Purpose

Neuromuscular Electrical Stimulation (NMES) is a widely used treatment modality for dysphagia therapy despite the inconclusive evidence of its effectiveness. Our objective was to complete a retrospective review to analyze the results of NMES with our patient population in an acute rehabilitation facility. In this clinical focus article, we briefly review the current literature on NMES, discuss a clinical protocol of NMES use in an inpatient rehabilitation hospital, and discuss the need for future research in this area.

Conclusions

As with much of the NMES literature, we observed improvement in the ability to swallow following a cerebrovascular accident and traumatic brain injury when a combination of swallowing therapy and NMES treatment was used. Although this combination works for our patients to improve swallow function, the impact of swallow therapy alone remains unclear. Further investigative research to clarify NMES protocols and patient population is needed to optimize results. Therefore, a large randomized clinical trial would be beneficial to clearly define the role of NMES in recovery of swallowing ability following a brain injury.

References

  • Baijens, L., Barikroo, A., & Pilz, W. (2013). Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing.European Journal of Radiology, 82(10), 1683–1695. https://doi.org/10.1016/j.ejrad.2013.05.009
  • Barikroo, A., Carnaby, G., & Crary, M. (2017). Electrical stimulation therapy for dysphagia: A follow-up survey of USA dysphagia practitioners.International Journal of Rehabilitation Research, 40(4), 360–365. https://doi.org/10.1097/MRR.0000000000000241
  • Bülow, M., Speyer, R., Baijens, L., Woisard, V., & Ekberg, O. (2008). Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction.Dysphagia, 23(3), 302–309. https://doi.org/10.1007/s00455-007-9145-9
  • Carnaby-Mann, G. D., & Crary, M. A. (2007). Examining the evidence on neuromuscular electrical stimulation for swallowing: A meta-analysis.Archives of Otolaryngology—Head & Neck Surgery, 133(6), 564–571. https://doi.org/10.1001/archotol.133.6.564
  • Carter, J. (2011). Point/counterpoint: Electrical stimulation for dysphagia: The argument for electrical stimulation for dysphagia.SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 20(4), 96–101.
  • Choi, J.-B. (2016). Effect of neuromuscular electrical stimulation on facial muscle strength and oral function in stroke patients with facial palsy.Journal of Physical Therapy Science, 28(9), 2541–2543. https://doi.org/10.1589/jpts.28.2541
  • Clark, H., Lazarus, C., Arvedson, J., Schooling, T., & Frymark, T. (2009). Evidence-based systematic review: Effects of neuromuscular electrical stimulation on swallowing and neural activation.American Journal of Speech-Language Pathology, 18(4), 361–375. https://doi.org/10.1044/1058-0360(2009/08-0088)
  • Crary, M. A., Mann, G. D., & Groher, M. E. (2005). Initial psychometric assessment of a Functional Oral Intake Scale for dysphagia in stroke patients.Archives of Physical Medicine and Rehabilitation, 86(8), 1516–1520. https://doi.org/10.1016/j.apmr.2004.11.049
  • Freed, M. L., Freed, L., Chatburn, R. L., & Christian, M. (2001). Electrical stimulation for swallowing disorders caused by stroke.Respiratory Care, 46(5), 466–474.
  • Gallas, S., Marie, J. P., Leroi, A. M., & Verin, E. (2010). Sensory transcutaneous electrical stimulation improves post-stroke dysphagic patients.Dysphagia, 25(4), 291–297. https://doi.org/10.1007/s00455-009-9259-3
  • Hainaut, K., & Duchateau, J. (1992). Neuromuscular electrical stimulation and voluntary exercise.Sports Medicine, 14(2), 100–113.
  • Heijnen, B. J., Speyer, R., Baijens, L. W., & Bogaardt, H. C. (2012). Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson's disease and oropharyngeal dysphagia: Effects on quality of life.Dysphagia, 27(3), 336–345. https://doi.org/10.1007/s00455-011-9371-z
  • Huang, K.-L., Liu, T.-Y., Huang, Y.-C., Leong, C.-P., Lin, W.-C., & Pong, Y.-P. (2014). Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy.Journal of Stroke and Cerebrovascular Diseases, 23(10), 2547–2553. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.05.031
  • Humbert, I. A., Michou, E., MacRae, P. R., & Crujido, L. (2012). Electrical stimulation and swallowing: How much do we know.Seminars in Speech and Language, 33(3), 203–216. https://doi.org/10.1055/s-0032-1320040
  • Kavanagh, S., Newell, J., Hennessy, M., & Sadick, N. (2012). Use of a neuromuscular electrical stimulation device for facial muscle toning: A randomized, controlled trial.Journal of Cosmetic Dermatology, 11(4), 261–266. https://doi.org/10.1111/jocd.12007
  • Kushner, D. S., Peters, K., Eroglu, S. T., Perless-Carroll, M., & Johnson-Greene, D. (2013). Neuromuscular electrical stimulation efficacy in acute stroke feeding tube-dependent dysphagia during inpatient rehabilitation.American Journal of Physical Medicine and Rehabilitation, 92(6), 486–495. https://doi.org/10.1097/PHM.0b013e31828762ec
  • Langmore, S. E., McCulloch, T. M., Krisciunas, G. P., Lazarus, C. L., Van Daele, D. J., Pauloski, B. R., … Doros, G. (2016). Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial.Head and Neck, 38(Suppl. 1), E1221–E1231. https://doi.org/10.1002/hed.24197
  • Lee, K. W., Kim, S. B., Lee, J. H., Lee, S. J., Ri, J. W., & Park, J. G. (2014). The effect of early neuromuscular electrical stimulation therapy in acute/subacute ischemic stroke patients with dysphagia.Annals of Rehabilitation Medicine, 38(2), 153–159. https://doi.org/10.5535/arm.2014.38.2.153
  • Li, L., Li, Y., Huang, R., Yin, J., Shen, Y., & Shi, J. (2015). The value of adding transcutaneous neuromuscular electrical stimulation (VitalStim) to traditional therapy for post-stroke dysphagia: A randomized controlled trial.European Journal of Physical and Rehabilitation Medicine, 51(1), 71–78.
  • Lim, K.-B., Lee, H.-J., Lim, S.-S., & Choi, Y.-I. (2009). Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: A randomized controlled trial.Journal of Rehabilitation Medicine, 41, 174–178.
  • Lim, K.-B., Lee, H.-J., Yoo, J., & Kwon, Y.-G. (2014). Effect of low-frequency rTMS and NMES on subacute unilateral hemispheric stroke with dysphagia.Annals of Rehabilitation Medicine, 38(5), 592–602. https://doi.org/10.5535/arm.2014.38.5.592
  • Ludlow, C. L., Humbert, I., Saxon, K., Poletto, C., Sonies, B., & Crujido, L. (2007). Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia.Dysphagia, 22(1), 1–10. https://doi.org/10.1007/s00455-006-9029-4
  • Mehndiratta, M. M., Gupta, P., & Kaur, M. (2017). The effect of sensory-level electrical stimulation of the masseter muscle in early stroke patients with dysphagia.Neurology India, 65(4), 743–745. https://doi.org/10.4103/neuroindia.NI_522_17
  • Nudo, R. J. (2013). Recovery after brain injury: Mechanisms and principles.Frontiers in Human Neuroscience, 7, 887. https://doi.org10.3389/fnhum.2013.00887
  • Park, J.-S., Oh, D.-H., Hwang, N.-K., & Lee, J.-H. (2016). Effects of neuromuscular electrical stimulation combined with effortful swallowing on post-stroke oropharyngeal dysphagia: A randomised controlled trial.Journal of Oral Rehabilitation, 43(6), 426–434. https://doi.org/10.1111/joor.12390
  • Permsirivanich, W., Tipchatyotin, S., Wongchai, M., Leelamanit, V., Setthawatcharawanich, S., Sathirapanya, P., … Boonmeeprakob, A. (2009). Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: A randomized controlled study.Journal of the Medical Association of Thailand, 92(2), 259–265.
  • Rosenbek, J. C., Robbins, J. A., Roecker, E. B., Coyle, J. L., & Wood, J. L. (1996). A penetration-aspiration scale.Dysphagia, 11(2), 93–98.
  • Shune, S., & Moon, J. B. (2012). Neuromuscular electrical stimulation in dysphagia management: Clinician use and perceived barriers.Contemporary Issues in Communication Science and Disorders, 39, 55–68.
  • Sun, S.-F., Hsu, C.-W., Lin, H.-S., Sun, H.-P., Chang, P.-H., Hsieh, W.-L., & Wang, J.-L. (2013). Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and traditional swallowing rehabilitation in the treatment of stroke-related dysphagia.Dysphagia, 28(4), 557–566. https://doi.org/10.1007/s00455-013-9466-9
  • Toyama, K., Matsumoto, S., Kurasawa, M., Setoguchi, H., Noma, T., Takenaka, K., … Kawahira, K. (2014). Novel neuromuscular electrical stimulation system for treatment of dysphagia after brain injury.Neurologia Medico-Chirurgica (Tokyo), 54(7), 521–528.
  • Waxman, M. J., Durfee, D., Moore, M., Morantz, R. A., & Koller, W. (1990). Nutritional aspects and swallowing function of patients with Parkinson’s disease.Nutrition in Clinical Practice, 5(5), 196–199.
  • Wright, J. (2000). The Functional Assessment Measure. Retrieved from http://www.tbims.org/combi/FAM
  • Xia, W., Zheng, C., Lei, Q., Tang, Z., Hua, Q., Zhang, Y., & Zhu, S. (2011). Treatment of post-stroke dysphagia by VitalStim therapy coupled with conventional swallowing training.Journal of Huazhong University of Science and Technology [Medical Sciences], 31(1), 73–76. https://doi.org/10.1007/s11596-011-0153-5

Additional Resources