The effects of neuromuscular electrical stimulation for dysphagia in opercular syndrome: a case study

A 76-year-old man with opercular syndrome characterized by complete bilateral loss of voluntary control of facial, lingual, pharyngeal and masticatory muscles is presented with focus on the severe dysphagia. Three years earlier the patient had experienced two strokes resulting in opercular syndrome with severe dysphagia. Despite initial logopedic dysphagia treatment, swallowing did not improve. A new treatment for dysphagia, consisting of neuromuscular electrical stimulation was applied on the patient. He returned to oral feeding. Clinical and treatment observations are reported

Tactile thermal oral stimulation increases the cortical representation of swallowing

<p>Abstract</p> <p>Background</p> <p>Dysphagia is a leading complication in stroke patients causing aspiration pneumonia, malnutrition and increased mortality. Current strategies of swallowing therapy involve on the one hand modification of eating behaviour or swallowing technique and on the other hand facilitation of swallowing with the use of pharyngeal sensory stimulation. Thermal tactile oral stimulation (TTOS) is an established method to treat patients with neurogenic dysphagia especially if caused by sensory deficits. Little is known about the possible mechanisms by which this interventional therapy may work. We employed whole-head MEG to study changes in cortical activation during self-paced volitional swallowing in fifteen healthy subjects with and without TTOS. Data were analyzed by means of synthetic aperture magnetometry (SAM) and the group analysis of individual SAM data was performed using a permutation test.</p> <p>Results</p> <p>Compared to the normal swallowing task a significantly increased bilateral cortical activation was seen after oropharyngeal stimulation. Analysis of the chronological changes during swallowing suggests facilitation of both the oral and the pharyngeal phase of deglutition.</p> <p>Conclusion</p> <p>In the present study functional cortical changes elicited by oral sensory stimulation could be demonstrated. We suggest that these results reflect short-term cortical plasticity of sensory swallowing areas. These findings facilitate our understanding of the role of cortical reorganization in dysphagia treatment and recovery.</p

Biomechanical analysis of hyoid bone displacement in videofluoroscopy: a systematic review of intervention effects

This systematic review explores studies using biomechanical analysis of hyoid bone displacement in videofluoroscopy of swallowing as a spatial outcome parameter to evaluate intervention effects. Two authors independently carried out the literature search using the electronic databases Embase, PubMed, and Cochrane Library. Differences in their search findings were settled by discussion. The search was limited to publications in the English, German, French, Spanish, or Dutch language. MeSH terms were used, supplemented by free-text words to identify the most recent publications. In addition, reference lists were searched by hand. Only studies using videofluoroscopy to evaluate the biomechanical effects of swallowing interventions in dysphagic subjects were included in the review. While the body of literature on measuring hyoid bone displacement in videofluoroscopy has grown, only 12 studies met the inclusion criteria. Several of the 12 studies had methodological shortcomings. In general, the conclusions could not be compared across the studies because of their heterogeneous designs and outcome measures. Overall, several intervention effect studies reported significant results. In particular, bolus modification and swallowing maneuvers showed a greater range of hyoid bone displacement. In light of this review, further research on hyoid bone displacement as a spatial variable in well-defined patient populations using well-defined videofluoroscopic protocols to measure intervention effects is recommended