Tratamiento con electroestimulación neuromuscular de la disfagia orofaríngea en pacientes con ictus / Treatment of oropharyngeal dysphagia with neuromuscular electrostimulaiton

Fundamento y objetivo: La disfagia orofarínge a es muy prevalente en pacientes con ictus, con una elevada morbimortalidad asociada. La electroestimulación neuromuscular (EENM) es un nuevo tratamiento potencialmente útil. El objetivo de este estudio fue valorar la eficacia terapéutica y la seguridad de la EENM en el tratamiento de la disfagia orofaríngea en pacientes con ictus. Pacientes y método: Estudio prospectivo de 9 pacientes con ictus, con aspiración traqueal confirmada mediante exploración videofluoroscópica (VDF), tratados con el tratamiento convencional de la disfagia orofaríngea junto con EENM. Se realizó seguimiento al finalizar el tratamiento con EENM y a los 3 meses. Resultados: El número medio de sesiones efectuadas fueron 18 (intervalo 15-20), con una intensidad media de estimulación de 12,45mA (intervalo 6,6-16,7mA). Antes del tratamiento 8 pacientes se alimentaban exclusivamente por sonda de gastrostomía; tras el mismo únicamente un paciente persistía con alimentación exclusiva por sonda de gastrostomía. Ningún paciente presentó complicaciones. Los parámetros VDF previos al tratamiento, tiempo de tránsito oral, disparo del reflejo deglutorio (DRD) y tiempo de tránsito faríngeo, estaban alargados y el ascenso hioideo reducido. Después del tratamiento se redujo a 6 el número de pacientes con aspiración traqueal, pero únicamente en 3 persistía para las 3 viscosidades estudiadas (líquido, néctar y pudin), objetivándose una mejoría global en los parámetros VDF. El único factor predictivo de efectividad terapéutica fue el retraso en el DRD (AU)

Background and objective: Oropharyngeal dysphagia is highly prevalent in stroke patients, with a high mortality and morbidity. Neuromuscular electro stimulation (NMES) is a new and potentially useful therapy. We assessed the therapeutic effectiveness and safety of NMES in the treatment of or pharyngeal dysphagia in patients with stroke. Patients and method: Prospective study of stroke patients, with tracheal aspiration revealed by videofluoroscopy (VDF), who underwent conventional therapy of or pharyngeal dysphagia as well as NMES. We did a follow-up at the end of the treatment and 3 months later. Results: Patients underwent 18 courses of treatment (15-20) with a mean stimulation intensity of12.45 mA (range: 6.6-16.7 mA). Before starting therapy, 8 patients were fed exclusively by means of a gastrostomy tube; after the treatment, only one patient needed it. No patient had complications. VDF parameters before treatment: oral transition time, swallowing reflex shooting (SRS) and pharyngeal transition time were longer and the hyoid elevation was reduced. After the treatment, the number of patients with tracheal aspiration decreased to 6, but only in 6 it persisted for the three analyzed viscosities (liquid, nectar and pudding), with an overall improvement of the VDF parameters. The only predictive factor of therapeutic effectiveness was the delay in the SRS. Conclusion: NMES is an effective and safe treatment for stroke patients with or pharyngeal dysphagia (AU)

[Treatment of oropharyngeal dysphagia with neuromuscular electrostimulaiton]. / Tratamiento con electroestimulación neuromuscular de la disfagia orofaríngea en pacientes con ictus.

BACKGROUND AND OBJECTIVE: Oropharyngeal dysphagia is highly prevalent in stroke patients, with a high mortality and morbidity. Neuromuscular electrostimulation (NMES) is a new and potentially useful therapy. We assessed the therapeutic effectiveness and safety of NMES in the treatment of oropharyngeal dysphagia in patients with stroke. PATIENTS AND METHOD: Prospective study of stroke patients, with tracheal aspiration revealed by videofluoroscopy (VDF), who underwent conventional therapy of oropharyngeal dysphagia as well as NMES. We did a follow-up at the end of the treatment and 3 months later. RESULTS: Patients underwent 18 courses of treatment (15-20) with a mean stimulation intensity of 12.45mA (range: 6.6-16.7mA). Before starting therapy, 8 patients were fed exclusively by means of a gastrostomy tube; after the treatment, only one patient needed it. No patient had complications. VDF parameters before treatment: oral transition time, swallowing reflex shooting (SRS) and pharyngeal transition time were longer and the hyoid elevation was reduced. After the treatment, the number of patients with tracheal aspiration decreased to 6, but only in 6 it persisted for the three analyzed viscosities (liquid, nectar and pudding), with an overall improvement of the VDF parameters. The only predictive factor of therapeutic effectiveness was the delay in the SRS. CONCLUSION: NMES is an effective and safe treatment for stroke patients with oropharyngeal dysphagia.