using videofluorography (VF) in an unnatural posture in healthy individuals. Subjects and methods Subjects were 28 healthy adults (12 men, 16 women; mean age, 39.75±9.50 years) without any history or present complaints of swallowing disorders. We first established the participant’s posture a reclining wheelchair that was adjusted to a 30-degree angle with the headrest (without excessive neck muscle tone) or without headrest (with excessive neck muscle tone), used an electromyogram above the mylohyoid muscle to represent the suprahyoid muscles and above the sternohyoid muscle to represent the infrahyoid muscles to confirm neck muscle tone, and then conducted VF of swallowing measurements. Videofluorographic images were obtained when 5 mL of 50% (w/v) barium sulfate was being swallowed, and hyoid bone coordinate (the resting position and the elevated position), extent of horizontal and vertical hyoid bone elevation, as well as duration and velocity of hyoid bone elevation were evaluated (x-axis and y-axis coordinates for the resting position of hyoid bone are referred to as Xr and Yr, respectively; those for the elevated hyoid bone position induced during swallowing are referred to as Xs and Ys, respectively). Results In the resting position of the hyoid bone, the Yr coordinates in those with excessive neck muscle tone were significantly lower than in those without excessive neck muscle tone. Vertical hyoid bone elevation and hyoid bone elevation velocity were significantly higher with excessive neck muscle tone than without excessive neck muscle tone, whereas horizontal elevation showed no significant differences. Conclusion Our findings suggest that the generation of neck muscle tone due to inappropriate posture may encourage hyoid depression and increase the extent of hyoid bone elevation, thereby increasing the risk of aspiration.
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Affiliation(s)
- Yasuhiro Yamazaki
- Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruka Tohara
- Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Hara
- Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Nakane
- Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoko Wakasugi
- Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Yamaguchi
- Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan
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Park D, Lee HH, Lee ST, Oh Y, Lee JC, Nam KW, Ryu JS. Normal contractile algorithm of swallowing related muscles revealed by needle EMG and its comparison to videofluoroscopic swallowing study and high resolution manometry studies: A preliminary study. J Electromyogr Kinesiol 2017; 36:81-89. [DOI: 10.1016/j.jelekin.2017.07.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 11/16/2022] Open
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Takahashi K, Hori K, Hayashi H, Fujiu-Kurachi M, Ono T, Tsujimura T, Magara J, Inoue M. Immediate effect of laryngeal surface electrical stimulation on swallowing performance. J Appl Physiol (1985) 2017; 124:10-15. [PMID: 28935826 DOI: 10.1152/japplphysiol.00512.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Surface electrical stimulation of the laryngeal region is used to improve swallowing in dysphagic patients. However, little is known about how electrical stimulation affects tongue movements and related functions. We investigated the effect of electrical stimulation on tongue pressure and hyoid movement, as well as suprahyoid and infrahyoid muscle activity, in 18 healthy young participants. Electrical stimulation (0.2-ms duration, 80 Hz, 80% of each participant's maximal tolerance) of the laryngeal region was applied. Each subject swallowed 5 ml of barium sulfate liquid 36 times at 10-s intervals. During the middle 2 min, electrical stimulation was delivered. Tongue pressure, electromyographic activity of the suprahyoid and infrahyoid muscles, and videofluorographic images were simultaneously recorded. Tongue pressure during stimulation was significantly lower than before or after stimulation and was significantly greater after stimulation than at baseline. Suprahyoid activity after stimulation was larger than at baseline, while infrahyoid muscle activity did not change. During stimulation, the position of the hyoid at rest was descended, the highest hyoid position was significantly inferior, and the vertical movement was greater than before or after stimulation. After stimulation, the positions of the hyoid at rest and at the maximum elevation were more superior than before stimulation. The deviation of the highest positions of the hyoid before and after stimulation corresponded to the differences in tongue pressures at those times. These results suggest that surface electrical stimulation applied to the laryngeal region during swallowing may facilitate subsequent hyoid movement and tongue pressure generation after stimulation. NEW & NOTEWORTHY Surface electrical stimulation applied to the laryngeal region during swallowing may facilitate subsequent hyoid movement and tongue pressure generation after stimulation. Tongue muscles may contribute to overshot recovery more than hyoid muscles.
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Affiliation(s)
- Keizo Takahashi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan.,Niigata University of Rehabilitation , Niigata , Japan
| | - Kazuhiro Hori
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Hirokazu Hayashi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | | | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
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