Arquivo da categoria: Electrical Stimulation

Laryngeal elevation achieved by neuromuscular stimulation at rest

Theresa A. BurnettEric A. MannSonia A. Cornell, and Christy L. Ludlow

Journal of Applied PhysiologyJanuary 1, 2003 vol. 94 no. 1128-134


During swallowing, airway protection is achieved in part by laryngeal elevation. Although multiple muscles are normally active during laryngeal elevation, neuromuscular stimulation of select muscles was evaluated to determine which single muscle or muscle pair best elevates the larynx and should be considered during future studies of neuromuscular stimulation in dysphagic patients. Hooked-wire monopolar electrodes were inserted into mylohyoid, thyrohyoid, and geniohyoid muscle regions in 15 healthy men selected for having a highly visible thyroid prominence for videotaping. During trials of single, bilateral, and combined muscle stimulations, thyroid prominence movements were video recorded, digitized, and normalized relative to elevation during a 2-ml water swallow. Individual muscle stimulation induced ∼30% of the elevation observed during a swallow and ∼50% of swallow velocity, whereas paired muscle stimulation resulted in ∼50% of the elevation and ∼80% of the velocity produced during a swallow. Paired muscle stimulation produced significantly greater elevation than single muscle stimulation and could assist with laryngeal elevation in dysphagic patients with reduced or delayed laryngeal elevation.

Electrical stimulation in dysphagia treatment: a justified controversy?

H.C.A. Bogaardt1

Department of Otorhinolaryngology, Academic Medical Center,

University of Amsterdam, the Netherlands


Neuromuscular electrostimulation (NMES) is a method for stimulating muscles with short electrical pulses. Neuromuscular electrostimulation is frequently used in physiotherapy to strengthen healthy muscles (as in sports training) or to prevent muscle atrophy in patients. The first article on the use of NMES as a motor treatment in dysphagic patients was published in 2001. The study involved treating a group of stroke patients with NMES. The supralaryngeal muscles were stimulated using transcutaneous electrostimulation. On the basis of that study and additional reports from the same researcher, a commercial product was developed and marketed. The way in which this product was designed by its producers and evaluated in publications has rendered the use of NMES in the field of dysphagia treatment controversial. Recent literature reports are rather mixed about the effects of NMES on swallowing physiology and possible treatment outcomes. However, critical appraisal of the literature on NMES in dysphagia treatment shows a diversity of treatment parameters, which may be a confounder for the different outcomes in these studies. NMES is used with a variety of different parameters for different types of treatment since muscle contraction is dependent on different electrical parameters. A standard operation protocol for the use of NMES in the treatment of dysphagia seems to be required in order to study the outcomes of this treatment modality in different populations. The current controversy seems to be a threat to the potential benefits of NMES in the treatment of dysphagia.


Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a randomized controlled trial

Journal of Rehabilitation Medicine Volume 41, Issue 3 DOI: 10.2340/16501977-0317 Pages: 174-178

Kil-Byung Lim, Hong-Jae Lee, Sung-Shick Lim, Yoo-Im Choi


OBJECTIVE: The aim of this study was to assess the effectiveness of neuromuscular electrical stimulation in patients with dysphagia caused by stroke.
METHODS: Thirty-six subjects were randomized into experimental and control groups. The control group was given thermal-tactile stimulation treatment only, while in the experimental group neuromuscular electrical stimulation and thermal-tactile stimulation treatments were applied simultaneously. Swallowing function was assessed before and 4 weeks after treatment, and evaluated via the swallow function scoring system, penetration-aspiration scale, and pharyngeal transit time. In addition, the discomfort score during the treatments and the satisfaction score 4 weeks after the treatments were measured.
RESULTS: Twenty-eight persons with dysphagia completed the study, 16 in the experimental group and 12 in the control group. Both groups showed improvement, but the experimental group showed more significant improvement in the swallow function scoring system, penetration-aspiration scale and pharyngeal transit time than the control group. The patient’s discomfort score did not show statistically significant differences in either group, but the satisfactory score was higher in the experimental group.
CONCLUSION: The results suggest that neuromuscular electrical stimulation combined with thermal-tactile stimulation is a better treatment for patients with swallowing disorders after stroke than thermal-tactile stimulation alone.


The Effect of Surface Electrical Stimulation on Hyo-Laryngeal Movement in Normal Individuals at Rest and During Swallowing

J Appl Physiol. 2006 December; 101(6): 1657–1663.

Ianessa A. HumbertChristopher J. PolettoKeith G. Saxon et al.


Surface electrical stimulation is currently used in therapy for swallowing problems, although little is known about its physiological effects on neck muscles or swallowing. Previously, when one surface electrode placement was used in dysphagic patients at rest, it lowered the hyo-laryngeal complex. Here we examined the effects of nine other placements in normal volunteers to determine: 1) if movements induced by surface stimulation using other placements differ, and 2) if lowering the hyo-laryngeal complex by surface electrical stimulation interfered with swallowing in healthy adults. Ten bipolar surface electrode placements overlying the submental and laryngeal regions were tested. Maximum tolerated stimulation levels were applied at rest while participants held their mouths closed. Videofluoroscopic recordings were used to measure hyoid bone and subglottic air column (laryngeal) movements from resting position and while swallowing 5ml of liquid barium with and without stimulation. Videofluoroscopic recordings of swallows were rated blind to condition using the NIH-Swallowing Safety Scale (NIH-SSS). Significant (p<0.0001) laryngeal and hyoid descent occurred with stimulation at rest. During swallowing, significant (p≤0.01) reductions in both the larynx and hyoid bone peak elevation occurred during stimulated swallows. The stimulated swallows were also judged less safe than non-stimulated swallows using the NIH-SSS (p=0.0275). Because surface electrical stimulation reduced hyo-laryngeal elevation during swallowing in normal volunteers, our findings suggest that surface electrical stimulation will reduce elevation during swallowing therapy for dysphagia.

Keywords: dysphagia, videofluoroscopy, neuromuscular stimulation, neck muscles

The effect of electrical stimulation therapy on dysphagia following treatment for head and neck cancer

Ryu, J.S., Kang, J.Y., Park, J.Y., Nam, S.Y., Choi, S.H., Roh, J.L., Kim, S.Y., Choi, K.H.

Oral Oncology, 2009,  45 (8), pp. 665-668


The purpose of this study was to evaluate the effect of neuromuscular electrical stimulation (NMES) in patients suffering from dysphagia following treatment for head and neck cancer. In a prospective, double blinded, randomized case control study between January 2006 and December 2007, 14 patients were randomized to 30min of NMES and 30min of traditional swallowing training for 5 days per week for 2 weeks (experimental group), and 12 patients were randomized to sham stimulation plus traditional swallowing training (control group). Effects were assessed using the clinical dysphagia scale (CDS), the functional dysphagia scale (FDS), the American speech-language-hearing association national outcome measurement system (ASHA NOMS) and the M.D. Anderson dysphagia inventory (MADI). Pretreatment evaluation showed no significant differences between the two groups for all parameters. Average changes of FDS score were 11.4±8.1 for the experimental group and 3.3±14.0 for the control group (P=0.039). CDS, ASHA NOMS and MADI showed some difference with treatment, but the changes were not significant (P>0.05). NMES combined with traditional swallowing training is superior to traditional swallowing training alone in patients suffering from dysphagia following treatment for head and neck cancer.


Transcutaneous electricalstimulation versus traditional dysphagia therapy: A nonconcurrent cohort study

L Blumenfeld, Y Hahn, A LePage, R Leonard, P Belafsky


The purpose of this investigation was to critically evaluate the efficacy of electrical stimulation (ES) in treating persons with dysphagia and aspiration.

Study design

Nonconcurrent cohort study.


The charts of 40 consecutive individuals undergoing ES and 40 consecutive persons undergoing traditional dysphagia therapy (TDT) were reviewed. Pre- and post-therapy treatment success was compared utilizing a previously described swallow severity scale. A linear regression analysis was employed to adjust for potential confounding variables.


The swallow severity scale improved from 0.50 to 1.48 in the TDT group (P < 0.05) and from 0.28 to 3.23 in the ES group (P < 0.001). After adjusting for potential confounding factors, persons receiving ES did significantly better in regard to improvement in their swallowing function than persons receiving TDT (P = 0.003).


The results of this nonconcurrent cohort study suggest that dysphagia therapy with transcutaneous electrical stimulation is superior to traditional dysphagia therapy alone in individuals in a long-term acute care facility.



Synchronized electrical stimulation in treating pharyngeal dysphagia

V Leelamanit, C Limsakul, A Geater

The Laryngoscope, Volume 112, Issue 12, pages 2204–2210, December 2002



Objective/Hypothesis The objectives were to test the hypothesis that synchronous contraction of the thyrohyoid muscle by electrical stimulation during swallowing would improve dysphagia resulting from reduced laryngeal elevation and to evaluate the effectiveness of the synchronous electrical stimulator.

Study Design Prospective study.

Methods Eleven male and 12 female patients (age range, 35–87 y) with moderate to severe degree of dysphagia resulting from reduced laryngeal elevation who did not respond to medical treatment were treated by stimulating synchronous contraction of the thyrohyoid muscle during swallowing with the synchronous electrical stimulator. Treatment was given daily for 4 hours until criteria for improved swallow were fulfilled or other intervention was deemed necessary. Follow-up was performed monthly (range, 3–33 mo).

Results Of the 23 patients, 20 showed marked improvement at the first course of treatment. The duration of stimulation varied from 2 to 4 days (median duration, 2 d) in patients with moderate dysphagia and from 3 to 30 days (median duration, 6 d) in patients with severe dysphagia. Three patients showed failed synchronous electrical stimulator treatment, one owing to device failure and two requiring gastrostomy for feeding. Six patients who achieved improved swallow criteria relapsed at 2 to 9 months after the first treatment course and were successfully treated with an additional course of synchronous electrical stimulation.

Conclusions The study supports the hypothesis that stimulating synchronous contraction of the thyrohyoid muscle by synchronous electrical stimulator during swallowing improves dysphagia resulting from reduced laryngeal elevation. Synchronized electrical stimulation has the advantages of noninvasiveness and actively assisting swallowing and can be used as an alternative treatment. The synchronized feature of the synchronous electrical stimulator helps to restore normal swal- lowing mechanism and decreases the incidence of nasogastric tube insertion and gastrostomy.


Neuromuscular electrical stimulation in the rehabilitation of oropharyngeal dysphagia

Guimarães, Bruno Tavares de Lima; Furkim, Ana Maria; Silva, Roberta Gonçalves da
Rev. soc. bras. fonoaudiol. 15(4): 615-621, ND. 2010 Dec.


The rehabilitation of oropharyngeal dysphagia has a new therapeutic tool, the neuromuscular electrical stimulation (NMES), and the most renowned researchers have been studying the applicability and the results of this approach. The aim of this study was to present a literature review regarding the applicability of NMES in the rehabilitation of oropharyngeal dysphagia. An extensive literature review was carried out, considering the last two decades of research in the area. The review showed that there is still no consensus on the use of NMES in the rehabilitation of dysphagia. It was found that most studies described the use of NMES in isolation, did not describe the techniques associated with speech-language therapy associated to electrotherapy, and used heterogeneous samples that clustered mechanical and neurogenic oropharyngeal dysphagia. Only recently specific programs have been designed and tested in more homogeneous populations.

Keywords: Dysphagia/rehabilitation; Deglutition disorders; Electric stimulation therapy/methods;


Eletroestimulação neuromuscular na reabilitação da disfagia orofaríngea

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.

Descritores: Disfagia/reabilitação; Transtornos de deglutição; Terapia por estimulação elétrica/métodos


Electrical neuromuscular stimulation in dysphagia: current status.

Ludlow CL.

Curr Opin Otolaryngol Head Neck Surg. 2010 Jun;18(3):159-64.



To assess current information regarding the physiological effects of transcutaneous electrical stimulation (TES) on the neck and current evidence regarding the clinical effects of adding TES to dysphagia rehabilitation.


Physiological studies have demonstrated that when electrical stimulation is applied on the throat it will lower the hyo-laryngeal complex and resist elevation needed for airway protection during swallowing. Submental TES has not been found to effectively elevate the hyo-laryngeal complex. Recent controlled clinical trials have had mixed results. Most indicate that TES is beneficial in the treatment of dysphagia; however, studies differ on whether these effects are greater than, equal to, or less than traditional therapy alone for the rehabilitation of swallowing.


Currently TES for dysphagia is one of several tools available to the clinician for the rehabilitation of dysphagia. The two controlled clinical trials demonstrate that use of TES in dysphagia therapy is equivalent to traditional dysphagia therapy and of greater benefit only on one of several measures in one study. TES should be used only in patients who can overcome the resistive lowering of the hyo-laryngeal complex induced by TES which could place severely affected patients at greater risk of penetration.