Guimarães, Bruno Tavares de Lima; Furkim, Ana Maria; Silva, Roberta Gonçalves da
Rev. soc. bras. fonoaudiol. 15(4): 615-621, ND. 2010 Dec.
A reabilitação da disfagia orofaríngea ganhou um novo instrumento terapêutico, a eletroestimulação neuromuscular (EENM), sendo que os mais renomados pesquisadores têm estudado a indicação e os resultados desta abordagem. O objetivo deste trabalho foi apresentar revisão bibliográfica sobre a aplicabilidade da EENM na reabilitação da disfagia orofaríngea. Realizou-se amplo levantamento bibliográfico em bases de dados, englobando as duas últimas décadas de pesquisa na área. Este artigo de revisão mostrou que ainda não há consenso sobre o uso da EENM na reabilitação da disfagia. Constatou-se que a maioria dos trabalhos descreveu o uso da EENM de forma isolada, não relatou as técnicas fonoaudiológicas associadas à eletroterapia e utilizou amostras heterogêneas que agrupavam disfagias orofaríngeas mecânicas e neurogênicas. Somente recentemente programas específicos têm sido delineados e testados em populações mais homogêneas.
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Li L, Li Y, Huang R, Yin J, Shen Y, Shi J.
Eur J Phys Rehabil Med. 2014 Jul 23.
Dysphagia is not uncommon after stroke. Dysphagia may delay the functional recovery and substantially affects the quality of life after stroke, mainly if lest untreated. To detect and treat dysphagia as early as possible is critical for patients’ recovery after stroke. Electrical stimulation has been reported as a treatment for pharyngeal dysphagia in recent studies, but the therapeutic effects of neuromuscular electrical stimulation(VitalStim) therapy lacks convincing supporting evidence, needs further clinical investigation.
To investigate the effects of neuromuscular electrical stimulation (VitalStim) and traditional swallowing therapy on recovery of swallowing difficulties after stroke.
Randomized controlled trial.
135 stroke patients who had a diagnosis of dysphagia at the age between 50–80.
135 subjects were randomly divided into three groups: traditional swallowing therapy(n=45), VitalStim therapy (n=45), and VitalStimtherapy plus traditional swallowing therapy (n=45). The traditional swallowing therapy included basic training and direct food intake training. Electrical stimulation was applied by an occupational therapist, using a modified hand–held battery–powered electrical stimulator (VitalStim® Dual Channel Unit and electrodes, Chattanooga Group, Hixson, TN, USA). Surface electromyography (sEMG), the Standardized Swallowing Assessment (SSA), Videofluoroscopic Swallowing Study (VFSS) and visual analog scale (VAS) were used to assess swallowing function before and 4 weeks after the treatment.
118 subjects with dysphagia completed the study, 40 in the traditional swallowing therapy group and VitalStim therapy group, 38 in the VitalStim and traditional swallowing therapy group. There were significant differences in sEMG value, SSA and VFSS scores in each group after the treatment (P<.001). After 4–week treatment, sEMG value (917.1±91.2), SSA value (21.8 ± 3.5), Oral transit time (0.4 ± 0.1) and Pharyngeal transit time (0.8±0.1) were significantly improved in the VitalStim and traditional swallowing therapy group than the other two groups (P<.001).
Data suggest that VitalStim therapy coupled with taditional swallowing therapy may be beneficial for post–stroke dysphagia.
CLINICAL REHABILITATION IMPACT:
VitalStim therapy coupled with taditional swallowing therapy can improve functional recovery for post–strokedysphagia.
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Kyeong Woo Lee, MD, PhD, Sang Beom Kim, MD, PhD, Jong Hwa Lee, MD, PhD, Sook Joung Lee, MD, PhD, Jae Won Ri, MD, and Jin Gee Park, MD
Ann Rehabil Med. Apr 2014; 38(2): 153–159.
Published online Apr 29, 2014.
To compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS).
Fifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one patients received NMES combined with TDT (NMES/TDT group) and 26 patients received TDT only (TDT group). Electrical stimulation with a maximal tolerable intensity was applied on both suprahyoid muscles for 30 minutes, 5 days per week during 3 weeks. The swallowing function was evaluated at baseline and 3, 6, and 12 weeks after baseline. Outcomes of the VFSS were assessed using the Functional Oral Intake Scale (FOIS).
The mean ages were 63.5±11.4 years in the NMES/TDT group and 66.7±9.5 years in the TDT group. Both groups showed a significant improvement on the FOIS after treatment. The FOIS score was significantly more improved at 3 and 6 weeks after baseline in the NMES/TDT group than in the TDT group (p<0.05).
An early application of NMES combined with TDT showed a positive effect in acute/subacute ischemic stroke patients with dysphagia. These results indicated that the early application of NMES could be used as a supplementary treatment of TDT to help rehabilitate acute/subacute dysphagic stroke patients by improving their swallowing coordination.
Nam HS, Beom J, Oh BM, Han TR.
Dysphagia. 2013 Apr 20.
The purpose of this study was to assess the effect of repeated sessions of electrical stimulation therapy (EST) on the neck muscles with respect to the stimulation site by using quantitative kinematic analysis of videofluoroscopic swallowing studies (VFSS) in dysphagia patients with acquired brain injury. We analyzed 50 patients in a tertiary hospital who were randomly assigned into two different treatment groups. One group received EST on the suprahyoid muscle only (SM), and the other group received stimulation with one pair of electrodes on the suprahyoid muscle and the other pair on the infrahyoid muscle (SI). All patients received 10–15 sessions of EST over 2–3 weeks. The VFSS was carried out before and after the treatment. Temporal and spatial parameters of the hyoid excursion and laryngeal elevation during swallowing were analyzed by two-dimensional motion analysis. The SM group (n = 25) revealed a significant increase in maximal anterior hyoid excursion distance (mean ± SEM = 1.56 ± 0.52 mm, p = 0.008) and velocity (8.76 ± 3.42 mm/s, p = 0.017), but there was no significant increase laryngeal elevation. The SI group (n = 25), however, showed a significant increase in maximal superior excursion distance (2.09 ± 0.78 mm, p = 0.013) and maximal absolute excursion distance (2.20 ± 0.82 mm, p = 0.013) of laryngeal elevation, but no significant increase in hyoid excursion. There were no significant differences between the two groups with respect to changes in maximal anterior hyoid excursion distance (p = 0.130) and velocity (p = 0.254), and maximal distance of superior laryngeal elevation (p = 0.525). EST on the suprahyoid muscle induced an increase in anterior hyoid excursion, and infrahyoid stimulation caused an increase in superior laryngeal elevation. Hyolaryngeal structural movements were increased in different aspects according to the stimulation sites. Targeted electrical stimulation based on pathophysiology is necessary.
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Baijens LW, Speyer R, Passos VL, Pilz W, van der Kruis J, Haarmans S, Desjardins-Rombouts C.
Laryngoscope. 2013 Apr 17.
A new treatment for oropharyngeal dysphagia in Parkinson’s disease was evaluated in the present study.
Prospective randomized controlled trial.
The study describes the effects of surface electrical stimulation (SES) of the neck (submental region) in dysphagic Parkinson patients using different intensities of electrical current. Quasi-random allocation was performed when assigning patients to treatment groups. Three groups consisting of dysphagic patients with idiopathic Parkinson’s disease (N = 90) received daily treatment for 15 days with periods of no treatment during the weekend. All three received traditional logopedic dysphagia treatment. In addition, two groups received SES, either motor-level or sensory-level stimulation. A standardized measurement protocol, including fiber optic endoscopic evaluation of swallowing (FEES) and videofluoroscopy of swallowing (VFS), was performed before and after therapy. A team of experienced raters was blinded to the treatment group and to the moment of measurement. Intrarater and interrater reliability were calculated.
Using proportional odds models (POMs), some of the visuoperceptual ordinal outcome variables showed significant improvement in all groups following treatment. Following 15 days of SES of the submental region, few significant effects were found, suggesting a therapy effect of traditional logopedic dysphagia treatment without any additional influence of SES.
On the grounds of this study, it is concluded that further research is needed on the exact mechanism of SES and its effects on the neural pathways involved in swallowing.
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Tan C, Liu Y, Li W, Liu J, Chen L.
J Oral Rehabil. 2013 Apr 23.
There is still debate over whether the effect of transcutaneous neuromuscular electrical stimulation (NMES) in dysphagia rehabilitation is superior to traditional therapy (TT). The purpose of this meta-analysis was to assess the overall efficacy by comparing the two treatment protocols. Published medical studies in the English language were obtained by comprehensive searches of the Medline, Cochrane and EMBASE databases from January 1966 to December 2011. Studies that compared the efficacy of treatment and clinical outcomes of NMES versus TT in dysphagia rehabilitation were assessed. Two reviewers independently performed data extraction. Data assessing swallowing function improvement were extracted as scores on the Swallowing Function Scale as the change from baseline (change scores). Seven studies were eligible for inclusion, including 291 patients, 175 of whom received NMES and 116 of whom received TT. Of the seven studies, there were two randomised controlled trials, one multicentre randomised controlled trial and four clinical controlled trials. The change scores on the Swallowing Function Scale of patients with dysphagia treated with NMES were significantly higher compared with patients treated with TT [standardised mean difference (SMD) = 0·77, 95% confidence interval (CI): 0·13 to 1·41, P = 0·02]. However, subgroup analysis according to aetiology showed that there were no differences between NMES and TT in dysphagia post-stroke (SMD = 0·78, 95% CI: -0·22 to 1·78, P = 0·13, 4 studies, 175 patients). No studies reported complications of NMES. NMES is more effective for treatment of adult dysphagia patients of variable aetiologies than TT. However, in patients with dysphagia post-stroke, the effectiveness was comparable.
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