Evaluating oral stimulation as a treatment for dysphagia after stroke

Abstract Deglutitive aspiration is common after stroke and can have devastating consequences. While the application of oral sensory stimulation as a treatment for dysphagia remains controversial, data from our laboratory have suggested that it may increase corticobulbar excitability, which in previous work was correlated with swallowing recovery after stroke. Our study assessed the effects of oral stimulation at the faucial pillar on measures of swallowing and aspiration in patients with dysphagic stroke. Swallowing was assessed before and 60 min after 0.2-Hz electrical or sham stimulation in 16 stroke patients (12 male, mean age = 73 ± 12 years). Swallowing measures included laryngeal closure (initiation and duration) and pharyngeal transit time, taken from digitally acquired videofluoroscopy. Aspiration severity was assessed using a validated penetration-aspiration scale. Preintervention, the initiation of laryngeal closure, was delayed in both groups, occurring 0.66 ± 0.17 s after the bolus arrived at the hypopharynx. The larynx was closed for 0.79 ± 0.07 s and pharyngeal transit time was 0.94 ± 0.06 s. Baseline swallowing measures and aspiration severity were similar between groups (stimulation: 24.9 ± 3.01; sham: 24.9 ± 3.3, p = 0.2). Compared with baseline, no change was observed in the speed of laryngeal elevation, pharyngeal transit time, or aspiration severity within subjects or between groups for either active or sham stimulation. Our study found no evidence for functional change in swallow physiology after faucial pillar stimulation in dysphagic stroke. Therefore, with the parameters used in this study, oral stimulation does not offer an effective treatment for poststroke patients. Keywords Aspiration - Deglutition disorders - Stroke - Treatment - Deglutition Abbreviations: mA = milliamps; FP = faucial pillar; LCD = laryngeal closure duration; OTT = oral transit time; PTT = pharyngeal transit time; SRT = swallow response time; TMS = transcranial magnetic stimulation; UES = upper esophageal sphincter