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Pharyngeal electrical stimulation

Ivan M Lang, Bidyut K Medda, Sudarshan R Jadcherla, Reza Shaker
Stimulation of the esophagus activates the pharyngeal swallow response (EPSR) in human infants and animals. The aims of this study were to characterize the stimulus and response of the EPSR, and to determine the function and mechanisms generating the EPSR. Studies were conducted in 46 decerebrate cats in which pharyngeal, laryngeal and esophageal motility was monitored using EMG, strain gauges, or manometry. The esophagus was stimulated by balloon distension or luminal fluid infusion. We found that esophageal distension increased the chance of occurrence of the EPSR, but the delay was variable...
September 15, 2016: American Journal of Physiology. Gastrointestinal and Liver Physiology
Kyung Rok Ko, Hee Jung Park, Jung Keun Hyun, In-Hyo Seo, Tae Uk Kim
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...
August 2016: Annals of Rehabilitation Medicine
L Rofes, O Ortega, N Vilardell, L Mundet, P Clavé
BACKGROUND: Oropharyngeal dysphagia (OD) is a highly prevalent symptom in older people. Appropriate oropharyngeal sensory feedback is essential for safe and efficient swallowing. However, pharyngeal sensitivity decreases with advancing age and could play a fundamental role in the physiopathology of swallowing dysfunction associated with aging. We aimed to characterize pharyngeal sensitivity and cortical response to a pharyngeal electrical stimulus in healthy volunteers (HV) and older patients with and without OD...
August 2, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Martino F Pengo, Sichang Xiao, Culadeeban Ratneswaran, Kate Reed, Nimish Shah, Tao Chen, Abdel Douiri, Nicholas Hart, Yuanming Luo, Gerrard F Rafferty, Gian Paolo Rossi, Adrian Williams, Michael I Polkey, John Moxham, Joerg Steier
INTRODUCTION: Obstructive sleep apnoea (OSA) is characterised by a loss of neuromuscular tone of the upper airway dilator muscles while asleep. This study investigated the effectiveness of transcutaneous electrical stimulation in patients with OSA. PATIENTS AND METHODS: This was a randomised, sham-controlled crossover trial using transcutaneous electrical stimulation of the upper airway dilator muscles in patients with confirmed OSA. Patients were randomly assigned to one night of sham stimulation and one night of active treatment...
October 2016: Thorax
Christopher Cabib, Omar Ortega, Hatice Kumru, Ernest Palomeras, Natalia Vilardell, Daniel Alvarez-Berdugo, Desirée Muriana, Laia Rofes, Rosa Terré, Fermín Mearin, Pere Clavé
Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. This review covers advances in the pathophysiology, diagnosis, and physiologically based neurorehabilitation strategies for poststroke OD. The pathophysiology of oropharyngeal biomechanics can be assessed by videofluoroscopy, as delayed laryngeal vestibule closure is closely associated with aspiration. Stroke may affect afferent or efferent neuronal circuits participating in deglutition...
July 11, 2016: Annals of the New York Academy of Sciences
A Brodsky, Y Dotan, M Samri, A R Schwartz, A Oliven
Respiratory stimulation (RS) during sleep often fails to discontinue flow limitation, whereas electrical stimulation (ES) of the hypoglossus (HG) nerve frequently prevents obstruction. The present work compares the effects of RS and HG-ES on pharyngeal mechanics and the relative contribution of tongue muscles and thoracic forces to pharyngeal patency. We determined the pressure-area relationship of the collapsible segment of the pharynx in anesthetized pigs under the following three conditions: baseline (BL), RS induced by partial obstruction of the tracheostomy tube, and HG-ES...
September 1, 2016: Journal of Applied Physiology
Anna Guillén-Solà, Monique Messagi Sartor, Neus Bofill Soler, Esther Duarte, M Camelia Barrera, Ester Marco
OBJECTIVE: To evaluate the effectiveness of inspiratory/expiratory muscle training (IEMT) and neuromuscular electrical stimulation (NMES) to improve dysphagia in stroke. DESIGN: Prospective, single-blind, randomized-controlled trial. SETTING: Tertiary public hospital. SUBJECTS: Sixty-two patients with dysphagia were randomly assigned to standard swallow therapy (SST) (Group I, controls, n=21), SST+ IEMT (Group II, n=21) or SST+ sham IEMT+ NMES (Group III, n=20)...
June 7, 2016: Clinical Rehabilitation
Philip M Bath, Polly Scutt, Jo Love, Pere Clavé, David Cohen, Rainer Dziewas, Helle K Iversen, Christian Ledl, Suzanne Ragab, Hassan Soda, Anushka Warusevitane, Virginie Woisard, Shaheen Hamdy
BACKGROUND AND PURPOSE: Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials. METHODS: We randomly assigned 162 patients with a recent ischemic or hemorrhagic stroke and dysphagia, defined as a penetration aspiration score (PAS) of ≥3 on video fluoroscopy, to PES or sham treatment given on 3 consecutive days...
June 2016: Stroke; a Journal of Cerebral Circulation
Carolyn A Coughlan, Sunil P Verma
OBJECTIVES: The recurrent laryngeal nerve is at risk of injury during open pharyngeal diverticula operations. The utility of recurrent laryngeal nerve (RLN) monitoring during these procedures was investigated. METHODS: A retrospective chart review was performed of 8 open pharyngeal diverticulectomies completed between 2009 and 2014. Intraoperative RLN monitoring took place during all operations. RESULTS: Open pharyngectomy and myotomy was successfully performed in all cases...
August 2016: Annals of Otology, Rhinology, and Laryngology
J Magara, E Michou, A Raginis-Zborowska, M Inoue, S Hamdy
BACKGROUND: Previous reports have revealed that excitation of human pharyngeal motor cortex can be induced by pharyngeal electrical stimulation (PES) and swallowing carbonated water (CW). This study investigated whether combining PES with swallowing (of still water, SW or CW) can potentiate this excitation in either cortical and/or brain stem areas assessed with transcranial and transcutaneous magnetic stimulation (TMS). METHODS: Fourteen healthy volunteers participated and were intubated with an intraluminal catheter to record pharyngeal electromyography and deliver PES...
September 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Dipesh H Vasant, Emilia Michou, Neil O'Leary, Andy Vail, Satish Mistry, Shaheen Hamdy
Background Pharyngeal electrical stimulation (PES) appears to promote cortical plasticity and swallowing recovery poststroke. Objective We aimed to assess clinical effectiveness with longer follow-up. Methods Dysphagic patients (n = 36; median = 71 years; 61% male) recruited from 3 trial centers within 6 weeks of stroke, received active or sham PES in a single-blinded randomized design via an intraluminal pharyngeal catheter (10 minutes, for 3days). The primary outcome measure was the Dysphagia Severity Rating (DSR) scale (<4, no-mild; ≥4, moderate-severe)...
October 2016: Neurorehabilitation and Neural Repair
J-S Park, D-H Oh, N-K Hwang, J-H Lee
Neuromuscular electrical stimulation (NMES) has been used as a therapeutic intervention for dysphagia. However, the therapeutic effects of NMES lack supporting evidence. In recent years, NMES combined with traditional swallowing therapy has been used to improve functional recovery in patients with post-stroke dysphagia. This study aimed to investigate the effects of effortful swallowing combined with neuromuscular electrical stimulation on hyoid bone movement and swallowing function in stroke patients. Fifty stroke patients with mild dysphagia who were able to swallow against the resistance applied by using NMES and cooperate actively in training were included...
June 2016: Journal of Oral Rehabilitation
S Suntrup-Krueger, S Bittner, S Recker, S G Meuth, T Warnecke, I Suttrup, T Marian, R Dziewas
BACKGROUND: Substance P (SP) is a neuropeptide known to enhance the swallow response. It likely acts as a neurotransmitter in the pharyngeal mucosa in response to local stimuli. It has been proposed that dysphagia after stroke may be related to reduced levels of SP, which therefore constitutes a therapeutic target. In the present pilot study, we evaluated whether electrical pharyngeal stimulation (EPS), a neuromodulation device to enhance cortical reorganization for the restoration of swallowing function after brain injury, is able to increase SP in saliva or serum...
June 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Polly Scutt, Han S Lee, Shaheen Hamdy, Philip M Bath
Background. Dysphagia after stroke is common, associated independently with poor outcome, and has limited treatment options. Pharyngeal electrical stimulation (PES) is a novel treatment being evaluated for treatment of poststroke dysphagia. Methods. We searched electronically for randomised controlled trials of PES in dysphagic patients within 3 months of stroke. Individual patient data were analysed using regression, adjusted for trial, age, severity, and baseline score. The coprimary outcomes were radiological aspiration (penetration aspiration score, PAS) and clinical dysphagia (dysphagia severity rating scale, DSRS) at 2 weeks; secondary outcomes included functional outcome, death, and length of stay in hospital...
2015: Stroke Research and Treatment
Seiya Aida, Ryosuke Takeishi, Jin Magara, Masahiro Watanabe, Kayoko Ito, Yuki Nakamura, Takanori Tsujimura, Hirokazu Hayashi, Makoto Inoue
We investigated (1) how peripheral inputs might assist central inputs in the control of voluntary evoked swallowing, (2) inter-individual variation in involuntary and voluntary swallowing initiation, and (3) whether natural chewing behavior affects the initiation of involuntary swallowing in healthy humans. Eleven participants completed a repetitive saliva swallowing test (RSST), chewing test (CHEW), and rest period (REST). In RSST, participants repetitively swallowed as quickly as possible. In CHEW, subjects chewed gum freely...
November 1, 2015: Physiology & Behavior
E Castel-Lacanal
Rehabilitation aims to decrease neurological impairments, in guiding plasticity. Electrical stimulation has been used for many years in rehabilitation treatment of neurological disabilities as a tool for neuromodulation inducing plasticity, although the mechanisms of its action are not well known. The applications vary, encompassing therapeutic and rehabilitative aims. The type and site of stimulation vary depending on the objectives. Some techniques are widely used in clinical practice; others are still in the research stage...
September 2015: Annals of Physical and Rehabilitation Medicine
Sonja Suntrup, Thomas Marian, Jens Burchard Schröder, Inga Suttrup, Paul Muhle, Stephan Oelenberg, Christina Hamacher, Jens Minnerup, Tobias Warnecke, Rainer Dziewas
PURPOSE: Treatment of post-stroke dysphagia is notoriously difficult with different neurostimulation strategies having been employed with a variable degree of success. Recently, electrical pharyngeal stimulation (EPS) has been shown to improve swallowing function and in particular decrease airway aspiration in acute stroke. We performed a randomized controlled trial to assess EPS effectiveness on swallowing function in severely dysphagic tracheotomized patients. METHODS: All consecutive stroke patients successfully weaned from the respirator but with severe dysphagia precluding decannulation were screened for eligibility...
September 2015: Intensive Care Medicine
Emilia Michou, Steve Williams, Rishma Vidyasagar, Darragh Downey, Satish Mistry, Richard A E Edden, Shaheen Hamdy
INTRODUCTION: Paired associative stimulation (PAS), is a novel non-invasive technique where two neural substrates are employed in a temporally coordinated manner in order to modulate cortico-motor excitability within the motor cortex (M1). In swallowing, combined pharyngeal electrical and transcranial-magnetic-stimulation induced beneficial neurophysiological and behavioural effects in healthy subjects and dysphagic stroke patients. Here, we aimed to investigate the whole-brain changes in neural activation during swallowing using functional magnetic resonance imaging (fMRI) following PAS application and in parallel assess associated GABA changes with magnetic resonance spectroscopy (MRS)...
August 15, 2015: NeuroImage
Hoo Young Lee, Ji Seong Hong, Kil Chan Lee, Yoon-Kyum Shin, Sung-Rae Cho
OBJECTIVE: To investigate immediate changes in hyolaryngeal movement and swallowing function after a cycle of neuromuscular electrical stimulation (NMES) on both submental and throat regions and submental placement alone in patients with dysphagia. METHODS: Fifteen patients with dysphagia were recruited. First, videofluoroscopic swallowing study (VFSS) was performed before NMES. All patients thereafter received a cycle of NMES by 2 methods of electrode placement: 1) both submental and throat regions and 2) submental placement alone concomitant with VFSS...
April 2015: Annals of Rehabilitation Medicine
R Terré, F Mearin
BACKGROUND AND PURPOSE: To evaluate the effectiveness of neuromuscular electrical stimulation (NMES) treatment in patients with oropharyngeal dysphagia secondary to acquired brain injury. METHODS: Twenty patients with neurological oropharyngeal dysphagia (14 stroke and six severe traumatic brain injury) were enrolled in a prospective randomized study, with patients and assessors blinded (to group allocation): 10 patients underwent NMES and conventional swallowing therapy and 10 patients underwent sham electrical stimulation (SES) and conventional swallowing therapy...
April 2015: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
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