SpringerLink
Log in

Swallowing Function After Continuous Neuromuscular Electrical Stimulation of the Submandibular Region Evaluated by High-Resolution Manometry

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Although neuromuscular electrical stimulation (NMES) is increasingly used in dysphagia therapy, patient responses to NMES are inconsistent and conflicting results have been reported. This, together with a lack of information about the effects of NEMS on the swallowing process, has led to an ongoing debate about its impact on swallowing function. In order to address this, we set out to (i) collect baseline information on the physiological effects of NMES on the complex pharyngeal phase of swallowing and (ii) to compare two different stimulation protocols. In doing so, we provide information useful for evaluating the therapeutic effectiveness of NMES on the swallowing process. In a prospective study, 29 healthy participants performed water swallows after receiving continuous NMES for 10 min. The stimulus was applied in the submandibular region using one of two different stimulation protocols: low-frequency stimulation (LFS) and mid-frequency stimulation (MFS). Swallowing parameters of the pharynx and UES were measured using high-resolution manometry. Maximum tongue base pressure increased by 8.4% following stimulation with the MFS protocol. Changes in UES function were not found. LFS stimulation did not result in any significant changes in the parameters examined. The MFS protocol enhances tongue base retraction during swallowing in healthy volunteers. The magnitude of the effect, however, was small, possibly due to the ability of healthy subjects to compensate for external influences, such as NMES, and may actually prove to be much greater in patients with diminished tongue base retraction. Thus, further studies are needed to determine whether a similar effect is also achievable in dysphagic patients with impaired bolus propulsion, possibly allowing MFS stimulation of the tongue base region to be used as an additional treatment tool.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Geeganage C, Beavan J, Ellender S, Bath PMW. Interventions for dysphagia and nutritional support in acute and subacute stroke. In: Bath PM, editor. The Cochrane database of systematic reviews, vol. 10. Chichester: Wiley; 2012. p. CD000323.

    Google Scholar 

  2. Miller S, Jungheim M, Kühn D, Ptok M. Electrical stimulation in treatment of pharyngolaryngeal dysfunctions. Folia Phoniatr Logop. 2013;65:154–68.

    Article  PubMed  Google Scholar 

  3. Carnaby-Mann GD, Crary MA. Examining the evidence on neuromuscular electrical stimulation for swallowing: a meta-analysis. Arch Otolaryngol Head Neck Surg. 2007;133:564–71.

    Article  PubMed  Google Scholar 

  4. Chen Y-W, Chang K-H, Chen H-C, Liang W-M, Wang Y-H, Lin Y-N. The effects of surface neuromuscular electrical stimulation on post-stroke dysphagia: a systemic review and meta-analysis. Clin. Rehabil. 2016;30:24–35.

    Article  PubMed  Google Scholar 

  5. Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respir. Care. 2001;46:466–74.

    CAS  PubMed  Google Scholar 

  6. Huang K-L, Liu T-Y, Huang Y-C, Leong C-P, Lin W-C, Pong Y-P. Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy. J. Stroke Cerebrovasc. Dis. 2014;23:2547–53.

    Article  PubMed  Google Scholar 

  7. Kushner DS, Peters K, Eroglu ST, Perless-Carroll M, Johnson-Greene D. Neuromuscular electrical stimulation efficacy in acute stroke feeding tube-dependent dysphagia during inpatient rehabilitation. Am J Phys Med Rehabil. 2013;92:486–95.

    Article  PubMed  Google Scholar 

  8. Lee KW, Kim SB, Lee JH, Lee SJ, Ri JW, Park JG. The effect of early neuromuscular electrical stimulation therapy in acute/subacute ischemic stroke patients with dysphagia. Ann. Rehabil. Med. 2014;38:153–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lim K-B, Lee H-J, Lim S-S, Choi Y-I. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a randomized controlled trial. J Rehabil Med. 2009;41:174–8.

    Article  PubMed  Google Scholar 

  10. Heijnen BJ, Speyer R, Baijens LWJ, Bogaardt HCA. Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson’s disease and oropharyngeal dysphagia: effects on quality of life. Dysphagia. 2012;27:336–45.

    Article  CAS  PubMed  Google Scholar 

  11. Ryu JS, Kang JY, Park JY, Nam SY, Choi SH, Roh JL, et al. The effect of electrical stimulation therapy on dysphagia following treatment for head and neck cancer. Oral Oncol. 2009;45:665–8.

    Article  PubMed  Google Scholar 

  12. Tan C, Liu Y, Li W, Liu J, Chen L. Transcutaneous neuromuscular electrical stimulation can improve swallowing function in patients with dysphagia caused by non-stroke diseases: a meta-analysis. J Oral Rehabil. 2013;40:472–80.

    Article  CAS  PubMed  Google Scholar 

  13. Bülow M, Speyer R, Baijens L, Woisard V, Ekberg O. Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia. 2008;23:302–9.

    Article  PubMed  Google Scholar 

  14. Kiger M, Brown CS, Watkins L. Dysphagia management: an analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy. Dysphagia. 2006;21:243–53.

    Article  PubMed  Google Scholar 

  15. Robertson V, Ward A, Low J, Reed A. Electrotherapy explained. 4th ed. Edinburgh: Butterworth Heinemann Elsevier; 2006.

    Google Scholar 

  16. Suntrup S, Teismann I, Wollbrink A, Winkels M, Warnecke T, Pantev C, et al. Pharyngeal electrical stimulation can modulate swallowing in cortical processing and behavior—magnetoencephalographic evidence. NeuroImage. 2015;104:117–24.

    Article  PubMed  Google Scholar 

  17. Burnett TA, Mann EA, Cornell SA, Ludlow CL. Laryngeal elevation achieved by neuromuscular stimulation at rest. J Appl Physiol. 2003;94:128–34.

    Article  PubMed  Google Scholar 

  18. Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Crujido L, Wright-Harp W, et al. The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol. 2006;101:1657–63.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L. Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia. 2007;22:1–10.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ludlow CL. Electrical neuromuscular stimulation in dysphagia: current status. Curr. Opin. Otolaryngol. Head Neck Surg. 2010;18:159–64.

    Article  PubMed  Google Scholar 

  21. Park J-W, Oh J-C, Lee HJ, Park S-J, Yoon T-S, Kwon BS. Effortful swallowing training coupled with electrical stimulation leads to an increase in hyoid elevation during swallowing. Dysphagia. 2009;24:296–301.

    Article  PubMed  Google Scholar 

  22. Berretin-Felix G, Sia I, Barikroo A, Carnaby GD, Crary MA. Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults. Gerodontology. 2016;33:348–55.

    Article  PubMed  Google Scholar 

  23. Barikroo A, Berretin-Felix G, Carnaby G, Crary M. Effect of transcutaneous electrical stimulation amplitude on timing of swallow pressure peaks between healthy young and older adults. Gerodontology. 2017;34:24–32.

    Article  PubMed  Google Scholar 

  24. Jungheim M, Janhsen AM, Miller S, Ptok M. Impact of neuromuscular electrical stimulation on upper esophageal sphincter dynamics: a high-resolution manometry study. Ann. Otol. Rhinol. Laryngol. 2015;124:5–12.

    Article  PubMed  Google Scholar 

  25. Ward AR, Shkuratova N. Russian electrical stimulation: the early experiments. Phys Ther. 2002;82:1019–30.

    PubMed  Google Scholar 

  26. Gallas S, Marie JP, Leroi AM, Verin E. Sensory transcutaneous electrical stimulation improves post-stroke dysphagic patients. Dysphagia. 2010;25:291–7.

    Article  PubMed  Google Scholar 

  27. Rofes L, Arreola V, López I, Martin A, Sebastián M, Ciurana A, et al. Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction. Neurogastroenterol Motil. 2013;25:888-e701.

    PubMed  Google Scholar 

  28. Pandolfino JE, Ghosh SK, Zhang Q, Han A, Kahrilas PJ. Upper sphincter function during transient lower oesophageal sphincter relaxation (tLOSR); it is mainly about microburps. Neurogastroenterol Motil. 2007;19:203–10.

    Article  CAS  PubMed  Google Scholar 

  29. Kahrilas PJ. Pharyngeal structure and function. Dysphagia. 1993;8:303–7.

    Article  CAS  PubMed  Google Scholar 

  30. Dodds WJ, Man KM, Cook IJ, Kahrilas PJ, Stewart ET, Kern MK. Influence of bolus volume on swallow-induced hyoid movement in normal subjects. AJR Am J Roentgenol. 1988;150:1307–9.

    Article  CAS  PubMed  Google Scholar 

  31. Kahrilas PJ, Dodds WJ, Dent J, Logemann JA, Shaker R. Upper esophageal sphincter function during deglutition. Gastroenterology. 1988;95:52–62.

    Article  CAS  PubMed  Google Scholar 

  32. Lee HY, Hong JS, Lee KC, Shin Y-K, Cho S-R. Changes in hyolaryngeal movement and swallowing function after neuromuscular electrical stimulation in patients with Dysphagia. Ann. Rehabil. Med. 2015;39:199–209.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors are extremely grateful to Professor K. Hodges for his valuable ideas, constructive comments, and correction of the English text and to Mr. B. Vaske for his support with the statistical analyses.

Author information

Authors and Affiliations

  1. Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Michael Jungheim, Christoph Schubert, Simone Miller & Martin Ptok

Authors
  1. Michael Jungheim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph Schubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simone Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Ptok
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.J. supervision of acquisition of data, analysis and interpretation of data, drafting of the manuscript. C.S. acquisition, analysis, and interpretation of data, contributions to the manuscript. S.M. technical support for neuromuscular electrical stimulation, contributions to the manuscript. M.P. study concept and design, study supervision, revision of the manuscript.

Corresponding author

Correspondence to Michael Jungheim.

Ethics declarations

Conflict of interest

Martin Ptok and Simone Miller received refund of travel expenses from Physiomed not related to this study. All authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jungheim, M., Schubert, C., Miller, S. et al. Swallowing Function After Continuous Neuromuscular Electrical Stimulation of the Submandibular Region Evaluated by High-Resolution Manometry. Dysphagia 32, 501–508 (2017). https://doi.org/10.1007/s00455-017-9791-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-017-9791-5

Keywords

Search

Navigation