1. Neuromuscular Electrical Stimulation: A Review of the Literature By: Jessica Stewart B.A. Wayne State University Graduate Student

2. Neuromuscular electrical stimulation (NMES) has been used for many decades a part of rehabilitative therapy In the early 2000’s, the Food & Drug Administration approved NMES for use with dysphagia treatment

3. Uses O NMES applies electrical impulses to the nervous system to stimulate sensory and/or motor neurons O Common Uses Relaxation of muscle spasms Prevention or retardation of disuse atrophy Improvement of local blood circulation Re-education of the muscle

4. Application Transcutaneous O Stimulates sensory nerves under the skins surface O Benefits Non invasive Generally inexpensive O Cons Needs higher amplitude to reach deeper muscles

5. Application O Percutaneous Electrodes temporarily placed in muscle O Surgical Permanent Placement

6. Candidates O Ideal Individuals who have central nervous system abnormalities with intact peripheral nerve functions O Contraindications Individuals with motor neuron death Individuals with progressive fatigue Individuals with pacemaker, metal implant, skin breakdown, cancer, cardiac or seizure disorder, impaired peripheral nerves, pregnant

7. Swallowing Therapy O Speech Language Pathologists typically administer transcutaneous applications O One to Two sets of electrodes placed on anterior neck O NMES is most effective if paired with the actual swallowing of a bolus

8. Studies Permsirivanich et al. (2009) O Participants: stroke survivors with dysphagia O Group 1: NMES O Group 2: Traditional Postural adjustment Supraglottic swallowing Mendelsohn maneuver Effortful swallow O Results: NMES greater increase in functional oral intake

9. Studies Christiaanse et al. (2011) O Participants: pediatric patients with dysphagia O Group 1: NMES O Group 2: Traditional therapy Oral motor training Diet modification O Results: MNES did lead to improvement but not more than traditional therapy

10. Studies Heijnen, Speyer, Baijens, and Bogaardt (2011) O Participants: Parkinson's patients with oropharyngeal dysphagia O Group 1: Traditional Therapy Oral motor exercises, airway protection maneuvers, posture adjustments O Group 2: Traditional Therapy listed above and MNES to suprahyoid musculature at motor level O Group 3:Traditional Therapy listed above and MNES to suprahyoid musculature at sensory level O Results: all the groups demonstrated a significant increase in health related qualities of life, however there was no difference between the groups

11. Studies Bulow, Speyer, Baijens, Woisard, and Ekberg (2008) O Participants: 25 individuals who received swallowing therapy from three area hospitals O Group 1: NMES O Group 2: Traditional Therapy Diet modification Oral motor exercise Varying postures and maneuvers O Results: Both groups demonstrated significantly positive results; however, there was not a statically significant difference between groups

12. Studies Carnaby-Mann and Crary (2007) O Meta Analysis of 7 transcutaneous neuromuscular electrical stimulation studies O Results: Significant, but small, results support use of NMES to improve swallowing and therapeutic effects maintain present even after the stimulation has been removed

13. Biggest Challenge O Lack of standardized and objective outcome measurement All results are based on clinician’s subjective judgment

14. Should I Do It? O Review current literature O Safety of patient O Cost O Client’s needs and values

15. Conclusion & Questions

16. References Bailey, R., Fletcher, K., Gosa, M., Miller, J.L., Saavedra, J., Scarborough, D., & Miller, C.K. (2009). Frequently asked questions regarding the use of electrical stimulation to treat feeding and swallowing disorders in the pediatric population. Retrieved June 26, 2012, from www.asha.org.www.asha.org Bulow, M., Speyer, S., Baijens, L., Woisard, V., & Ekberg, O. (2008). Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia, 23, 302- 309. Doi: 10.1007/s00455-007-9145-9 Carnaby-Mann, G.D., & Crary, M.A. (2007). Examining the evidence on neuromuscular electrical stimulation for swallowing. Arch Otolaryngol Head Neck Surgery, 133, 564-571. Clark, H., Lazarus, C., Arvedson, J., Schooling, T., & Frymark, T. (2009). Evidence-based systematic review: Effects of neuromuscular electrical stimulation on swallowing and neural activation. American Journal of Speech-Language Pathology, 18, 361-375. Christiaanse, M.E., Mabe, B., Russell, G., Long Simeone, T., Fortunato, J., & Rubin, B. (2011). Neuromuscular electrical stimulation is no more effective than usual care for the treatment of primary dysphagia in children. Pediatric Pulmonology, 46, 559-565. Groher, M.E., & Crary, M.A. (2010). Dysphagia: Clinical management in adults and children. Maryland Height, Missouri: Mosby, Inc. Heijnen, B.J., Speyer, R., Baijens, L.W.J., & Bogaardt, B.C.A. (2011). Neuromuscular electrical stimulation versus traditional therapy in patients with Parkinson’s disease and oropharyngeal dysphagia: Effects on quality of life. Dysphagia, doi: 10.1007/s00455-011-9371-z

17. References Huckabee, M., & Doeltgen, S. (2007). Emerging modalities in dysphagia rehabilitation: neuromuscular electrical stimulation. The New Zealand Medical Journal, 120, (1263). Humbert, I., & Ludlow, C.L. (March 16, 2004). Electrical stimulation aids dysphagia. The ASHA Leader. Retrieved from www.asha.org/publications.leader/2004/040316/040316c.htmwww.asha.org/publications.leader/2004/040316/040316c.htm Linkov, G., Branski, R.C., Amin, M., Chernichenko, N., Chen, C., Alon, G., Langmore, S., Wong, R.J., & Kraus, D.H. (2011). Murine model of neuromuscular electrical stimulation on squamous cell carcinoma: Potential implications for dysphagia therapy. Head & Neck, doi: 10.1002/hed Ludlow, C.L. (March 4, 2008). Electrical stimulation and dysphagia: What we do and don’t know. The ASHA Leader, 13 (3), 8-11. www.asha.org/publications.leader/2008/080304/f080304a Permsirivanich, W., Tipehatyotin, S., Wongchai, M., Leelamait, V., Setthawatcharawanich, S. Sathirapanya, P., Phabphal, K., Juntawises, U., & Boonmeeprakob, A. (2009). Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: A randomized controlled study. Journal of the Medical Association of Thailand, 92 (2), 259-265. Steel, C.M., Thrasher, A.T., & Popovid, M.R. (2007). Electric stimulation approaches to the restoration and rehabilitation of swallowing: a review. Neurological Research, 29, 9-15. United States Food and Drug Administration 510 (k) summary (June 6, 2001). Dysphagia Treatment Device.