Neuromuscular Electrical Stimulation Therapy for Patients with Chronic Dysphagia Caused by Stroke

OBJECTIVE: To evaluate the effect of neuromuscular electrical stimulation (NMES) therapy on swallowing dysfunction in patients with chronic (more than 6 months) dysphagia caused by stroke. METHOD: A total of 16 patients with stroke-caused swallowing disorders based on a videofluoroscopic swallowing study (VFSS) were treated with NMES for two weeks. NMES was applied to the skin over the anterior neck muscles for one hour a day. Swallowing function was evaluated by the functional dysphagia scale using the VFSS, clinical dysphagia scale and the American Speech-Language Hearing Association National Outcomes Measurements System Swallowing Scale (ASHA NOMS scale) before and after electrical stimulation. Follow up VFSS was performed one month after intervention. RESULTS: After completing ten treatment sessions, aspiration, reflex coughing and the total score in the clinical dysphagia scale were significantly decreased (p<0.05). There was also a significant improvement in the ASHA NOMS scale (p<0.05). Regarding the functional dysphagia scale, the residue in the valleculae and piriformis sinus, and total scores were significantly decreased (p<0.05). Specifically, the scores of the pharyngeal phase were mainly decreased as compared to that of the oral phase. In addition, these effects were maintained one month after the intervention as measured with functional dysphagia scale. CONCLUSION: After ten sessions of NMES, we found improvement in dysphagia parameters in chronic dysphagia patients. Specifically, residue in the valleculae and piriformis sinus, and a parameter of the pharyngeal phase were significantly improved.

Gait Analysis in Patients with Idiopathic Parkinson's Disease during Obstacle Crossing

OBJECTIVE: To compare gait parameters of patients with idiopathic Parkinson's disease (IPD) during obstacle crossing with those of healthy control subjects. METHOD: Conventional physical examinations and three- dimensional gait analysis were performed on 16 patients of IPD with stage 2~3 of the Hoehn and Yahr disease rating scale, and 11 healthy control subjects during stepping over the obstacle. Temporospatial, kinematic and kinetic parameters of patients were compared with those of the control group. RESULTS: In patients with IPD, walking velocity was slower and stride length were shorter than control group. Decreased post-obstacle distance of the lead limb and increased pre-swing time of the lead and trail limbs were noted in IPD patients compared to control group. Many significant modifications of kinematic and kinetic parameters were detected in IPD patients compared to control group during obstacle crossing. CONCLUSION: Using three-dimensional gait analysis, we could identify specific modifications of gait parameters in IPD patients during obstacle crossing. These modifications may reduce or increase the risk of a falling in IPD patients.