Publications
Transcutaneous electrical stimulation (TES) is a frequently used adjunctive modality in dysphagia rehabilitation. Stimulating deeper swallowing muscles requires higher TES amplitude. However, TES amplitude is limited by maximum amplitude tolerance (MAT). Previous studies have reported high interindividual variability regarding MAT and perceived discomfort. This variability might be one of the potential reasons of conflicting outcomes in TES-based swallowing studies. MAT and perceived discomfort are influenced by a variety of biopsychological factors. The influence of these factors related to swallow applications is poorly understood. This study explored the relation of biopsychological factors with MAT and perceived discomfort related to TES in the submental area. A convenience sample of thirty community-dwelling older adults between 60 and 70 years of age provided data for this study. Gender, submental adipose tissue thickness, perceptual pain sensitivity, and pain-coping strategies were evaluated for each subject. Subsequently, MAT and perceived discomfort level were determined using TES on the submental area. Relation of different biopsychological variables with MAT and discomfort level was examined using Pearson and Spearman correlation, and Mann-Whitney U test. Results indicated that neither gender nor adipose thickness was related to MAT and perceived discomfort. Among studied pain-coping strategies, catastrophizing was significantly related to MAT(r = - 0.552, p < .002). Distraction was significantly related to perceived discomfort level (r = - 0.561, p < 0.002). Given the negative impact of pain catastrophizing on MAT and the positive impact of distraction on perceiving discomfort, these coping strategies should be considered as amplitude-limiting and discomfort-moderating factors in TES-based dysphagia rehabilitation.
Limited research in swallowing physiology has suggested that the most common existing transcutaneous electrical stimulation (TES) protocol (VitalStim) may not penetrate to layers of tissue to affect deep swallowing muscles. TES amplitude is the primary parameter that determines the depth of electrical current penetration (DECP). Preliminary work suggests that replacing a long-pulse duration with a short-pulse duration can increase maximum amplitude tolerance (MAT) within subjects’ comfort level. Increasing MAT may indicate a higher DECP. The current study evaluates this premise in reference to the effects of varying pulse duration on lingual-palatal pressure during swallowing. Thirty healthy older adults (60–70 years of age) participated in this study. Each subject swallowed three trials of 10 mL pudding under three TES conditions: no stimulation, short-pulse duration, and long-pulse duration. TES was delivered using two pairs of surface electrodes on the submental muscles. MAT and perceived discomfort levels were identified separately for short and long-pulse TES conditions. Lingual-palatal peak pressure, pressure integral, and pressure duration were measured under each condition. Two-way repeated measures ANOVAs were conducted to identify within subject effects of TES condition and tongue bulb location. Lingual-palatal pressure and pressure integral were significantly reduced in the short-pulse duration condition. MAT was significantly higher in the short-pulse duration versus the long-pulse duration condition. Furthermore, MAT was significantly correlated with lingual-palatal pressure. Changing pulse duration had no significant impact on tongue pressure duration. Results suggest that a short-pulse duration may penetrate deeper into muscles involved in swallowing. The specific impact is reflected in a reduced upward pressure of the tongue on the palate during swallowing. This ‘restrictive’ effect of TES on tongue pressure may have the potential to be used during a resistive exercise paradigm for tongue elevation during swallowing.
One of the treatments for dysphagia in older adults is Transcutaneous electrical stimulation (TES), which is an electrical pulse delivered with the intent of stimulating the muscles needed for swallowing. The purpose of this study was to compare pulse durations and frequency levels during TES that had an effect on maximum amplitude tolerance (MAT) and perceived discomfort levels in those treated. Twenty-four healthy, community-dwelling, older adults (x= 63.42 years) participated. TES was delivered through 4 electrodes and MAT and discomfort level were determined by the participant through gradual increases in the stimulation amplitude and visual scales. The study found that the length of the pulse duration had a significant impact on MAT, and that the perceived discomfort level is different for each TES protocol.
The purpose of this study was to compare the data of two surveys, one from 2005 and the other 2017, on the use of electrical stimulation therapy for dysphagia treatment. Through the responses of 271 speech-language pathologists gathered through a web-based survey the clinical application, practice patterns, therapeutic outcomes, and the clinician attitudes towards electrical stimulation were compared across a 10-year gap. The study found that the use of electrical stimulation has increased by 47% over the past 10 years, with many clinicians from both surveys reporting positive treatment outcomes, including advanced oral diet and reduced tube dependency. The satisfaction among clinicians and patients of the use of electrical stimulation during dysphagia treatment reduced between the studies: however; the majority of clinicians who use electrical stimulation continue to recommend this treatment to other clinicians who work with dysphagia. As a result, the practices, patterns, outcomes, and attitudes involving electrical stimulation as dysphagia treatment are continuously undergoing change as more research and clinical practice is analyzed.
The purpose of this study was to determine if applying transcutaneous electrical stimulation at various intervals during swallow affected the timing of the swallow pressure peaks between healthy younger and older adults. In older populations, aging often leads to declining neuro-motor system performance which creates the need for enhanced activation of the motor system in the central nervous system during motor activities such as swallowing. Through the placement of transcutaneous electrodes to stimulate both the suprahyoid and infrahyoid muscles, the swallow pressure peaks were measured under high amplitude, low amplitude, and no stimulation. The results conclude that, while further testing needs to be pursued, there are differences between the effects of various amounts of stimulation on swallowing time between older and younger adults. As a result, dysphagia treatment should not be “one-size-fits-all” between different populations and should be adapted to which population is presently being treated by an SLP.
In this study, healthy adults between the ages of 20 and 83 years were given both a small and large amount of thin liquid to swallow in order to analyze the effects of age and bolus volume on the velocity of hyoid and laryngeal excursion. Because of the higher prevalence of dysphagia among older populations, it is important to investigate how the size of a bolus affects swallowing as age increases. The magnitude, duration, and velocity of the superior and anterior hyoid excursion and superior and anterior laryngeal excursion were measured for liquids of 5 mL and 20 mL. Regardless of age, the superior hyoid excursion magnitude and anterior laryngeal excursion magnitude increased for the 20 mL of liquid. The superior hyoid excursion velocity increased at 20 mL across all age groups; however, anterior and superior laryngeal excursion velocity increased selectively at 20 mL only in the older adult (aged 56-83 years). In conclusion, this increase in velocity selectively in the older population reflects the need for increased laryngeal velocity to maintain functional swallow during the aging process.
Similar to Dr. Barikroo’s 2015 article on the effects of transcutaneous electrical stimulation on swallowing pressure peaks, this study analyzed the immediate impact of stimulation during swallow on the swallowing effort in healthy younger and older adults. Transcutaneous electrodes were placed above the hyoid bone and also between the hyoid bone and thyroid cartilage, with different levels of stimulation presented separately to measure sensory stimulation and motor stimulation. Lingua-palatal and pharyngeal pressure data were collected from three air-filled bulbs placed on the alveolar ridge and at the junction between the hard and soft palates. Pharyngeal pressure was measured from pressure sensors through a transnasal catheter placement. Participants were given materials of thin liquids, thick liquids, and pudding consistencies. Results found that older adults had lower anterior lingua-palatal swallowing pressures than young adults for all types of transcutaneous electrical stimulation. This data suggests that dysphagia rehabilitation and treatment should move beyond the “one-size-fits-all” model to a more case-by-case personalization treatment.
The purpose of this article was to analyze and determine the intra- and interreliability for measurements in videofluoroscopy (VFS) of swallowing. Through Embase, PubMed, and The Cochrane Library electronic databases, 19 articles were selected for review of reliability. These articles were about reliability in experiments in VFS. The authors of this analysis assessed the articles’ methodological quality of the studies based on a list of criteria for quality assessment, including such items as “Was a representative sample of raters used?” and “Were raters’ characteristics stable during the study?”. They found that many of the articles had problems with the reliability of their measurements, particularly interrater reliability and consistency, but intrarater agreement was better than interrater agreement on those studies with measurements of ordinal visuoperceptual variables. In conclusion, inter- and intrareliabilty for measurements on VFS will vary, depending upon several factors such as detailed descriptions of variables, the rating scales being used, and the pre-experimental training of the rater’s. These factors need to be properly discussed in the studies to increase reliability.
Through the process of aging, the prevalence of certain disorders and health problems can lead to the inability for the elderly to care for themselves. Common among these conditions is dysphagia, or disordered swallow. The purpose of this study was to determine the prevalence of oropharyngeal dysphagia among nursing home residents in Isfahan, Iran. 165 randomly selected elderly persons were selected and screened with a dysphagia test. The screening involved a medical history, paying close attention to the history of feeding, swallowing, and place of dysphagia. Each subject additionally underwent a swallowing test where the swallowing abilities under three different consistencies (liquid, semi-liquid, and solid) were analyzed. Results found that the prevalence of dysphagia among these 165 subjects was 41.2, with the prevalence being higher among females than males. Additionally, the percentage of dysphagia rose with age increase, suggesting the need for speech therapy to meet the dysphagia problems in the elderly.
This case study reported the effects of functional neuromuscular electrical stimulation (NMES) on an encephalitis patient who demonstrated liquid dysphagia. The patient, a 48-year old male, suffered from dysphagia after a severe fever caused encephalitis 6 months prior to the study. He also had a history of aspiration pneumonia suggested by chest X-ray results. Before the initiation of treatment, the patient was assessed using a 3-oz water swallow test, where he demonstrated clinical penetration or aspiration on all consistencies tested, except puree. In addition, on the Functional Oral Intake Scale his diet was limited to level 5, and based on the Swallow Quality of Life (SWAL-QOL) he showed a considerable decrease in many areas of his quality of life. The patient’s treatment involved two phases: the first involved rehabilitation swallowing therapy, which consisted of diet modification, thermal stimulation, head and neck positioning, and instruction of the chin-down maneuver during swallow. The second phase was the functional NMES, with electrodes placed over the mylohyoid muscle and the thyroid cartilage, and the patient was then given a single swallowing strategy for the test. The results found that at the end of phase two the client was able to perform the 3-oz water test without any penetration during all stages of swallow, he did not have any signs of aspiration pneumonia, and his measured quality of life improved. As a result of this study, the use of functional NMES on patients with dysphagia should be further studied on its efficacy during treatment.