Effects of neuromuscular electrical stimulation on swallowing - real or placebo? One case study

Abstract

Neuromuscular electrical stimulation (NMES) of laryngeal muscles is a popular treatment strategy for adults with dysphagia (swallowing difficulty). However, the evidence base for the theoretical premise of this strategy is limited. Advocates of the approach state that notable improvements in swallowing ability can be observed after 12 consecutive days of treatment. The adult in this case study was a 42 year-old woman with a history of drug abuse and related physical and nutritional problems. She suffered a series of strokes and was admitted to the Veterans Administration system for care. Her difficulties were documented through a Modified Barium Swallow (MBS) videofluoroscopic examination as she swallowed thin and nectar-thick liquids. The transit of each liquid was measured at five specific landmarks and showed that her swallow was significantly delayed with evident aspiration of liquid into her airway. She underwent 10 consecutive days of NMES treatment and a repeat MBS examination. Post-NMES liquid transit measures continued to document a delayed swallow and aspiration. However, the participant felt strongly that NMES was effective. Results raise important considerations about the placebo effect in treatment and its influence in decision-making.