Comparing the Effects of Rehabilitation Swallowing Therapy vs. Neuromuscular Electrical Stimulation Therapy among Stroke Patients with Persistent Pharyngeal Dysphagia: A Randomized Controlled Study
Wutichai Permsirivanich MD*, Suttipong Tipchatyotin MD*, Manit Wongchai BSc (Occupational Therapy)*, Vitoon Leelamanit MD**, Suwanna Setthawatcharawanich MD***, Pornchai Sathirapanya MD***, Kanitpong Phabphal MD***, Uma Juntawises MSN****, Achara Boonmeeprakob BSc (Nursing)*
Affiliation : * Department of Orthopedic Surgery and Rehabilitation Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand ** Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand *** Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand **** Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Background : Dysphagia after stroke is associated with increased mortality, higher dependence, and longer
hospitalization. Different therapeutic strategies have been introduced to improve swallowing impairment.
There are no current studies that compare rehabilitation swallowing therapy (RST) and neuromuscular
electrical stimulation therapy (NMES).
Objective : To compare treatment outcomes between RST and NMES intervention in stroke patients with
pharyngeal dysphagia.
Study design: A randomized controlled study.
Material and Method: Twenty-three stroke patients with persistent pharyngeal dysphagia (RST 11, NMES
12) were enrolled in the present study. The subjects received 60 minutes of either RST or NMES treatment for
five consecutive days, had two days off, and then five more consecutive days of treatment for a four-week period
or until they reached functional oral intake scale (FOIS) level 7. The outcome measures assessed were change
in FOIS, complications related to the treatment and number of therapy sessions.
Results : There were no significant differences in the stroke characteristics and the VFSS results between the
two groups. At the end of treatment, the average numbers of therapy sessions per subject in the RST and NMES
groups were 18.36 + 3.23 and 17.25 + 5.64, respectively, a non-significant difference. Average changes in
FOIS scores were 2.46 + 1.04 for the RST group and 3.17 + 1.27 for the NMES group, statistically significant
at p < 0.001. No complications were observed in either group.
Conclusion : While both RST and NMES therapy showed a positive effect in the treatment of persistent
dysphagia in stroke patients, NMES was significantly superior.
Keywords : Deglutition disorders, Electric stimulation therapy, Neuromuscular junction, Stroke, Therapy
