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Neuromuscular electrical stimulation as a treatment dysphagia in stroke patients

Three Part Question

In [stroke patients with new onset dysphagia], is [neuromuscular electrical stimulation (NMES) better than compensatory strategies or thermo-tactile stimulation] in the [recovery of swallow function]

Clinical Scenario

There is new emerging technology designed to electrically stimulate key muscles involved in swallowing for treating people with dysphagia. This is more commonly used in the United States but it is now being provided in the UK by independent practitioners. The Royal College of speech and language therapists do not endorse this treatment due to lack of a robust evidence base so we do not know if this type of therapy is effective and for which client group it is most effective for. Patients are beginning to ask therapists about this kind of treatment so a search of the available evidence is useful to inform patients of the most up to date evidence.

Search Strategy

Medline was used as the search engine. The title and abstract were searched and criteria was set to human subjects and English language only. The search was: (neuromuscular electrical stimulation OR NMES OR e-stim OR transcutaneous electrical stimulation OR vitalstim OR TES OR electrical stimulation) AND (dysphagia OR swallow*)
NMES= 14 articles
e-stim= 1
transcutaneous electrical stimulation= 10
vitalstim= 6
TES= 3
electrical stimulation= 65

Search Outcome

After the removal of duplicates 74 articles were found. Out of these only 5 were accepted for the BET. Articles were excluded for reasons such as low grade evidence, mixed client groups, reviews and studies on normal subjects.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Freed M, Freed L, Chatburn R, Christian M
May 2001
strokeTrialswallow function scoreBoth groups showed improvement but ES had higher final swallow scoresNo sample size calculations,swallow function score is a subjective measure and does not include solids, only liquids. Outcome measure is aspiration only, not control of bolus/residue etc. The final score was determined by functional improvement (subjective), not by repeat objective barium swallow, subjects and SLTs were unblinded. The TS group were longer post stroke than the ES group
Lim K, Lee H, Lim S, Choi Y
stokeRandomised control trialswallow function score, Rosenbek penetration/aspiration scale, pharyngeal transit timeimproved outcomes for electrical stimulation groupsmall sample size (28), various types of CVA and post onset time, short follow up period
Permsirivanich W, Tipchatyotin S, Wongchai M, Leeamanit V et al
strokeRandomised control trialfunctional oral intake scaleelectrical stimulation appeared to have better outcomesvery early on in recovery (2 weeks post CVA), no account for spontaneous recovery, unclear how blinded, small sample size (28), subjective and vague outcome measures,
Xia W, Zheng C, Lei Q, Tang Z, Hua Q, Zhang Y, Zhu S
StrokeRandomised control trialbedside swallow assessment, videofluoscopy, swallow related quality of lifeNo significance difference found between vitalstim vs conventional swallow therapy but significant result in both combinednot made clear what conventional swallow training is, no mention of spontaneous recovery or definition of 'acute' dysphagia, small sample size, no long term impact included, some outcome measures are subjective or fully explained what was measured. More info on stroke severity and functional severity of dysphagia pre and post treatment would be useful, all results are statistically significant
Bulow M, Speyer R, Baijens L, Woisard V, Ekberg O
strokeRandomised trialvideofluroscopy, nutritional status, oromotor function, visual analogue scaleno statistically significant difference between electrical stimulation and traditional therapy. Patients subjective views had little corrolation with objective measuressmall sample size


From the original search there is little high grade evidence available at present. Althought some studies show an improvement in swallow function, the outcome measures are often subjective or not fully explained.

Clinical Bottom Line

More robust studies need to be conducted before the use of electrical stimulation can proved to be an effective and safe option for dysphagia therapy

Level of Evidence

Level 2 - Studies considered were neither 1 or 3.


  1. Freed M, Freed L, Chatburn R, Christian M Electrical stimulation for swallowing disorders caused by stroke Respiratory Care May 2001, vol 46, no 5
  2. Lim K, Lee H, Lim S, Choi Y Neuromuscular electrical stimulation and hermal tactile stimulation for dysphagia caused by stroke: an RCT Journal of rehabilitation medicine 2009 41: 174-178
  3. Permsirivanich W, Tipchatyotin S, Wongchai M, Leeamanit V et al Comparing the effects of rehabiliation swallowing therapy vs neuromuscular elctrical stimulation therapy among stoke patients with persistent laryngeal dysphagia: an RCT Journal of the medical association of Thailand 2009 92 (2) 259-65
  4. Xia W, Zheng C, Lei Q, Tang Z, Hua Q, Zhang Y, Zhu S Treatment of post stroke dysphagia by VitalStim therapy coupled with conventional swallowing training. Journal Huazhong University of Science and Technology 31 (1):73-76 2011
  5. Bulow M, Speyer R, Baijens L, Woisard V, Ekberg O Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction Dysphagia 23:302-309