The Effects of Neuromuscular Electrical Stimulation on Dysphagia Secondary to Head and Neck Cancer Hollee N. Eastwood, B.S. Ed. Melissa A. Carter, M.S., CCC-SLP Katie M. Walden, M.S., CCC-SLP

Disclosures No authors had any financial or non-financial conflicts of interest associated with the content of this presentation.

Introduction Dysphagia is difficulty with any phase of the swallow. Causes of dysphagia: Neurological: stroke Muscular: myasthenia gravis Obstructive: head and neck cancer Treatment for head and neck cancer can lead to dysphagia. Neuromuscular electrical stimulation used in conjunction with dysphagia therapy is a recent tool in swallowing rehabilitation.

Purpose This study investigated if neuromuscular electrical stimulation will have an effect on residue in the pharyngeal area in head and neck cancer patients.

Participant The participant was one74 year old male. Stage 3 head and neck cancer 33 radiation treatments in 2000 Partial glossectomy Reconstruction of tongue

Methods Therapy exercises: Food trials: Effortful swallow Mendelsohn maneuver Modified Shaker Food trials: Puree consistencies Soft solid consistencies Solid consistencies Seven point rating scale used to examine pharyngeal residue.

Instrumentation Fiberoptic endoscopic evaluation of swallowing (FEES) Completed all exercises and trials while utilizing VitalStim NMES, placement 3b, 12mAMp, for 40-50 minutes for 12 sessions.

Results

Discussion This study has demonstrated that the use of neuromuscular electrical stimulation could be beneficial to swallowing abilities, visualized by less pharyngeal residue. Before treatment the participant presented with an average score of 4 or mild to moderate pharyngeal residue. After treatment the participant presented with an average score of 3 or mild pharyngeal residue.

Limitations Small participant size Consistency of bolus used in pre-treatment and post-treatment FEES Extended period of time since initial radiation treatments Previous swallowing therapy

Recommendations In a future study, larger sample size. Precisely measure bolus size for FEES. Use participants that have never had swallowing therapy previously. Clinical recommendation: Neuromuscular electrical stimulation could enhance swallowing abilities.

References Ciucci, M., Jones, C., Malandraki, A. G., Hutcheson, A. K. (2016). Dysphagia practice in 2035: Beyond fluorography, thickener, and electrical stimulation. Seminars in Speech and Language, 37(3), p. 201-218. Langmore, E. S., McCulloch, M. T., Krisclunas, P. G., Lazarus, L. C., Daele, J. D., Pauloski, B. R., . . . Doros, G. (2015). Efficacy of electrical stimulation and exercise for dysphagia patients with neck cancer: A randomized clinical trial. Head & Neck, E1221-E1231. Malhi, H. (2016). Dysphagia: Warning signs and management. British Journal of Nursing, 25(10), 546-549 Pauloski, R. B. (2008). Rehabilitation of dysphagia following head and neck cancer. Physical Medicine and Rehabilitation Clinics of North America, 19(4), 889–928. Ryu, S. J., Kang, Y. J., Park, Y. J., Nam, Y. S., Choi, H. S., Roh, L. J., . . . Choi, H. K. (2009). The effect of electrical stimulation therapy on dysphagia following treatment for head and neck cancer. Oral Oncology, 45, 665-668. Seikel, J. A., King, D. W., & Drumright, D. G. (2010). Anatomy & physiology for speech, language, and hearing. Clifton Park, NY: Delmar.