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.

Lee, So Young; Park, Donghwi; Jang, Joonyoung; Jang, Eun Gyeong; Lee, Jun Chang; Park, Yulhyun; Cho, Seon; Kim, Won-Seok; Park, Jihong; Kim, Bo Ryun; Seo, Kyoung-Ho; Park, Sungwon; Ryu, Ju Seok

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.

CHRONIC disease treatment; THERAPEUTIC use of honey; THERAPEUTICS; DEGLUTITION; DEGLUTITION disorders; PATIENT satisfaction; TREATMENT effectiveness; RANDOMIZED controlled trials; PRE-tests & post-tests; ELECTRIC stimulation; SCALE analysis (Psychology); BLIND experiment; DESCRIPTIVE statistics; STATISTICAL sampling; NECK muscles; ACUTE diseases; LONGITUDINAL method; KINEMATICS

Neurorehabilitation & Neural Repair, 2021, Vol 35, Issue 9, p801

1545-9683

Academic Journal

10.1177/15459683211029891