The effect of sensory versus motor level electrical stimulation in acute stroke patients with dysphagia

Research Objectives: Dysphagia is a serious cause of morbidity and mortality in stroke survivors. Electrical stimulation is often included as part of the treatment plan for dysphagia, and can be applied at a sensory or motor level intensity. However, evidence to support these different modes of stimulation is lacking. This study compared the effectiveness of sensory and motor level stimulation on post-stroke dysphagia.

Design: Randomized trial

Setting: Inpatient rehabilitation facility

Participants: Participants who had dysphagia caused by a stroke within 6 months prior to enrollment were included. Participants were excluded if they had a contraindication for electrical stimulation, previous stroke, psychiatric disorder, contraindications for modified barium swallow study (MBSS), or pre-morbid dysphagia.

Interventions: Each patient received ten sessions which included 45-minutes of anterior neck sensory or motor level electrical stimulation in addition to traditional dysphagia therapy. Motor stimulation was administered at an intensity sufficient to produce muscle contractions. Sensory stimulation was defined as the threshold when the patient feels a tingling sensation on their skin.

Main Outcome Measures: Swallow Functional Assessment Measure (FAM), National Outcome Measurement System (NOMS), Dysphagia Outcome Severity Scale (DOSS), Penetration Aspiration Scale (Pen Asp), diet change and the swallowing quality of life questionnaire (SWAL-QOL).

Results: There was no significant difference in age, length of stay, or initial swallow FAM between groups. Patients in the sensory group showed significant improvement on swallow FAM, DOSS, and NOMS while those in the motor group did not. There was also a significant difference in improvement on NOMS for the sensory group compared to motor. There was no significant difference in diet change for solid food or liquids amongst the groups, although 50% more participants in the sensory group saw improvement in diet.

Conclusions: This study supports the use of electrical stimulation as part of the treatment plan for post-stroke dysphagia. Sensory-level stimulation was associated with greater improvement on outcome measures compared to motor-level stimulation.

Author(s) Disclosures: The authors have nothing to disclose.