Abstract
Introduction: Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. Methods: In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. Results: MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. Conclusion: NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.
Journal Section:
Research Article
References
1.
Beckmann
Y
, Gurgor
N
, Çakır
A
, Arıcı
Ş
, İncesu
TK
, Secil
Y
. Electrophysiological evaluation of dysphagia in the mild or moderate patients with multiple sclerosis: a concept of subclinical dysphagia
. Dysphagia
. 2015
;30
(3
):296
–303
.2.
Guan
XL
, Wang
H
, Huang
HS
, Meng
L
. Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis
. Neurol Sci
. 2015
;36
(5
):671
–81
.3.
De Pauw
A
, Dejaeger
E
, D’Hooghe
B
, Carton
H
. Dysphagia in multiple sclerosis
. Clin Neurol Neurosurg
. 2002
;104
(4
):345
–51
.4.
Fernandes
AMF
, Duprat
Ad C
, Eckley
CA
, Silva
Ld
, Ferreira
RB
, Tilbery
CP
. Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity
. Braz J Otorhinolaryngol
. 2013
;79
(4
):460
–5
.5.
Lunde
HMB
, Assmus
J
, Myhr
K-M
, Bø
L
, Grytten
N
. Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study
. J Neurol Neurosurg Psychiatry
. 2017
;88
(8
):621
–5
.6.
Poorjavad
M
, Derakhshandeh
F
, Etemadifar
M
, Soleymani
B
. Associated factors with swallowing disorders in patients with multiple sclerosis
. J Isfahan Med Sch
. 2010
;28
(104
):44
–51
.7.
Giusti
A
, Giambuzzi
M
. Management of dysphagia in patients affected by multiple sclerosis: state of the art
. Neurol Sci
. 2008
29
Suppl 4
364
6
.8.
Bai
AV
, Agostini
F
, Bernetti
A
, Mangone
M
, Fidenzi
G
, D’Urzo
R
. State of the evidence about rehabilitation interventions in patients with dysphagia
. Eur J Phys Rehabil Med
. 2021
;57
(6
):900
–11
.9.
Bogaardt
H
, van Dam
D
, Wever
NM
, Bruggeman
CE
, Koops
J
, Fokkens
WJ
. Use of neuromuscular electrostimulation in the treatment of dysphagia in patients with multiple sclerosis
. Ann Otol Rhinol Laryngol
. 2009
;118
(4
):241
–6
.10.
Brown
TR
, Kraft
GH
. Exercise and rehabilitation for individuals with multiple sclerosis
. Phys Med Rehabil Clin N Am
. 2005
;16
(2
):513
–55
.11.
Tarameshlu
M
, Ghelichi
L
, Azimi
AR
, Ansari
NN
, Khatoonabadi
AR
. The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: a pilot double-blinded randomized controlled trial
. J Bodyw Mov Ther
. 2019
;23
(1
):171
–6
.12.
Meng
P
, Zhang
S
, Wang
Q
, Wang
P
, Han
C
, Gao
J
. The effect of surface neuromuscular electrical stimulation on patients with post-stroke dysphagia
. J Back Musculoskelet Rehabil
. 2018
;31
(2
):363
–70
.13.
Tate
RL
, Perdices
M
, Rosenkoetter
U
, McDonald
S
, Togher
L
, Shadish
W
. The single-case reporting guideline in BEhavioural interventions (SCRIBE) 2016: explanation and elaboration
. Arch Scientific Psychol
. 2016
;4
(1
):10
–31
.14.
Tate
RL
, Perdices
M
, Rosenkoetter
U
, Shadish
W
, Vohra
S
, Barlow
DH
. The single-case reporting guideline in behavioural interventions (SCRIBE) 2016 statement
. Phys Ther
. 2017
;27
(1
):e1
–15
.15.
Byiers
BJ
, Reichle
J
, Symons
FJ
. Single-Subject experimental design for evidence-based practice
. Am J Speech Lang Pathol
. 2012
;21
(4
):397
–414
.16.
Carter
R
, Lubinsky
J
Rehabilitation research: principles and applications
Elsevier Health Sciences
2015
.17.
McDonald
WI
, Compston
A
, Edan
G
, Goodkin
D
, Hartung
HP
, Lublin
FD
. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis
. Ann Neurol
. 2001
;50
(1
):121
–7
.18.
Restivo
DA
, Casabona
A
, Centonze
D
, Marchese-Ragona
R
, Maimone
D
, Pavone
A
. Pharyngeal electrical stimulation for dysphagia associated with multiple sclerosis: a pilot study
. Brain Stimul
. 2013
;6
(3
):418
–23
.19.
Baijens
LW
, Speyer
R
, Passos
VL
, Pilz
W
, van der Kruis
J
, Haarmans
S
. Surface electrical stimulation in dysphagic Parkinson patients: a randomized clinical trial
. Laryngoscope
. 2013
123
11
E38
44
.20.
Beom
J
, Oh
BM
, Choi
KH
, Kim
W
, Song
YJ
, You
DS
. Effect of electrical stimulation of the suprahyoid muscles in brain-injured patients with dysphagia
. Dysphagia
. 2015
;30
(4
):423
–9
.21.
Poorjavad
M
, Talebian Moghadam
S
, Ansari
NN
. Effects of the head lift exercise and neuromuscular electrical stimulation on swallowing muscles activity in healthy older adults: a randomized pilot study
. Clin Interv Aging
. 2019
;14
:1131
–40
.22.
Daniels
SK
, Brailey
K
, Priestly
DH
, Herrington
LR
, Weisberg
LA
, Foundas
AL
. Aspiration in patients with acute stroke
. Arch Phys Med Rehabil
. 1998
;79
(1
):14
–9
.23.
Daniels
SK
, McAdam
CP
, Brailey
K
, Foundas
AL
. Clinical assessment of swallowing and prediction of dysphagia severity
. Am J Speech Lang Pathol
. 1997
;6
(4
):17
–24
.24.
Bergamaschi
R
, Crivelli
P
, Rezzani
C
, Patti
F
, Solaro
C
, Rossi
P
. The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis
. J Neurol Sci
. 2008
269
1–2
49
53
.25.
Grasso
MG
, Gamberini
G
, Patti
F
, D’Amico
E
, Bergamaschi
R
, Berra
E
. The dysphagia in multiple sclerosis questionnaire correlates with fiber-optic endoscopic examination for detecting swallowing deficits in MS
. Dysphagia
. 2021
;36
(2
):192
–7
.26.
Burkhead
LM
, Sapienza
CM
, Rosenbek
JC
. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research
. Dysphagia
. 2007
;22
(3
):251
–65
.27.
Deschenes
MR
, Kraemer
WJ
. Performance and physiologic adaptations to resistance training
. Am J Phys Med Rehabil
. 2002
81
11 Suppl
S3
16
.28.
Lieber
RL
Skeletal muscle structure, function, and plasticity
Lippincott Williams & Wilkins
2002
.29.
Moritani
T
, deVries
HA
. Neural factors versus hypertrophy in the time course of muscle strength gain
. Am J Phys Med
. 1979
;58
(3
):115
–30
.30.
Sheppard
JJ
Using motor learning approaches for treating swallowing and feeding disorders: a review
. 2008
.31.
Khamis
A
, Novak
I
, Morgan
C
, Tzannes
G
, Pettigrew
J
, Cowell
J
. Motor learning feeding interventions for infants at risk of cerebral palsy: a systematic review
. Dysphagia
. 2020
;35
(1
):1
–17
.32.
Kraaijenga
S
, Van Der Molen
L
, Stuiver
M
, Teertstra
H
, Hilgers
F
, van Den Brekel
M
. Effects of strengthening exercises on swallowing musculature and function in senior healthy subjects: a prospective effectiveness and feasibility study
. Dysphagia
. 2015
;30
(4
):392
–403
.33.
Wada
S
, Tohara
H
, Iida
T
, Inoue
M
, Sato
M
, Ueda
K
. Jaw-opening exercise for insufficient opening of upper esophageal sphincter
. Arch Phys Med Rehabil
. 2012
;93
(11
):1995
–9
.34.
Murry
T
, Carrau
RL
, Chan
K
Clinical management of swallowing disorders
Plural Publishing
2020
.35.
Provencio-Arambula
M
, Provencio
D
, Hegde
MN
Treatment of dysphagia in adults: resources and protocols in English and Spanish
Plural Publishing
2006
.36.
Kim
SJ
, Han
TR
. Effect of surface electrical stimulation of suprahyoid muscles on hyolaryngeal movement
. Neuromodulation
. 2009
;12
(2
):134
–40
.37.
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
):1
–10
.38.
Robertson
V
, Ward
A
, Low
J
, Reed
ABAMDTP
Electrotherapy explained: principles and practice
Elsevier Health Sciences
2006
.39.
Mann
G
, Hankey
GJ
, Cameron
D
. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy
. Cerebrovasc Dis
. 2000
;10
(5
):380
–6
.40.
Ohira
M
, Ishida
R
, Maki
Y
, Ohkubo
M
, Sugiyama
T
, Sakayori
T
. Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults
. Geriatr Gerontol Int
. 2017
;17
(4
):561
–7
.41.
González-Fernández
M
, Sein
MT
, Palmer
JB
Clinical experience using the Mann assessment of swallowing ability for identification of patients at risk for aspiration in a mixed-disease population
. 2011
.42.
Asadollahpour
F
, Mehri
A
, Khatoonabadi
A
, Mohammadzaheri
F
, Ebadi
A
. Validation of the Persian version of the dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis
. J Res Med Sci
. 2019
;24
:52
.43.
Nathadwarawala
K
, Nicklin
J
, Wiles
C
. A timed test of swallowing capacity for neurological patients
. J Neurol Neurosurg Psychiatry
. 1992
;55
(9
):822
–5
.44.
Crary
MA
, Mann
GDC
, Groher
ME
. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients
. Arch Phys Med Rehabil
. 2005
;86
(8
):1516
–20
.45.
Barzegar-Bafrooei
E
, Bakhtiary
J
, Khatoonabadi
AR
, Fatehi
F
, Maroufizadeh
S
, Fathali
M
. Validation of the Persian version of the dysphagia handicap index in patients with neurological disorders
. Iran J Neurol
. 2016
;15
(3
):128
–32
.46.
Silbergleit
AK
, Schultz
L
, Jacobson
BH
, Beardsley
T
, Johnson
AF
. The Dysphagia handicap index: development and validation
. Dysphagia
. 2012
;27
(1
):46
–52
.47.
Cichero
JA
, Lam
P
, Steele
CM
, Hanson
B
, Chen
J
, Dantas
RO
. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework
. Dysphagia
. 2017
;32
(2
):293
–314
.48.
Logemann
JA
. The evaluation and treatment of swallowing disorders
. Curr Opin Otolaryngol Head Neck Surg
. 1998
;6
(6
):395
–400
.49.
O’Neil
KH
, Purdy
M
, Falk
J
, Gallo
L
. The dysphagia outcome and severity scale
. Dysphagia
. 1999
;14
(3
):139
–45
.50.
Ledford
JR
, Gast
DL
Single subject research methodology in behavioral sciences: applications in special education and behavioral sciences
Routledge
2009
.51.
52.
53.
Lane
JD
, Gast
DL
. Visual analysis in single case experimental design studies: brief review and guidelines
. Neuropsychol Rehabil
. 2014
24
3–4
445
63
.54.
Scruggs
TE
, Mastropieri
MA
, Cook
SB
, Escobar
C
. Early intervention for children with conduct disorders: a quantitative synthesis of single-subject research
. Behav Disord
. 1986
;11
(4
):260
–71
.55.
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
(3
):302
–9
.56.
FAARC
RLCR
, Christian
M
. Electrical stimulation for swallowing disorders caused by stroke
. Respir Care
. 2001
46
5
).57.
Park
JW
, Kim
Y
, Oh
JC
, Lee
HJ
. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study
. Dysphagia
. 2012
;27
(4
):521
–7
.58.
Rofes
L
, Arreola
V
, López
I
, Martin
A
, Sebastián
M
, Ciurana
A
. Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction
. Neuro Gastroenterol Motil
. 2013
;25
(11
):888
–e701
.59.
Sheffler
LR
, Chae
J
. Neuromuscular electrical stimulation in neurorehabilitation
. Muscle Nerve
. 2007
;35
(5
):562
–90
.60.
Chisari
C
, Bertolucci
F
, Dalise
S
, Rossi
B
. Chronic muscle stimulation improves muscle function and reverts the abnormal surface EMG pattern in myotonic dystrophy: a pilot study
. J NeuroEng Rehabil
. 2013
;10
:94
.61.
Shimoura
K
, Nishida
Y
, Abiko
S
, Suzuki
Y
, Zeidan
H
, Kajiwara
Y
. Immediate effect of neuromuscular electrical stimulation on the abductor hallucis muscle: a randomized controlled trial
. Electromagn Biol Med
. 2020
;39
(4
):257
–61
.62.
Krekeler
BN
, Rowe
LM
, Connor
NP
. Dose in exercise-based dysphagia therapies: a scoping review
. Dysphagia
. 2021
;36
(1
):1
–32
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