NMES: Sensory Versus Motor Level Neuromuscular Electrical Stimulation
Study Details
Study Description
Brief Summary
Dysphagia is a serious cause of morbidity and mortality in stroke survivors. Electrical stimulation is often included as part of the treatment plan for dysphagia, and can be applied at a sensory or motor level intensity. However, evidence to support these different modes of stimulation is lacking. This study compared the effectiveness of sensory and motor level stimulation on post-stroke dysphagia.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Objective: Dysphagia is a serious cause of morbidity and mortality in stroke survivors. Electrical stimulation is often included as part of the treatment plan for dysphagia, and can be applied at a sensory or motor level intensity. However, evidence to support sensory versus motor stimulation is lacking. This study compares the effect of sensory and motor stimulation on post-stroke dysphagia.
Design: Randomized controlled trial
Setting: Inpatient rehabilitation facility.
Participants: Participants (50-75 years of age) who had dysphagia caused by a stroke within 6 months prior to enrollment were included. Participants were excluded if they had a contraindication for electrical stimulation, previous stroke, psychiatric disorder, contraindications for MBS, or pre-stroke swallowing disorders.
Interventions: Each patient received ten, 45-minute anterior neck sensory or motor level electrical stimulation sessions in addition to standard speech therapy. Motor stimulation was administered as a stimulus intensity sufficient to produce muscle contractions. Sensory stimulation was defined as the threshold when the patient feels a tingling sensation on their skin (approximately 4-5mA).
Main Outcome Measures: Swallow FIM, National Outcome Measurement System (NOMS), Dysphagia Outcome Severity Scale (DOSS), and change in modified diet.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Sensory level stimulation ten, 45-minute anterior neck sensory level electrical stimulation sessions in addition to traditional dysphagia therapy. |
Device: Neuromuscular electrical stimulation
Motor stimulation was administered at an intensity sufficient to produce muscle contractions. Sensory stimulation was defined as the threshold when the patient feels a tingling sensation on their skin.
|
| Experimental: Motor level stimulation ten, 45-minute anterior neck sensory level electrical stimulation sessions in addition to traditional dysphagia therapy. |
Device: Neuromuscular electrical stimulation
Motor stimulation was administered at an intensity sufficient to produce muscle contractions. Sensory stimulation was defined as the threshold when the patient feels a tingling sensation on their skin.
|
Outcome Measures
Primary Outcome Measures
- Change in Swallow Functional Assessment Measure [up to 2 months]
7 point swallow scale the Functional oral intake scale (FOIS) lowest score = 1; highest = 7.
- Change in Dysphagia outcome Severity Scale [up to 2 months]
seven-point functional outcome scale designed to assess dysphagia severity on the MBSS, lowest score = 1; highest = 7.
Secondary Outcome Measures
- Change in PenAsp [up to 2 months]
Evaluates the depth response and clearance of material entering into the airway, lowest score = 8; highest =1.
- Change in Swal-Qol [up to 3 months]
93-item outcome tool 24 was used to determine impact on quality-of-life and quality-of-care. Each item has a 5 point likert scale.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
18-80
-
acute ischemic CVA within the first month and confirmed by MRI.
-
Diagnosis of dysphagia will be obtained by bedside swallowing exam and MBS/FEES studies.
Exclusion Criteria:
-
patients who have contraindications for electrical stimulation (malignancy, DVT/thrombophlebitis, hemorrhagic conditions, pregnancy, pacemaker or other electrical hardware)
-
known premorbid swallowing disorders
-
GERD
-
dementia or psychiatric disorder
-
bilateral cerebral involvement
-
contraindications for FEES/MBS (infectious disease such as HIV, HCV, HBV, nasal obstruction, decompensated heart disease, risk of bleeding such as active ulcers, allergy to contrast).
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Casa Colina Hospital and Centers for Healthcare | Pomona | California | United States | 91769 |
Sponsors and Collaborators
- Casa Colina Hospital and Centers for Healthcare
Investigators
- Principal Investigator: Emily R. Rosario, PhD, Casa Colina Hospital and Centers for Healthcare
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- NMES 1.1