scholarly journals Effects of Pharyngeal Electrical Stimulation on Swallow Timings, Clearance and Safety in Post-Stroke Dysphagia: Analysis from the Swallowing Treatment Using Electrical Pharyngeal Stimulation (STEPS) Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Lisa F. Everton ◽  
Jacqueline K. Benfield ◽  
Emilia Michou ◽  
Shaheen Hamdy ◽  
Philip M. Bath
Keyword(s):  
Electrical Stimulation ◽  
Spontaneous Recovery ◽  
Residue Analysis ◽  
Group Analysis ◽  
Frame Rate ◽  
Swallowing Function ◽  
Post Stroke ◽  
Stage Transition Duration ◽  
Pharyngeal Transit ◽  
Post Hoc

Swallowing impairment (dysphagia) post-stroke results in poorer outcomes. Pharyngeal electrical stimulation (PES) is a potential treatment for post-stroke dysphagia. In a post hoc analysis, we investigated PES using videofluoroscopy swallow studies (VFSS) from the STEPS trial incorporating multiple measures of safety (penetration aspiration scale-PAS), speed and duration (timing), and efficiency (clearance), as opposed to the original trial which only measured PAS scores. 81 randomised participants (PES ( N = 43 ) versus sham ( N = 38 )) were analysed at baseline and 2 weeks. Participants swallowed up to 6 × 5   ml and 1 × 50   ml of thin liquid barium at 40% w / v , images at ≥25 fps. Based on PAS, the 5 ml mode bolus (most frequently occurring PAS from 6 × 5   ml ) and the worst 50 ml bolus were chosen for further analysis. Eight timing measures were performed, including stage transition duration (STD) and pharyngeal transit time (PTT). Clearance measures comprised oral and pharyngeal residue and swallows to clear. Comparisons of change of scoring outcomes between PES and sham were done at 2 weeks. Wilcoxon Signed Ranks Test was also used to evaluate longitudinal changes from both groups’ combined results at two weeks. Between-group analysis showed no statistically significant differences. Issues with suboptimal image quality and frame rate acquisition affected final numbers. At two weeks, both groups demonstrated a significant improvement in most safety scores (PAS) and STD, possibly due to spontaneous recovery or a combination of spontaneous recovery and swallowing treatment and usual care. A nonsignificant trend for improvement was seen in other timing measures, including PTT. This study, which conducted additional measurements of kinematic and residue analysis on the STEPS data did not detect “missed” improvements in swallowing function that the PAS is not designed to measure. However, more studies with greater numbers are required.

scholarly journals Repetitive transcranial magnetic stimulation in combination with neuromuscular electrical stimulation for treatment of post-stroke dysphagia

2018 ◽  
Vol 47 (2) ◽  
pp. 662-672 ◽  
Author(s):  
Chengliang Zhang ◽  
Xiuqin Zheng ◽  
Rulan Lu ◽  
Wenwei Yun ◽  
Huifang Yun ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Excitability ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Neuromuscular Electrical Stimulation ◽  
Motor Evoked Potential ◽  
Swallowing Function ◽  
Post Stroke ◽  
Representative Area

Objective This study was performed to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with neuromuscular electrical stimulation (NMES) effectively ameliorates dysphagia and how rTMS protocols (bilateral vs. unilateral) combined with NMES can be optimized. Methods Sixty-four patients were randomly divided into four groups using a random distribution table: the sham rTMS plus NMES (Sham-rTMS/NMES), ipsilesional 10-Hz rTMS plus NMES (Ipsi-rTMS/NMES), contralesional 1-Hz rTMS plus NMES (Contra-rTMS/NMES), and bilateral rTMS plus NMES (Bi-rTMS/NMES) groups. Cortical excitability as measured by the amplitude of the motor evoked potential at the mylohyoid muscle cortical representative area, swallowing function as measured by the Standardized Swallowing Assessment, and the degree of dysphagia were evaluated at baseline, after the stimulation course, and at the 1-month follow-up. Results Bi-rTMS/NMES produced higher cortical excitability and better swallowing function recovery. Compared with NMES alone, unilateral rTMS plus NMES had additional effects on cortical excitability and rehabilitation of dysphagia, but there were no differences between the Contra-rTMS/NMES and Ipsi-rTMS/NMES groups. No adverse events occurred. Conclusion The combination of rTMS with NMES was superior to NMES alone in improving the recovery of post-stroke dysphagia, and the combination of bilateral rTMS with NMES was more effective than unilateral rTMS combined with NMES.

Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation

2016 ◽  
Vol 21 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Silvia Convento ◽  
Cristina Russo ◽  
Luca Zigiotto ◽  
Nadia Bolognini
Keyword(s):  
Electrical Stimulation ◽  
Cognitive Rehabilitation ◽  
Cognitive Disorders ◽  
Spatial Neglect ◽  
Transcranial Electrical Stimulation ◽  
Clinical Settings ◽  
Post Stroke ◽  
Neuropsychological Disorders ◽  
Current State ◽  
Stimulation Technique

Abstract. Cognitive rehabilitation is an important area of neurological rehabilitation, which aims at the treatment of cognitive disorders due to acquired brain damage of different etiology, including stroke. Although the importance of cognitive rehabilitation for stroke survivors is well recognized, available cognitive treatments for neuropsychological disorders, such as spatial neglect, hemianopia, apraxia, and working memory, are overall still unsatisfactory. The growing body of evidence supporting the potential of the transcranial Electrical Stimulation (tES) as tool for interacting with neuroplasticity in the human brain, in turn for enhancing perceptual and cognitive functions, has obvious implications for the translation of this noninvasive brain stimulation technique into clinical settings, in particular for the development of tES as adjuvant tool for cognitive rehabilitation. The present review aims at presenting the current state of art concerning the use of tES for the improvement of post-stroke visual and cognitive deficits (except for aphasia and memory disorders), showing the therapeutic promises of this technique and offering some suggestions for the design of future clinical trials. Although this line of research is still in infancy, as compared to the progresses made in the last years in other neurorehabilitation domains, current findings appear very encouraging, supporting the development of tES for the treatment of post-stroke cognitive impairments.

scholarly journals Distress disclosure and psychological Distress among men: the role of feeling understood and loneliness

2021 ◽  
Author(s):  
Brian TaeHyuk Keum ◽  
John L. Oliffe ◽  
Simon M. Rice ◽  
David Kealy ◽  
Zac E. Seidler ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Group Analysis ◽  
Mediation Model ◽  
Adult Men ◽  
Path Analyses ◽  
Asian Men ◽  
Race Ethnicity ◽  
Post Hoc ◽  
Distress Disclosure ◽  
Better Than

AbstractWe examined whether men’s distress disclosure would be indirectly associated with psychological distress through feeling understood by others and loneliness as serial or parallel mediators. We conducted path analyses (N = 1827 adult men; mean 37.53 years, SD = 14.14) to test the mediators while controlling for race/ethnicity. Post-hoc multi-group analysis was conducted to examine differences across White and Asian men. The serial mediation model fit the data better than the parallel mediation model. Controlling for race/ethnicity, a significant partial indirect association was found between greater distress disclosure and lower psychological distress through greater feelings of being understood and lower feelings of loneliness. Post-hoc multi-group analysis suggested that the hypothesized paths fit equivalently across White and Asian men, and the direct effect was not significant for Asian men. Our hypothesized serial model also fit the data significantly better than alternative models with distress and the mediators predicting disclosure. Distress disclosure may be a socially conducive strategy for men to feel understood and socially connected, a process that may be associated with lower psychological distress.

scholarly journals The ESCAPS study: a feasibility randomized controlled trial of early electrical stimulation to the wrist extensors and flexors to prevent post-stroke complications of pain and contractures in the paretic arm

2019 ◽  
Vol 33 (12) ◽  
pp. 1919-1930
Author(s):  
Joanna C Fletcher-Smith ◽  
Dawn-Marie Walker ◽  
Kate Allatt ◽  
Nikola Sprigg ◽  
Marilyn James ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Electrical Stimulation ◽  
Data Collection ◽  
Usual Care ◽  
Controlled Trial ◽  
Cost Effective ◽  
Outcome Data ◽  
Attrition Rates ◽  
Post Stroke ◽  
Randomized Controlled

Objective: To establish feasibility of initiating electrical stimulation treatment of wrist extensors and flexors in patients early after stroke to prevent muscle contractures and pain. Design: Feasibility randomized controlled trial with economic evaluation. Setting: A specialist stroke unit in Nottinghamshire. Subjects: A total of 40 patients recruited within 72 hours post-stroke with arm hemiparesis. Interventions: Participants were randomized to receive usual care or usual care and electrical stimulation to wrist flexors and extensors for 30 minutes, twice a day, five days a week for three months. Initial treatment was delivered by an occupational therapist or physiotherapist who trained participants to self-manage subsequent treatments. Measures: Measures of feasibility included recruitment and attrition rates, completion of treatment, and successful data collection. Outcome data on wrist range of motion, pain, arm function, independence, quality of life, and resource use were measured at 3-, 6-, and 12-months post-randomization. Results: A total of 40 participants (of 215 potentially eligible) were recruited in 15 months (20 men; mean age: 72 (SD: 13.0)). Half the participants lacked mental capacity and were recruited by consultee consent. Attrition at three-month follow-up was 12.5% (death ( n = 2), end-of-life care ( n = 2), and unable to contact ( n = 1)). Compliance varied (mean: 65 (SD: 53)) and ranged from 10 to 166 treatments per patient (target dosage was 120). Data for a valid economic analysis can be adequately collected. Conclusion: Early initiation of electrical stimulation was acceptable and feasible. Data collection methods used were feasible and acceptable to participants. A large definitive study is needed to determine if electrical stimulation is efficacious and cost effective.

scholarly journals Ability of people with post-stroke hemiplegia to self-administer FES-assisted hand therapy video games at home: An exploratory case series

2019 ◽  
Vol 6 ◽  
pp. 205566831985400 ◽  
Author(s):  
Michael J Fu ◽  
Mary Y Harley ◽  
Terri Hisel ◽  
Robyn Busch ◽  
Richard Wilson ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Video Games ◽  
Upper Extremity ◽  
Functional Electrical Stimulation ◽  
Video Game ◽  
Cognitive Outcomes ◽  
Hand Therapy ◽  
Post Stroke ◽  
Game Therapy ◽  
At Home

Introduction This article describes the development and initial clinical testing of an innovative home-based treatment for upper extremity hemiplegia that integrates contralaterally controlled functional electrical stimulation with hand therapy video games. Methods We explored the ability of seven participants with moderate-to-severe hand impairment to self-administer 12 weeks of contralaterally controlled functional electrical stimulation video game therapy at home for 10 h/week and in-lab with a therapist for four h/week. Clinical suitability was assessed by device usage logs, qualitative surveys, and clinical motor and cognitive outcomes. Results Three participants completed the study with > 95% compliance and four did not. Factors linked to incompletion included development of trigger finger in the non-paretic hand, acceptance of a new full-time job, residence relocation, and persistence of drowsiness from anti-spasticity medication. Those who completed the treatment perceived qualitative benefits and experienced gains in motor and cognitive outcomes. Conclusion Individuals with moderate-to-severe chronic post-stroke upper extremity hemiplegia can self-administer contralaterally controlled functional electrical stimulation video game therapy for up to 90 min/day at home. We also identified social and physiological factors that may preclude its use for daily home treatment. Further studies are warranted and are in progress to estimate treatment effect and optimal dose of this intervention.

The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: A systematic review with meta-analysis

2019 ◽  
Vol 44 (3) ◽  
pp. 389-412 ◽  
Author(s):  
Ardalan Shariat ◽  
Mahboubeh Ghayour Najafabadi ◽  
Noureddin Nakhostin Ansari ◽  
Joshua A. Cleland ◽  
Maria A. Fiatarone Singh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Lower Limb ◽  
Meta Analysis ◽  
Post Stroke
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