Post-stroke dysphagia in adults : neuromuscular electrical stimulation vs alternative/sham therapy

Abstract

i. Overview of the Topic: Stroke, also known as cerebrovascular accident (CVA), is a disorder that affects millions of people worldwide. It causes a disturbance in the brain's oxygen and nutrition flow, resulting in the death of brain cells and serious complications. If this disorder is not urgently addressed, irreversible brain damage might occur. As a result, tissues and organs may stop working, resulting in impairment and even death (Vahdati et al., 2017). Dysphagia is a swallowing impairment associated with stroke, and this dissertation focused on patients suffering with dysphagia after a stroke. ii. The research question: “Does neuromuscular electrical stimulation improve swallowing function in adults with post-stroke dysphagia when compared to alternative/sham therapy?” iii. PICO elements: The population (P) was composed of adult patients with poststroke dysphagia. The intervention (I) was neuromuscular electrical stimulation (NMES). The comparison (C) was alternative/sham therapy. The final desired outcome (O) was functional recovery of swallowing. iv. Method: The key elements from the PICO question along with ‘Boolean Operators’ were used to create alternative terms and later inputted in databases. The databases used were HyDi, EBSCO, ScienceDirect and PubMed. The PRISMA 2009 checklist was used to eliminate irrelevant articles. The Critical Appraisal Skill Programs (CASP) were used to critically appraise the selected articles. v. Limiters, inclusion and exclusion criteria applied: Human adults i.e. ≥18 years, English language and articles published in the last ten years i.e. 2011-2021. Meta-analyses, systematic reviews (SR) and randomised controlled trials (RCTs) were searched. After the set of inclusion and exclusion criteria were applied, a total of six articles were found to be eligible for this study. The six selected studies were a SR and 5 RCTs. vi. Main results and conclusion: The articles included in this study found that NMES showed significant improvement in the functional recovery of swallowing. However, most studies advise the use of NMES in combination with traditional swallowing therapy. In light of this finding, a definite conclusion about the efficacy of NMES when applied on its own cannot be presented. vii. Implications and relevant recommendations: Since NMES for post-stroke dysphagia has not been introduced in Malta yet, it is strongly recommended that protocols and procedures be developed in specialised unit at Karen Grech hospital and other wards in MDH that treatstroke patients to guide the multidisciplinary team in the proper use of NMES. Given the high rate of stroke prevalence in Malta, there is a compelling need to educate the general population about stroke prevention and to identify the risks of stroke through educational programmes nationwide. Further research in this area, using a larger sample and a more diverse demographic profile is strongly recommended to improve understanding of the benefits of NMES on post-stroke dysphagia.