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Changes in hyolaryngeal movement and swallowing function after neuromuscular electrical stimulation in patients with Dysphagia.

Lee HY, Hong JS, Lee KC, Shin YK, Cho SR - Ann Rehabil Med (2015)

Bottom Line: NMES on submental placement alone did not change the PAS and NIH-SSS.However, NMES on both submental and throat regions significantly reduced the NIH-SSS, although it did not change the PAS.Immediate hyolaryngeal movement was paradoxically depressed after NMES on both submental and throat regions with significant reductions in the NIH-SSS but not the PAS, suggesting improvement in pharyngeal peristalsis and cricopharyngeal functions at the esophageal entry rather than decreased aspiration and penetration.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Gangnam Severance Hospital, Seoul, Korea. ; Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To investigate immediate changes in hyolaryngeal movement and swallowing function after a cycle of neuromuscular electrical stimulation (NMES) on both submental and throat regions and submental placement alone in patients with dysphagia.

Methods: Fifteen patients with dysphagia were recruited. First, videofluoroscopic swallowing study (VFSS) was performed before NMES. All patients thereafter received a cycle of NMES by 2 methods of electrode placement: 1) both submental and throat regions and 2) submental placement alone concomitant with VFSS. The Penetration-Aspiration Score (PAS) and the NIH-Swallowing Safety Scale (NIH-SSS) were measured for swallowing function.

Results: During swallowing, hyolaryngeal descent significantly occurred by NMES on both submental and throat regions, and anterior displacement of hyolaryngeal complex was significant on submental placement alone. NMES on submental placement alone did not change the PAS and NIH-SSS. However, NMES on both submental and throat regions significantly reduced the NIH-SSS, although it did not change the PAS. Patients with no brainstem lesion and with dysphagia duration of <3 months showed significantly improved the NIH-SSS.

Conclusion: Immediate hyolaryngeal movement was paradoxically depressed after NMES on both submental and throat regions with significant reductions in the NIH-SSS but not the PAS, suggesting improvement in pharyngeal peristalsis and cricopharyngeal functions at the esophageal entry rather than decreased aspiration and penetration. The results also suggested that patients with dysphagia should be carefully screened when determining motor-level NMES.

No MeSH data available.


Related in: MedlinePlus

The electrode positions relative to hyoid bone and thyroid cartilage. (A) Electrodes placement in both submental and throat regions. The top pair was placed horizontally in the submental region over the region of the mylohyoid muscle above the hyoid bone. The bottom pair was placed on the skin over the thyroid cartilage on either side of the midline over the region of the thyrohyoid muscle medial to the sternocleidomastoid muscle. (B) Electrodes in submental placement alone. Both pairs of horizontally arranged electrode were placed in the skin overlying the submental region.
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Figure 1: The electrode positions relative to hyoid bone and thyroid cartilage. (A) Electrodes placement in both submental and throat regions. The top pair was placed horizontally in the submental region over the region of the mylohyoid muscle above the hyoid bone. The bottom pair was placed on the skin over the thyroid cartilage on either side of the midline over the region of the thyrohyoid muscle medial to the sternocleidomastoid muscle. (B) Electrodes in submental placement alone. Both pairs of horizontally arranged electrode were placed in the skin overlying the submental region.

Mentions: Two pairs of electrodes were used for placement in both submental and throat regions, with the top pair placed horizontally in the submental region over the region of the mylohyoid muscle above the hyoid bone. The bottom pair was placed on the skin over the thyroid cartilage on either side of the midline over the region of the thyrohyoid muscle medial to the sternocleidomastoid muscle (Fig. 1A). For the submental placement alone method, both pairs of horizontally arranged electrode were placed in the skin overlying the submental region (Fig. 1B). The edge of the hyoid bone was detected by palpation. Prior to data recording, each electrode pair was placed on the skin and the stimulation intensity was gradually raised in a 1-mA step-wise fashion until the participant could first feel a tingling sensation. Then, the stimulation level was gradually increased to the maximum level that the participant could tolerate. The maximum tolerance levels, which were at least 10 mA in all participants, were determined and recorded for all electrode pairs in a placement simultaneously. The stimulator contained 2-sets of bipolar electrodes, and automatically cycled at on for 59 seconds and off for 1 second.


Changes in hyolaryngeal movement and swallowing function after neuromuscular electrical stimulation in patients with Dysphagia.

Lee HY, Hong JS, Lee KC, Shin YK, Cho SR - Ann Rehabil Med (2015)

The electrode positions relative to hyoid bone and thyroid cartilage. (A) Electrodes placement in both submental and throat regions. The top pair was placed horizontally in the submental region over the region of the mylohyoid muscle above the hyoid bone. The bottom pair was placed on the skin over the thyroid cartilage on either side of the midline over the region of the thyrohyoid muscle medial to the sternocleidomastoid muscle. (B) Electrodes in submental placement alone. Both pairs of horizontally arranged electrode were placed in the skin overlying the submental region.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414966&req=5

Figure 1: The electrode positions relative to hyoid bone and thyroid cartilage. (A) Electrodes placement in both submental and throat regions. The top pair was placed horizontally in the submental region over the region of the mylohyoid muscle above the hyoid bone. The bottom pair was placed on the skin over the thyroid cartilage on either side of the midline over the region of the thyrohyoid muscle medial to the sternocleidomastoid muscle. (B) Electrodes in submental placement alone. Both pairs of horizontally arranged electrode were placed in the skin overlying the submental region.
Mentions: Two pairs of electrodes were used for placement in both submental and throat regions, with the top pair placed horizontally in the submental region over the region of the mylohyoid muscle above the hyoid bone. The bottom pair was placed on the skin over the thyroid cartilage on either side of the midline over the region of the thyrohyoid muscle medial to the sternocleidomastoid muscle (Fig. 1A). For the submental placement alone method, both pairs of horizontally arranged electrode were placed in the skin overlying the submental region (Fig. 1B). The edge of the hyoid bone was detected by palpation. Prior to data recording, each electrode pair was placed on the skin and the stimulation intensity was gradually raised in a 1-mA step-wise fashion until the participant could first feel a tingling sensation. Then, the stimulation level was gradually increased to the maximum level that the participant could tolerate. The maximum tolerance levels, which were at least 10 mA in all participants, were determined and recorded for all electrode pairs in a placement simultaneously. The stimulator contained 2-sets of bipolar electrodes, and automatically cycled at on for 59 seconds and off for 1 second.

Bottom Line: NMES on submental placement alone did not change the PAS and NIH-SSS.However, NMES on both submental and throat regions significantly reduced the NIH-SSS, although it did not change the PAS.Immediate hyolaryngeal movement was paradoxically depressed after NMES on both submental and throat regions with significant reductions in the NIH-SSS but not the PAS, suggesting improvement in pharyngeal peristalsis and cricopharyngeal functions at the esophageal entry rather than decreased aspiration and penetration.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Gangnam Severance Hospital, Seoul, Korea. ; Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To investigate immediate changes in hyolaryngeal movement and swallowing function after a cycle of neuromuscular electrical stimulation (NMES) on both submental and throat regions and submental placement alone in patients with dysphagia.

Methods: Fifteen patients with dysphagia were recruited. First, videofluoroscopic swallowing study (VFSS) was performed before NMES. All patients thereafter received a cycle of NMES by 2 methods of electrode placement: 1) both submental and throat regions and 2) submental placement alone concomitant with VFSS. The Penetration-Aspiration Score (PAS) and the NIH-Swallowing Safety Scale (NIH-SSS) were measured for swallowing function.

Results: During swallowing, hyolaryngeal descent significantly occurred by NMES on both submental and throat regions, and anterior displacement of hyolaryngeal complex was significant on submental placement alone. NMES on submental placement alone did not change the PAS and NIH-SSS. However, NMES on both submental and throat regions significantly reduced the NIH-SSS, although it did not change the PAS. Patients with no brainstem lesion and with dysphagia duration of <3 months showed significantly improved the NIH-SSS.

Conclusion: Immediate hyolaryngeal movement was paradoxically depressed after NMES on both submental and throat regions with significant reductions in the NIH-SSS but not the PAS, suggesting improvement in pharyngeal peristalsis and cricopharyngeal functions at the esophageal entry rather than decreased aspiration and penetration. The results also suggested that patients with dysphagia should be carefully screened when determining motor-level NMES.

No MeSH data available.


Related in: MedlinePlus