Recent investigations have posited that greater than 42% of individuals who have experienced stroke have been diagnosed with dysphagia (Crisan, Shaban, Boehme, Dubin, Jeungling, Schulter, Albright, Beasley, & Schild-Martin, 2013). In addition, these individuals have required either short term or long term interventions to compensate for the various levels of dysphagia they have experienced. Traditional interventions for the various phases of dysphagia (swallow dysfunction) have consisted of oral motor exercises (e.g., oral-labial and tongue resistance exercises), compensatory swallow strategies (e.g., Mendelsohn Maneuver), diet modifications, and airway protections (Heijen, Speyer, Baijens, & Bogaardt, 2012). Most recently, neuromuscular electrical stimulation (NMES), has appeared as an adjunctive intervention for dysphagia resulting from various diagnoses including stroke. This modality involves electrical stimulation of the various muscles involved in swallowing. The NMES modality has not been without controversy and there are those who believe that NMES is not beneficial for treatment of dysphagia of any kind (Biber & Barrera, 2012). The purpose of this investigation was to determine the effect of NMES, when combined with traditional dysphagia interventions, on swallow initiation duration of individuals with stroke and subsequent oral/pharyngeal dysphagia characterized by delayed swallow initiation. The single subject (small n) design was utilized with an A (baseline) and a B (intervention) phase. Traditional dysphagia treatments (oral motor movements, e.g. tongue protrusion and lateralization) were utilized during Phase A of the investigation. NMES was added and utilized simultaneously with the traditional treatments within the intervention phase (Phase B) of the investigation to determine if this combination of interventions had an effect on the targeted swallow initiation duration. A speech language pathologist (SLP) collected the pre-treatment and post-treatment swallow initiation times of the participants during each phase of the investigation. Results of the one participant who completed the investigation revealed that while the traditional dysphagia intervention positively impacted the swallow initiation durations of this individual, there was a statistically significant positive impact on the swallow initiation durations of this same participant when NMES was utilized simultaneously with the traditional dysphagia therapeutic approach within the intervention phase. The potential implications of this investigation are that it provides additional information for future research that may further confirm that NMES is a relevant mode of treatment, and should therefore be considered a viable recommendation for intervention of dysphagia in patients with dysphagia secondary to stroke.
Keywords: neuromuscular electrical stimulation (NMES), dysphagia, oral motor exercises
