Ann Rehabil Med.  2016 Aug;40(4):600-610. 10.5535/arm.2016.40.4.600.

Effect of Laryngopharyngeal Neuromuscular Electrical Stimulation on Dysphonia Accompanied by Dysphagia in Post-stroke and Traumatic Brain Injury Patients: A Pilot Study

Affiliations
  • 1Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Korea. magnarbor@dankook.ac.kr
  • 2Department of Nanobiomedical Science & BK21 Plus NBM Research Center for Regenerative Medicine, Dankook University, Cheonan, Korea.
  • 3Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Korea.
  • 4Voice & Speech Clinic, Department of Otorhinolaryngology-Head & Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.

Abstract


OBJECTIVE
To investigate the effect of laryngopharyngeal neuromuscular electrical stimulation (NMES) on dysphonia in patients with dysphagia caused by stroke or traumatic brain injury (TBI).
METHODS
Eighteen patients participated in this study. The subjects were divided into NMES (n=12) and conventional swallowing training only (CST, n=6) groups. The NMES group received NMES combined with CST for 2 weeks, followed by CST without NMES for the next 2 weeks. The CST group received only CST for 4 weeks. All of the patients were evaluated before and at 2 and 4 weeks into the study. The outcome measurements included perceptual, acoustic and aerodynamic analyses. The correlation between dysphonia and swallowing function was also investigated.
RESULTS
There were significant differences in the GRBAS (grade, roughness, breathiness, asthenia and strain scale) total score and sound pressure level (SPL) between the two groups over time. The NMES relative to the CST group showed significant improvements in total GRBAS score and SPL at 2 weeks, though no inter-group differences were evident at 4 weeks. The improvement of the total GRBAS scores at 2 weeks was positively correlated with the improved pharyngeal phase scores on the functional dysphagia scale at 2 weeks.
CONCLUSION
The results demonstrate that laryngopharyngeal NMES in post-stroke or TBI patients with dysphonia can have promising effects on phonation. Therefore, laryngopharyngeal NMES may be considered as an additional treatment option for dysphonia accompanied by dysphagia after stroke or TBI.

Keyword

Dysphonia; Deglutition disorders; Electrical stimulation therapy; Stroke; Brain injuries

MeSH Terms

Acoustics
Asthenia
Brain Injuries*
Deglutition
Deglutition Disorders*
Dysphonia*
Electric Stimulation Therapy
Electric Stimulation*
Humans
Phonation
Pilot Projects*
Stroke

Figure

  • Fig. 1 Schematization of perceptual evaluation changes: total GRBAS score at baseline and at 2 and 4 weeks after initiation of the study in each group. GRBAS, grade, roughness, breathiness, asthenia, and strain. a)p<0.017 by Mann-Whitney U test with Bonferroni correction. b)p<0.025 by Wilcoxon signed-rank test with Bonferroni correction.


Reference

1. Cohen SM, Elackattu A, Noordzij JP, Walsh MJ, Langmore SE. Palliative treatment of dysphonia and dysarthria. Otolaryngol Clin North Am. 2009; 42:107–121. PMID: 19134494.
2. Cohen SM, Dupont WD, Courey MS. Quality-of-life impact of non-neoplastic voice disorders: a meta-analysis. Ann Otol Rhinol Laryngol. 2006; 115:128–134. PMID: 16514796.
Article
3. Lee JW, Jang SJ, Kim DA, Park SW, Jung WK, Yoo JH, et al. Development and application of cognitive perceptual assessment for driving of people with brain injury: comparison with cognitive behavioral driver's inventory. J Korean Acad Rehabil Med. 2004; 28:523–531.
4. Ertzgaard P, Ward AB, Wissel J, Borg J. Practical considerations for goal attainment scaling during rehabilitation following acquired brain injury. J Rehabil Med. 2011; 43:8–14. PMID: 21174050.
Article
5. Tanaka T, Kudo A, Sugihara S, Izumi T, Maeda Y, Kato N, et al. A study of upper extremity training for patients with stroke using a virtual environment system. J Phys Ther Sci. 2013; 25:575–580. PMID: 24259805.
Article
6. Lagorio LA, Carnaby-Mann GD, Crary MA. Cross-system effects of dysphagia treatment on dysphonia: a case report. Cases J. 2008; 1:67. PMID: 18667069.
Article
7. McFarland DH, Tremblay P. Clinical implications of cross-system interactions. Semin Speech Lang. 2006; 27:300–309. PMID: 17117355.
Article
8. El Sharkawi A, Ramig L, Logemann JA, Pauloski BR, Rademaker AW, Smith CH, et al. Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT): a pilot study. J Neurol Neurosurg Psychiatry. 2002; 72:31–36. PMID: 11784821.
9. Yoon YS, Lim JT, Yun SB, Ohm BY, Kang JY, Lim HY, et al. The effect of functional electrical stimulation on swallowing function in stroke patients with dysphagia. J Korean Acad Rehabil Med. 2006; 30:417–423.
10. Fowler LP, Gorham-Rowan M, Hapner ER. An exploratory study of voice change associated with healthy speakers after transcutaneous electrical stimulation to laryngeal muscles. J Voice. 2011; 25:54–61. PMID: 20080024.
Article
11. Byeon H. Voice change associated with swallowing disorder caused by a stroke after neuromuscular electrical stimulation. J Korea Acad Ind Coop Soc. 2012; 13:1665–1671.
Article
12. Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Ludlow CL. The effect of surface electrical stimulation on vocal fold position. Laryngoscope. 2008; 118:14–19. PMID: 18043496.
Article
13. Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respir Care. 2001; 46:466–474. PMID: 11309186.
14. Hirano M. Clinical examination of voice. New York: Springer;1981.
15. Ko DH. A study of extracting acoustic parameters for individual speakers. Speech Sci. 2003; 10:129–143.
16. Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed;1998.
17. Han TR, Paik NJ, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001; 82:677–682. PMID: 11346847.
Article
18. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996; 11:93–98. PMID: 8721066.
Article
19. Wesling M, Brady S, Jensen M, Nickell M, Statkus D, Escobar N. Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation. Dysphagia. 2003; 18:203–210. PMID: 14506986.
Article
20. Lee KW, Kim SB, Lee JH, Kim YD, Han DW, Kim TH, et al. Relationship between the incidence of vocal cord palsy and aspiration risk in acute ischemic stroke patients. J Korean Acad Rehabil Med. 2010; 34:15–19.
21. Kent RD, Vorperian HK, Kent JF, Duffy JR. Voice dysfunction in dysarthria: application of the Multi-Dimensional Voice Program. J Commun Disord. 2003; 36:281–306. PMID: 12837587.
Article
22. Yu P, Ouaknine M, Revis J, Giovanni A. Objective voice analysis for dysphonic patients: a multiparametric protocol including acoustic and aerodynamic measurements. J Voice. 2001; 15:529–542. PMID: 11792029.
23. Wang YT, Chung YM, Chen HH, Chia LY, Lu HJ. Voice acoustic analysis of Taiwanese adults with dysarthria following stroke. Can Acoust. 2010; 38:142–143.
24. Stepp CE. Characterization and improvement of the clinical assessment of vocal hyperfunction [dissertation]. Cambridge: Massachusetts Institute of Technology;2009.
25. Burnett TA, Mann EA, Cornell SA, Ludlow CL. Laryngeal elevation achieved by neuromuscular stimulation at rest. J Appl Physiol (1985). 2003; 94:128–134. PMID: 12486019.
26. Zraick RI, Smith-Olinde L, Shotts LL. Adult normative data for the KayPENTAX Phonatory Aerodynamic System Model 6600. J Voice. 2012; 26:164–176. PMID: 21600731.
Article
27. Mehta RP, Goldman SN, Orloff LA. Long-term therapy for spasmodic dysphonia: acoustic and aerodynamic outcomes. Arch Otolaryngol Head Neck Surg. 2001; 127:393–399. PMID: 11296047.
28. Lu FL, Presley S, Lammers B. Efficacy of intensive phonatory-respiratory treatment (LSVT) for presbyphonia: two case reports. J Voice. 2013; 27:786.e11–786.e23. PMID: 24119640.
Article
29. McHenry MA, Reich AR. Effective airway resistance and vocal sound pressure level in cheerleaders with a history of dysphonic episodes. Folia Phoniatr (Basel). 1985; 37:223–231. PMID: 4093083.
Article
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