dear Dinesh>Dinesh Verma said:
Interesting question and please let me answer best to my ability since I have been involved in ESTIM for Dysphagia for past 10 years and conducted several Workshops across Asia n Europe ... Let me share my views :
Firstly we do not have that many research publications - with ESTIM and Paeds population - however some case studies and limited references available do show very positive out comes in PAEDS - with NMES. ADULT Population is Several researches Published till date - I would over 30 publications worldwide....
As far as your point that Positive Effect could be due to adhesive Plaster - I do not personally agree for the reasons - In the Original Work developing this technique - that was done by Ms Marcy Freed during early 2000s - an Speech Language pathologist - The plaster based electrodes were not developed and she used Round electrodes with 3 M tape ... with extremely positive outcomes that made the technique to be approved for clinical use in USA. Also there is no force applied to muscle in this application - the role of Adhesive plaster is NO MORE then a ADHESIVE BAND AID for sticking purposes. Kinesio Taping principles do work on different Application techniques as you very well know.
The effect of ESTIM is certainly well proven over the years and I do have references of several International Research publications.... for Adult population - largely with Stroke.
One of very interesting Physiological and LAB study was done in Spain - and I am giving you reference below - Led by Prof Pere Clave - Who is Chairperson of European Society of Swallowing disorder ( ESSD ) - and with their Extensively developed lab - That I was fortunate to visit - They produced some excellent outcomes - that actually Evaluated the effects on Swallow at SENSORY level intensity - IMPROVED SAFELY OF SWALLOW AS WELL AS Motor level intensity - IMPROVED SAFETY AND EFFICACY OF SWALLOW . Below is the summary .
Neurogastroenterol Motil (2013) doi: 10.1111/nmo.12211 Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction L. ROFES, V. ARREOLA,† I. L _OPEZ,,† A. MARTIN,† M. SEBASTI _AN,‡ A. CIURANA‡ & P. CLAV_E,† Centro de Investigaci_on Biom_edica en Red de enfermedades hep_aticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain †Gastrointestinal Physiology Lab, Hospital de Matar_o, Matar_o, Spain ‡Neurology Unit, Hospital de Matar_o, Matar_o, Spain
SENSORY LEVEL STIM Unsafe swallows were reduced by 66.7 % Laryngeal vestibule closure time was reduced by 22.9 % Max Hyoid vertical extension time reduced by 18.6 %
MOTOR LEVEL STIM Unsafe swallows were reduced by 62.5 % Laryngeal vestibule closure time was reduced by 38.2 % Max Hyoid vertical extension time reduced by 24.8%. Pharyngeal residues were reduced by 66.7 % . UES Opening time reduced by 39.4 % Bolus Propulsion force increased by 211 % Improved Safety and EFFICACY of swallow .
PLEASE NOTE - The Key Muscles that we address in the ESTIM technique are Supra-Hyoid muscle - those responsible for Forward and upward movement of Hyoid bone - Facilitating Normal Safer positioning to swallow also to some extent . Infra - Hyoid muscles - BOTH together resulting in HYO-LARANGEAL EXCUSRION. Pharyngeal Constrictor muscles - resulting in Greater contraction forces ( as shown in study above by Physiological measurements ) ... Now important point is - One must perform good Clinical Evaluation and Select Target Muscles and Activities those need to be encouraged - Hence it should NOT be the case that - Supra / infra hyoid muscle ground HAVE TO BE stimulated at Same intensity Levels. One could select Motor level at Channel 1 and Sensory level at Channel 2.
Regarding Size of electrodes - As for PAEDS group - You may consider - 2 electro placements ... It is not Mandatory that always 4 electrodes have to be placed... !
ESTIM indeed has VERY positive outcomes on Dysphagia management - and perhaps at current time - I could say one of VERY WELL researched area of application in Electrotherapy - with a few RCT - OUTCOME studies done as well.. !
Some of the EMG activity recording done at labs - have shown increased CORTICAL Activity in the brain while the Stim is ON and remaining Post Stim - This is reinforcing Cortical reorganization and Stimulation at sensory levels DO also facilitate Motor return.
Hope above is helpful in making some clarifications .
Esther - May I know your country of location Please..??
Dinesh Verma SINGAPORE
Improved SAFETY of swallow
dear Dinesh, Thank you very much for the detailed reaction. I will have a good read and will come back with more questions when I have done so. Am based in the Netherlands, but have worked in Germany and Spain also. In my role as advocate of taping, I am particularly interested because a number of studies comparing both NMES to Kinesiotaping have shown very similar outcomes. kind regards Esther