The article I read this month pertains to the use of neuromuscular electrical stimulation (NMES) in the treatment of dysphagia. It is almost an understatement to say this is a controversial topic for Speech-Language Pathologists. Few issues incite stronger emotions and philosophical polarity among my esteemed colleagues! Opposing sides defend their position with a passion that rivals a debate between liberal vs conservative politicians! This study attracted me because it scientifically and dispassionately compares traditional logopedic treatment (TT) vs. TT with NMES treatment for oropharyngeal dysphagia and the effect of treatment on quality of life in people with Parkinson’s disease (PD).
This is a strong study. It was conducted with a relatively high number of subjects (n=88) who were randomly assigned to one of three treatment groups according to well-defined inclusion/exclusion criteria. Subjects in Group 1 received TT consisting of exercises and swallow strategy training. Group 2 received TT along with suprahyoid application of NMES at a motor stimulation intensity. Group 3 received TT and NMES at a sensory stimulation intensity. Pre-treatment, post-treatment, and three-month follow-up assessments were conducted using the SWAL-QOL and M.D. Anderson Dysphagia Inventory (MDADI) quality of life questionnaires; a Dysphagia Severity Scale (DSS); and the Functional Oral Intake Scale (FOIS). All subjects received 13 to 15 dysphagia treatment sessions of 30 minutes duration.
Results of the study confirmed earlier findings of the benefit of dysphagia treatment in people with PD. Significant treatment effects were seen on the DSS, and limited benefits were noted on quality of life measures across all three groups. However, this study did not confirm added benefit of combining NMES with TT and actually points to a finding of no preferential benefit of any of the therapy models.
The authors provide an excellent discussion of their results. They cite a number of weaknesses in the study and do a fine job of explaining them. One that I find especially significant is that patients with severe PD were excluded. The authors concede that variation between the groups may have been less apparent due to this limitation.
In conclusion, this study has been enlightening in many ways, and the results are clinically applicable to my work with dysphagia patients with PD. I would like to see a future study conducted with a more inclusive severity range of subjects, but this effort has provided a comparison that I have long wished a group of our researchers would tackle.
Heijnen BJ, Speyer R, Baijens WJ, Bogaardt HCA. Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson’s disease and oropharyngeal dysphagia: effects on quality of life. Dysphagia. 2012;27:336-345. DOI 10:1007/s00455-011-9371-z
Cynthia Williams Bowen, MS, CCC-SLP owns Bowen Speech-Language Therapy, LLC in Clearwater, FL. Cyndee provides quality, creative, collaborative treatment to adults and adolescents with communication, swallowing, Parkinson’s, and related disorders.