Abstract
Purpose:
Previously, externally placed vibratory laryngeal stimulation increased rates of swallowing in persons with and without dysphagia. This study examined the feasibility of using a vibratory device on the skin over the thyroid cartilage for home-based swallowing rehabilitation in long-standing dysphagia.
Method:
Only participants with long-standing dysphagia (> 6 months) following cerebrovascular accident or head/neck cancer who had not previously benefited from dysphagia therapy participated. The device had two modes used daily for 90 days. In automatic mode, participants wore the device when awake, which vibrated for 4–8 s every 5 min to trigger a volitional swallow. In manual mode, participants practiced by activating vibration while swallowing rapidly. Study-related adverse events, such as pneumonia, and device-recorded adherence were tracked. Swallowing function on a modified barium swallow study was assessed at baseline and after 3 months of device use. Outcome measures included the Dysphagia Outcome and Severity Scale (DOSS), Penetration–Aspiration Scale (PAS), and swallowing timing measures. Participants' perceptions of the vibratory device and training were obtained.
Results:
The intent to treat analysis showed seven of 11 participants completed the study, all with severe chronic dysphagia. Of those seven participants completing the study, two developed respiratory complications (possibly due to pneumonia) that cleared after antibiotic intervention. For prescribed practice trials, adherence was 80% or greater in four of seven participants (57%) whereas prescribed automatic stimulations were met in only two of seven participants (29%). Three participants (43%) had a modest benefit on DOSS. The time to vestibule closure after the bolus passed the ramus was reduced in five participants (71%) on the modified barium swallow study.
Conclusion:
Overall, the results have indicated that intensive home-based practice with stimulation may provide limited functional benefits in severe chronic dysphagia.
Supplemental Material:
References
-
Arreola, V. D., Vilardell, N., Ortega, O., Rofes, L., Muriana, D., Palomeras, E., Álvarez-Berdugo, D., & Clavé, P. (2019). Natural history of swallow function during the three-month period after stroke.Geriatrics, 4(3), 42. https://doi.org/10.3390/geriatrics4030042 -
Bogaardt, H. C. A., Grolman, W., & Fokkens, W. J. (2009). The use of biofeedback in the treatment of chronic dysphagia in stroke patients.Folia Phoniatrica et Logopaedica, 61(4), 200–205. https://doi.org/10.1159/000227997 -
Carnaby, G., Sia, I., & Crary, M. (2019). Associations between spontaneous swallowing frequency at admission, dysphagia, and stroke-related outcomes in acute care.Archives of Physical Medicine Rehabilitation, 100(7), 1283–1288. https://doi.org/10.1016/j.apmr.2019.01.009 -
Cho, Y. S., Oh, D. H., Paik, Y. R., Lee, J. H., & Park, J. S. (2017). Effects of bedside self-exercise on oropharyngeal swallowing function in stroke patients with dysphagia: A pilot study.Journal of Physical Therapy Science, 29(10), 1815–1816. https://doi.org/10.1589/jpts.29.1815 -
Cnossen, I. C., van Uden-Kraan, C. F., Witte, B. I., Aalders, Y. J., de Goede, C. J., de Bree, R., Doornaert, P., Rietveld, D. H., Buter, J., Langendijk, J. A., Leemans, C. R., & Verdonck-de Leeuw, I. M. (2017). Prophylactic exercises among head and neck cancer patients during and after swallowing sparing intensity modulated radiation: Adherence and exercise performance levels of a 12-week guided home-based program.European Archives of Oto-Rhino-Laryngology, 274(2), 1129–1138. https://doi.org/10.1007/s00405-016-4367-9 -
Collins, A., Burns, C. L., Ward, E. C., Comans, T., Blake, C., Kenny, L., Greenup, P., & Best, D. (2017). Home-based telehealth service for swallowing and nutrition management following head and neck cancer treatment.Journal of Telemedicine and Telecare, 23(10), 866–872. https://doi.org/10.1177/1357633X17733020 -
Constantinescu, G., Loewen, I., King, B., Brodt, C., Hodgetts, W., & Rieger, J. (2017). Designing a mobile health app for patients with dysphagia following head and neck cancer: A qualitative study.JMIR Rehabilitation and Assistive Technologies, 4(1), e3. https://doi.org/10.2196/rehab.6319 -
Constantinescu, G., Rieger, J., Seikaly, H., & Eurich, D. (2021). Adherence to home-based swallowing therapy using a Mobile system in head and neck cancer survivors.American Journal of Speech-Language Pathology, 30(6), 2465–2475. https://doi.org/10.1044/2021_AJSLP-21-00026 -
Crary, M. A., Carnaby, 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 -
Crary, M. A., Carnaby, G. D., Groher, M. E., & Helseth, E. (2004). Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback.Dysphagia, 19(3), 160–164. https://doi.org/10.1007/s00455-004-0003-8 -
Crary, M. A., Carnaby, G. D., Sia, I., Khanna, A., & Waters, M. F. (2013). Spontaneous swallowing frequency has potential to identify dysphagia in acute stroke.Stroke, 44(12), 3452–3457. https://doi.org/10.1161/STROKEAHA.113.003048 -
Dong, H., Loomis, C. W., & Bieger, D. (2001). Vagal afferent input determines the volume dependence of rat esophageal motility patterns.American Journal of Physiology-Gastrointestinal and Liver Physiology, 281(1), G44–G53. https://doi.org/10.1152/ajpgi.2001.281.1.G44 -
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician.Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6 -
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 -
Gatto, A. R., Cola, P. C., da Silva, R. G., Spadotto, A. A., Ribeiro, P. W., Schelp, A. O., Carvalho, L. R., & Henry, M. A. (2013). Sour taste and cold temperature in the oral phase of swallowing in patients after stroke.CoDAS, 25(2), 163–167. https://doi.org/10.1590/s2317-17822013000200012 -
Goepfert, R. P., Lewin, J. S., Barrow, M. P., Fuller, G. C. D., Lai, S. Y., Song, J., Hobbs, B., Gunn, G. B., Beadle, B. M., Rosenthal, D. I., Garden, A. S., Kies, M., Papadimitrakopoulou, V., Schwartz, D. L., & Hutcheson, K. A. (2017). Predicting two-year longitudinal MD Anderson dysphagia inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma.The Laryngoscope, 127(4), 842–848. https://doi.org/10.1002/lary.26153 -
Humbert, I. A., Sunday, K. L., Karagiorgos, E., Vose, A. K., Gould, F., Greene, L., Azola, A., Tolar, A., & Rivet, A. (2018). Swallowing kinematic differences across frozen, mixed, and ultrathin liquid boluses in healthy adults: Age, sex, and normal variability.Journal of Speech, Language, and Hearing Research, 61(7), 1544–1559. https://doi.org/10.1044/2018_JSLHR-S-17-0417 -
Hutcheson, K. A., Yuk, M., Hubbard, R., Gunn, G. B., Fuller, C. D., Lai, S. Y., Lin, H., Garden, A. S., Rosenthal, D. I., Hanna, E. Y., Kies, M. S., & Lewin, J. S. (2017). Delayed lower cranial neuropathy after oropharyngeal intensity-modulated radiotherapy: A cohort analysis and literature review.Head & Neck, 39(8), 1516–1523. https://doi.org/10.1002/hed.24789 -
Kamarunas, E., Wong, S. M., & Ludlow, C. L. (2019). Laryngeal vibration increases spontaneous swallowing rates in chronic oropharyngeal dysphagia: A proof-of-principle pilot study.Dysphagia, 34(5), 640–653. https://doi.org/10.1007/s00455-018-9962-z -
Kim, H., Cho, N. B., Kim, J., Kim, K. M., Kang, M., Choi, Y., Kim, M., You, H., Nam, S. I., & Shin, S. (2020). Implementation of a home-based mHealth app intervention program with human mediation for swallowing tongue pressure strengthening exercises in older adults: Longitudinal observational study.JMIR mHealth and uHealth, 8(10), e22080. https://doi.org/10.2196/22080 -
Kim, H., Kown, Y., & Choi, H. (2021). Home based dysphagia rehabilitation for stroke patients using information and communication technology.Journal of International Academy of Physical Therapy Research, 12(1), 2267–2271. https://doi.org/10.20540/jiaptr.2021.12.1.2267 -
Kitagawa, J., Nakagawa, K., Hasegawa, M., Iwakami, T., Shingai, T., Yamada, Y., & Iwata, K. (2009). Facilitation of reflex swallowing from the pharynx and larynx.Journal of Oral Science, 51(2), 167–171. https://doi:10.2334/josnusd.51.167 -
Kitagawa, J., Shingai, T., Takahashi, Y., & Yamada, Y. (2002). Pharyngeal branch of the glossopharyngeal nerve plays a major role in reflex swallowing from the pharynx.American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 282(5), R1342–R1347. https://doi.org/10.1152/ajpregu.00556.2001 -
Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage.Journal of Speech, Language, and Hearing Research, 51(1), S225–S239. https://doi.org/10.1044/1092-4388(2008/018) -
Ko, H., Kim, H., Kim, Y., Sohn, M. K., & Jee, S. (2020). Dose-response effect of daily rehabilitation time on functional gain in stroke patients.Annals of Rehabilitation Medicine, 44(2), 101–108. https://doi.org/10.5535/arm.2020.44.2.101 -
Krekeler, B. N., Rowe, L. M., & Connor, N. P. (2021). Dose in exercise-based dysphagia therapies: A scoping review.Dysphagia, 36(1), 1–32. https://doi.org/10.1007/s00455-020-10104-3 -
Krekeler, B. N., Vitale, K., Yee, J., Powell, R., & Rogus-Pulia, N. (2020). Adherence to dysphagia treatment recommendations: A conceptual model.Journal of Speech, Language, and Hearing Research, 63(6), 1641–1657. https://doi.org/10.1044/2020_JSLHR-19-00270 -
Krekeler, B. N., Yee, J., Daggett, S., Leverson, G., & Rogus-Pulia, N. (2021). Lingual exercise in older veterans with dysphagia: A pilot investigation of patient adherence.Journal of Speech, Language, and Hearing Research, 64(5), 1526–1538. https://doi.org/10.1044/2021_JSLHR-20-00461 -
Kummar, S., Doroshow, J. H., Tomaszewski, J. E., Calvert, A. H., Lobbezoo, M., Giaccone, G. , & Task Force on Methodology for the Development of Innovative Cancer Therapies (MDICT). (2009). Phase 0 clinical trials: Recommendations from the task force on methodology for the development of innovative cancer therapies.European Journal of Cancer, 45(5), 741–746. https://doi.org/10.1016/j.ejca.2008.10.024 -
Kummar, S., Rubinstein, L., Kinders, R., Parchment, R. E., Gutierrez, M. E., Murgo, A. J., Ji, J., Mroczkowski, B., Pickeral, O. K., Simpson, M., Hollingshead, M., Yang, S. X., Helman, L., Wiltrout, R., Collins, J., Tomaszewski, J. E., & Doroshow, J. H. (2008). Phase 0 clinical trials: Conceptions and misconceptions.The Cancer Journal, 14(3), 133–137. https://doi.org/10.1097/PPO.0b013e318172d6f3 -
Langmore, S. E., McCulloch, T. M., Krisciunas, G. P., Lazarus, C. L., Van Daele, D. J., Pauloski, B. R., Rybin, D., & Doros, G. (2016). Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial.Head & Neck, 38(S1), E1221–E1231. https://doi.org/10.1002/hed.24197 -
Logemann, J. A., Rademaker, A., Pauloski, B. R., Kelly, A., Stangl-McBreen, C., Antinoja, J., Grande, B., Farquharson, J., Kern, M., Easterling, C., & Shaker, R. (2009). A randomized study comparing the Shaker exercise with traditional therapy: A preliminary study.Dysphagia, 24(4), 403–411. https://doi.org/10.1007/s00455-009-9217-0 -
Lohse, K. R., Lang, C. E., & Boyd, L. A. (2014). Is more better? Using metadata to explore dose–response relationships in stroke rehabilitation.Stroke, 45(7), 2053–2058. https://doi.org/10.1161/STROKEAHA.114.004695 -
Low, J., Wyles, C., Wilkinson, T., & Sainsbury, R. (2001). The effect of compliance on clinical outcomes for patients with dysphagia on videofluoroscopy.Dysphagia, 16(2), 123–127. https://doi.org/10.1007/s004550011002 -
Lowell, S. Y., Poletto, C. J., Knorr-Chung, B. R., Reynolds, R. C., Simonyan, K., & Ludlow, C. L. (2008). Sensory stimulation activates both motor and sensory components of the swallowing system.NeuroImage, 42(1), 285–295. https://doi.org/10.1016/j.neuroimage.2008.04.234 -
Mandel, A. (2019, February26). What is a phase 0 clinical trial?.News Medical. https://www.news-medical.net/health/What-is-a-Phase-0-Clinical-Trial.aspx -
Martin-Harris, B., Brodsky, M. B., Michel, Y., Castell, D. O., Schleicher, M., Sandidge, J., Maxwell, R., & Blair, J. (2008). MBS measurement tool for swallow impairment--MBSImp: Establishing a standard.Dysphagia, 23(4), 392–405. https://doi.org/10.1007/s00455-008-9185-9 -
Mulheren, R. W., & Ludlow, C. L. (2017). Vibration over the larynx increases swallowing and cortical activation for swallowing.Journal of Neurophysiology, 118(3), 1698–1708. https://doi.org/10.1152/jn.00244.2017 -
Murgo, A. J., Kummar, S., Rubinstein, L., Gutierrez, M., Collins, J., Kinders, R., Parchment, R. E., Ji, J., Steinberg, S. M., Yang, S. X., Hollingshead, M., Chen, A., Helman, L., Wiltrout, R., Tomaszewski, J. E., & Doroshow, J. H. (2008). Designing phase 0 cancer clinical trials.Clinical Cancer Research, 14(12), 3675–3682. https://doi.org/10.1158/1078-0432.CCR-07-4560 -
Nakazora, T., Iwamoto, K., Kiyozuka, T., Arimoto, H., Shirotani, T., & Domen, K. (2018). Effectiveness of 7-day versus weekday-only rehabilitation for stroke patients in an acute-care hospital: A retrospective cohort study.Disability and Rehabilitation, 40(25), 3050–3053. https://doi.org/10.1080/09638288.2017.1367964 -
O'Neil, K. H., Purdy, M., Falk, J., & Gallo, L. (1999). The dysphagia outcome and severity scale.Dysphagia, 14(3), 139–145. https://doi.org/10.1007/PL00009595 -
Pallant, J. (2011). SPSS survival manual: A step by step guide to data analysis using the SPSS program.(4th Ed. ). Allen & Unwin. -
Park, T., & Kim, Y. (2016). Effects of tongue pressing effortful swallow in older healthy individuals.Archives of Gerontology and Geriatrics, 66, 127–133. https://doi.org/10.1016/j.archger.2016.05.009 -
Robbins, J., Butler, S. G., Daniels, S. K., Diez Gross, R., Langmore, S., Lazarus, C. L., Martin-Harris, B., McCabe, D., Musson, N., & Rosenbek, J. (2008). Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence.Journal of Speech, Language, and Hearing Research, 51(1), S276–S300. https://doi.org/10.1044/1092-4388(2008/021) -
Robbins, J., Kays, S. A., Gangnon, R. E., Hind, J. A., Hewitt, A. L., Gentry, L. R., & Taylor, A. J. (2007). The effects of lingual exercise in stroke patients with dysphagia.Archives of Physical Medicine and Rehabilitation, 88(2), 150–158. https://doi.org/10.1016/j.apmr.2006.11.002 -
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. https://doi.org/10.1007/BF00417897 -
Rosenbek, J. C., Roecker, E. B., Wood, J. L., & Robbins, J. (1996). Thermal application reduces the duration of stage transition in dysphagia after stroke.Dysphagia, 11(4), 225–233. https://doi.org/10.1007/BF00265206 -
Son, Y. G., Shin, J., & Ryu, H. G. (2017). Pneumonitis and pneumonia after aspiration.Journal of Dental Anesthesia and Pain Medicine, 17(1), 1–12. https://doi.org/10.17245/jdapm.2017.17.1.1 -
Soros, P., Lalone, E., Smith, R., Stevens, T., Theurer, J., Menon, R. S., & Martin, R. E. (2008). Functional MRI of oropharyngeal air-pulse stimulation.Neuroscience, 153(4), 1300–1308. https://doi:10.1016/j.neuroscience.2008.02.079 -
Steele, C. M., & Cichero, J. A. (2014). Physiological factors related to aspiration risk: A systematic review.Dysphagia, 29(3), 295–304. https://doi.org/10.1007/s00455-014-9516-y -
Steele, C. M., & Grace-Martin, K. (2017). Reflections on clinical and statistical use of the Penetration–Aspiration Scale.Dysphagia, 32(5), 601–616. https://doi.org/10.1007/s00455-017-9809-z -
Steele, C. M., & Miller, A. J. (2010). Sensory input pathways and mechanisms in swallowing: A review.Dysphagia, 25(4), 323–333. https://doi.org/10.1007/s00455-010-9301-5 -
Steele, C. M., Peladeau-Pigeon, M., Barbon, C. A. E., Guida, B. T., Namasivayam-MacDonald, A. M., Nascimento, W. V., Smaoui, S., Tapson, M. S., Valenzano, T. J., Waito, A. A., & Wolkin, T. S. (2019). Reference values for healthy swallowing across the range from thin to extremely thick liquids.Journal of Speech, Language, and Hearing Research, 62(5), 1338–1363. https://doi.org/10.1044/2019_JSLHR-S-18-0448 -
Sweazey, R. D., & Bradley, R. M. (1989). Response characteristics of lamb trigeminal neurons to stimulation of the oral cavity and epiglottis with different sensory modalities.Brain Research Bulletin, 22(5), 883–891. https://doi.org/10.1016/0361-9230(89)90033-6 -
Takatori, K., Matsumoto, D., Nishida, M., Matsushita, S., Noda, T., & Imamura, T. (2016). Benefits of a novel concept of home-based exercise with the aim of preventing aspiration pneumonia and falls in frail older women: A pragmatic controlled trial.BMJ Open Sport & Exercise Medicine, 2(1), e000127. https://doi.org/10.1136/bmjsem-2016-000127 -
Theurer, J. A., Johnston, J. L., Fisher, J., Darling, S., Stevens, R. C., Taves, D., Teasell, R., Hachinski, V., & Martin, R. E. (2013). Proof-of-principle pilot study of oropharyngeal air-pulse application in individuals with dysphagia after hemispheric stroke.Archives of Physical Medicine and Rehabilitation, 94(6), 1088–1094. https://doi.org/10.1016/j.apmr.2012.11.033 -
Troche, M. S., Okun, M. S., Rosenbek, J. C., Musson, N., Fernandez, H. H., Rodriguez, R., Romrell, J., Pitts, T., Wheeler-Hegland, K. M., & Sapienza, C. M. (2010). Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: A randomized trial.Neurology, 75(21), 1912–1919. https://doi.org/10.1212/WNL.0b013e3181fef115 -
Umay, E. K., Yaylaci, A., Saylam, G., Gundogdu, I., Gurcay, E., Akcapinar, D., & Kirac, Z. (2017). The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: A randomized controlled study.Neurology India, 65(4), 734–742. https://doi.org/10.4103/neuroindia.NI_377_16 -
Yamada, Y., Shamoto, H., Maeda, K., & Wakabayashi, H. (2018). Home-based combined therapy with rehabilitation and aggressive nutrition management for a Parkinson's disease patient with sarcopenic dysphagia: A case report.Progress in Rehabilitation Medicine, 3, Article 20180019. https://doi.org/10.2490/prm.20180019 -
Wall, L. R., Ward, E. C., Cartmill, B., Hill, A. J., & Porceddu, S. V. (2017). Adherence to a prophylactic swallowing therapy program during (chemo) radiotherapy: Impact of service-delivery model and patient factors.Dysphagia, 32(2), 279–292. https://doi.org/10.1007/s00455-016-9757-z -
Wang, C. M., Shieh, W. Y., Ho, C. S., Hu, Y. W., & Wu, Y. R. (2018). Home-based orolingual exercise improves the coordination of swallowing and respiration in early Parkinson disease: A quasi-experimental before-and-after exercise program study.Frontiers in Neurology, 9, 624. https://doi.org/10.3389/fneur.2018.00624 -
Ward, E. C., Wall, L. R., Burns, C. L., Cartmill, B., & Hill, A. J. (2017). Application of telepractice for head and neck cancer management: A review of speech language pathology service models.Current Opinion in Otolaryngology & Head and Neck Surgery, 25(3), 169–174. https://doi.org/10.1097/MOO.0000000000000357 -
Wells, M., & King, E. (2017). Patient adherence to swallowing exercises in head and neck cancer.Current Opinion in Otolaryngology & Head and Neck Surgery, 25(3), 175–181. https://doi.org/10.1097/MOO.0000000000000356
Add to your Mendeley library