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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

Change in dysphagia rating scale according to the presence of brainstem lesion. (A, B) In the PAS, there was no significant difference after NMES on both submental and throat area and submental placement alone regardless of the brainstem lesion. (C) In the NIH-SSS, patients with no brainstem lesion in whom NMES was applied to both submental and throat regions showed significantly decreased scores (*p<0.05), whereas submental placement alone did not change the scores in the same patients. (D) On the other hand, patients with brainstem lesion did not show significant change in the NIH-SSS after NMES in both placement methods. PAS, Penetration-Aspiration Score; NIH-SSS, National Institutes of Health-Swallowing Safety Scale; NMES, neuromuscular electrical stimulation.
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Figure 3: Change in dysphagia rating scale according to the presence of brainstem lesion. (A, B) In the PAS, there was no significant difference after NMES on both submental and throat area and submental placement alone regardless of the brainstem lesion. (C) In the NIH-SSS, patients with no brainstem lesion in whom NMES was applied to both submental and throat regions showed significantly decreased scores (*p<0.05), whereas submental placement alone did not change the scores in the same patients. (D) On the other hand, patients with brainstem lesion did not show significant change in the NIH-SSS after NMES in both placement methods. PAS, Penetration-Aspiration Score; NIH-SSS, National Institutes of Health-Swallowing Safety Scale; NMES, neuromuscular electrical stimulation.

Mentions: There was no significant difference in the PAS after NMES on both submental and throat area stimulation and submental placement alone regardless of the brainstem lesion (Fig. 3A, B). In addition, patients with brainstem lesion did not show a significant change in the NIH-SSS after NMES with both placement methods (Fig. 3D). However, patients with no brainstem lesion in whom NMES was applied to both submental and throat regions showed a significant decrease in the NIH-SSS from 4.36±0.98 to 2.82±1.10 (p=0.026), whereas submental placement alone did not change the scores in the same patients (Fig. 3C).


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)

Change in dysphagia rating scale according to the presence of brainstem lesion. (A, B) In the PAS, there was no significant difference after NMES on both submental and throat area and submental placement alone regardless of the brainstem lesion. (C) In the NIH-SSS, patients with no brainstem lesion in whom NMES was applied to both submental and throat regions showed significantly decreased scores (*p<0.05), whereas submental placement alone did not change the scores in the same patients. (D) On the other hand, patients with brainstem lesion did not show significant change in the NIH-SSS after NMES in both placement methods. PAS, Penetration-Aspiration Score; NIH-SSS, National Institutes of Health-Swallowing Safety Scale; NMES, neuromuscular electrical stimulation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Change in dysphagia rating scale according to the presence of brainstem lesion. (A, B) In the PAS, there was no significant difference after NMES on both submental and throat area and submental placement alone regardless of the brainstem lesion. (C) In the NIH-SSS, patients with no brainstem lesion in whom NMES was applied to both submental and throat regions showed significantly decreased scores (*p<0.05), whereas submental placement alone did not change the scores in the same patients. (D) On the other hand, patients with brainstem lesion did not show significant change in the NIH-SSS after NMES in both placement methods. PAS, Penetration-Aspiration Score; NIH-SSS, National Institutes of Health-Swallowing Safety Scale; NMES, neuromuscular electrical stimulation.
Mentions: There was no significant difference in the PAS after NMES on both submental and throat area stimulation and submental placement alone regardless of the brainstem lesion (Fig. 3A, B). In addition, patients with brainstem lesion did not show a significant change in the NIH-SSS after NMES with both placement methods (Fig. 3D). However, patients with no brainstem lesion in whom NMES was applied to both submental and throat regions showed a significant decrease in the NIH-SSS from 4.36±0.98 to 2.82±1.10 (p=0.026), whereas submental placement alone did not change the scores in the same patients (Fig. 3C).

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