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Transcutaneous electrical stimulation (TES) was introduced as a modality for dysphagia rehabilitation more than a decade ago. The underlying premise of this modality is improving the structural movements and enhancing neural activation based on stimulation-induced muscle contractions. However, divisive evidence exists regarding the effectiveness of this treatment modality. This manuscript reviews current evidence regarding the effects of transcutaneous electrical stimulation (TES) on clinical and physiological aspects of swallowing function. Furthermore, this narrative review delineates the knowledge gap in this area and recommends future research roadmap. This review gives a comprehensive picture regarding current knowledge of TES to practicing speech and language pathologists and interested researchers. It highlights the need for more robust studies in this area. It also encourages researchers to focus more on the physiologic studies to understand the physiologic underpinning behind this treatment modality.

Background: Laryngeal vestibule closure (LVC) is one of the critical airway protection mechanisms during swallowing. LVC timing impairments during swallowing are among the common causes of airway invasion in patients with dysphagia. Objectives: To understand whether using submental transcutaneous electrical stimulation (TES) with varying pulse durations can impact the LVC reaction time (LVCrt) and LVC duration (LVCd) measures in healthy adults. Methods: Twenty‐six healthy adults underwent three TES conditions while receiving three trials of 10 ml pureed: no TES, TES with short pulse duration (300 μs) and TES with long pulse durations(700 μs). Two pairs of electrodes were placed diagonally on the submental area. For each active TES condition, the stimulation was increased up to the participant's self‐identified maximum tolerance. Each swallow trial was recorded using videofluoroscopic swallowing study. All data were extracted and analysed offline using VideoPad Video Editor program. Results: Submental TES reduced LVCrt during swallowing [F (2, 46) = 7.234, p <.007, ηp2 =.239] but had no significant impact on LVCd [F (2, 50) =.1.118, p <.335, ηp2 =.043]. Furthermore, pulse duration had no distinguished impact on any LVC timing measures. Conclusion: Transcutaneous electrical stimulation may benefit patients with dysphagia who suffer from delayed LVC during swallowing. Future studies should seek whether the same physiologic effect can be observed in patients with dysphagia. [ABSTRACT FROM AUTHOR]

Background: Limited knowledge exists regarding whether transcutaneous electrical stimulation (TES)‐based exercise can improve the lingual pressure generation. Objectives: To compare the effect of submental TES with two different pulse durations (PD) coupled with isometric lingual exercises on lingual pressure measures. Methods: Twenty‐eight healthy volunteers were divided into two submental TES groups: short PD (300 μs) and long PD (700 μs). The Iowa Oral Performance Instrument (IOPI) was used for lingual pressure measurements and exercise. In total, participants attended six exercise sessions 3 days per week for 2 consecutive weeks. Maximum and swallowing lingual pressures were measured 1 h following each exercise session and 3 days after the final session to assess any detraining effect. Data were analysed using repeated measure ANOVA. Results: Mean maximum lingual pressure change was significantly greater in TES with short PD versus the long PD condition following the first week of exercise. Following the 2‐week exercise, a significant increase was found in mean maximum lingual pressure for short and long PD conditions compared with the baseline. However, no significant difference was found between PD conditions for maximum lingual pressure. Likewise, no significant differences in swallowing lingual pressure were found compared with the baseline or across the two TES conditions. Conclusion: Although short PD induced greater gain in maximum lingual pressure than the long PD after week 1, the enhanced effect faded after week 2, leading to a comparable increase in maximum lingual pressure for both groups. However, increased gain in maximum lingual pressure was not transferred to lingual pressure during swallowing. [ABSTRACT FROM AUTHOR]

Background: One language-related area that has recently received more attention from researchers working in the field of stuttering is phonological working memory. The aim of the present study was to compare the phonological working memory abilities of normal children with those of children who stutter (CWS). Materials and Methods: 30 CWS aging 4-6 years were compared with their control counterparts in the same age range. Non-word immediate repetition task was used to measure reaction time and to study the effect of non-word length on the accuracy and verbal fluency of responses. The second task was non-word delayed repetition task which was applied to determine the speed and efficiency of learning non-words. Results: Between-group analysis showed significant differences for all of the indexes except accuracy of non-words. The mean of reaction times in CWS was significantly longer than that of the control group. Moreover, the rate of learning non-words in stutterers was slower than in the normal group and theses differences were significant. Furthermore, the analysis of response fluency on non-word repetitions across different non-word lengths in CWS showed that the percentage of disfluencies significantly increased along with an increase in nonword length. Although the percentage of correct non-words as a whole and across different lengths indicated that CWS produced slightly less correct non-words compared to the control group, this difference was not significant. Conclusion: The findings of the present study provides support for previous works, indicating that CWS’s phonological working memory abilities lag to some degree behind that of normal children. Key words: Phonological Working Memory, Stuttering, Non-Word Repetition Task

Introduction: Swallowing is critical for nutrition and health while affected swallowing is the source of pain, nutritional insufficiency and loss of health. Swallowing disorders especially in elderly may lead to malnutrition or a disabling condition and may cause the inability of individual to self care from himself. So, the aim of the present study was to estimate the prevalence of oropharyngeal dysphagia among elderly residents, who were in Isfahan nursing home centers. Materials and Methods: In this descriptive-analytic cross-sectional study, 165 elderly persons randomly selected and screened with dysphagia screening test. Screening form was consist of some questions regarding the review of their medical history, history of feeding, swallowing and the place of dysphagia as well as three trial swallows with three different consistencies including liquid, semiliquid and solid. Then, the acquired data were analyzed with two tests of Chi-square and Cochran's Q. Results: The prevalence of dysphagia among elderly individuals was 41.2. Furthermore, the analysis of the relationship between dysphagia and three bolus consistencies revealed that the maximum dysphagia was occurred in liquids and this difference was significant. Moreover, the prevalence of dysphagia was greater in females than males (49 % VS 31%) and this difference was also significant. In addition, the analysis of the relationship between the rates of dysphagia and age groups indicated that the percent of dysphagia rise with increasing in age and this difference was significant. Concluison: The prevalence of dysphagia was significant among residential elderly populations in the Isfahan nursing home centers. They are at risk of malnutrition and pneumonia. Therefore, they need speech therapy services for their dysphagia problems. Key Words : Oropharyngeal dysphagia , Elderly , nursing home

Objective: This study sought to evaluate the role and trajectory of spontaneous swallowing frequency (SFA) in patients with head and neck cancer (HNC) undergoing chemoradiotherapy (C/RT). Study Design. Prospective cohort. Setting: University comprehensive cancer center. Methods: A prospective cohort of 80 patients with HNC was followed from baseline to 3 months post-C/RT. Subjects were evaluated for performance on swallowing function, functional diet consumed, weight, swallowing frequency rate, perceived xerostomia, perceived pain, and mucositis. Relationships were evaluated using univariate correlations, t tests, and repeated-measures analysis of variance. The diagnostic accuracy of SFA to express dysphagia was calculated by area under the curve (AUROC) and displayed using receiver operator characteristic curves. Results: In general, patients with HNC demonstrated a parabolic decline in most measures over the C/RT trajectory. SFA and perceived xerostomia did not show improved recovery by 3 months. SFA was related to swallow function, xerostomia, and functional diet consumed posttreatment and pain at 3 months. The ability of SFA to correctly identify clinical dysphagia (Mann Assessment of Swallowing–Cancer version [MASA-C]) and reduced oral intake (Functional Oral Intake Scale [FOIS]) at posttreatment was strong (AUROC MASA-C: 0.824 [95% CI, 0.63-1.00], P <.0018; AUROC FOIS: 0.96 [95% CI, 0.87-0.96], P <.0001). Conclusion: This exploratory study suggests SFA may provide a useful method to identify dysphagia after HNC treatment. Furthermore, SFA may offer a simple, objective measure of swallowing function change in HNC over the C/RT trajectory. [ABSTRACT FROM AUTHOR]

Transcutaneous electrical stimulation (TES) was introduced as a modality for dysphagia rehabilitation more than a decade ago. The underlying premise of this modality is improving the structural movements and enhancing neural activation based on stimulation-induced muscle contractions. However, divisive evidence exists regarding the effectiveness of this treatment modality. This manuscript reviews current evidence regarding the effects of transcutaneous electrical stimulation (TES) on clinical and physiological aspects of swallowing function. Furthermore, this narrative review delineates the knowledge gap in this area and recommends future research roadmap. This review gives a comprehensive picture regarding current knowledge of TES to practicing speech and language pathologists and interested researchers. It highlights the need for more robust studies in this area. It also encourages researchers to focus more on the physiologic studies to understand the physiologic underpinning behind this treatment modality. [ABSTRACT FROM AUTHOR]

Summary: Maximum amplitude tolerance (MAT) has been known as a primary factor determining the depth of electrical current penetration. However, the effect of varying transcutaneous electrical stimulation (TES) parameters on MAT and discomfort level is poorly understood. Furthermore, limited information exists regarding the biopsychological factors that may impact MAT and discomfort. The primary aims of this study were to compare the effects TES protocol with varying levels of pulse duration (300 μs vs 700 μs) and frequency (30 Hz vs 80 Hz) on the MAT and discomfort in healthy older adults. The exploratory aim of this study was to examine relationships between submental adipose tissue thickness, pain sensitivity and gender with MAT and discomfort. Twenty‐four healthy older adults participated in this study. Transcutaneous electrical stimulation was delivered to the submental region. Maximum amplitude tolerance and discomfort were measured for each condition. Furthermore, submental adipose tissue thickness and pain sensitivity were measured for each subject. Maximum amplitude tolerance was significantly increased for the TES protocols with short‐pulse duration [F (3, 69) = 38.695, P < .0001]. Discomfort was similar across different TES protocols. Submental adipose tissue thickness (r = .30, P < .003) and pain sensitivity (r = −.43, P < .0001) were related to MAT. Pain sensitivity rating was also related to discomfort (r = .45, P < .0001). In conclusion, using TES protocols with short‐pulse duration may increase the MAT. Higher amplitude stimulation may increase the impact on deep swallowing muscles. In addition, submental adipose tissue thickness and pain sensitivity are potential biopsychological factors that may affect MAT and discomfort. [ABSTRACT FROM AUTHOR]

Objective: This study compared the immediate impact of different transcutaneous electrical stimulation (TES) amplitudes on physiological swallowing effort in healthy older adults versus young adults.Background: Swallowing physiology changes with age. Reduced physiological swallowing effort in older adults including lower lingua-palatal and pharyngeal pressures may increase risk for swallowing dysfunction (i.e. dysphagia). Transcutaneous electrical stimulation (TES) has been advocated as an adjunctive modality to enhance outcomes in exercise-based therapy for individuals with dysphagia. However, significant variation in how TES is applied during therapy remains and the physiological swallowing response to TES is poorly studied, especially in older adults.Materials and Methods: Physiological change in swallowing associated with no stimulation, sensory stimulation and motor stimulation was compared in 20 young adults versus 14 older adults. Lingua-palatal and pharyngeal manometric pressures assessed physiological swallowing effort.Results: Multivariate analyses identified interactions between age and stimulation amplitude on lingual and pharyngeal functions. Motor stimulation reduced anterior tongue pressure in both age groups but selectively reduced posterior lingua-palatal pressures in young adults only. Sensory stimulation increased base of tongue (BOT) pressures in older adults but decreased BOT pressures in young adults. Motor stimulation increased hypopharyngeal pressures in both groups.Conclusion: Age and TES level interact in determining immediate physiological responses on swallow performance. A one-size-fit-all approach to TES in dysphagia rehabilitation may be misdirected. [ABSTRACT FROM AUTHOR]

Introduction: Effortful swallow (ES) is a widely used technique in dysphagia management, believed to strengthen oropharyngeal muscles and enhance swallowing safety and efficiency. Although its impact on the oral phase of swallowing is well documented, its effects on pharyngeal swallowing physiology remain inconsistent. This study aimed to elucidate the effects of ES on swallowing kinematics and timing, addressing existing inconsistencies in the literature., Methods: This study involved 22 healthy adults using archived videofluoroscopic swallowing studies. Participants performed three swallow trials of 10 mL puree under regular conditions and with the ES maneuver. The outcome measures comprised swallow timing and kinematic measures. Swallow timing parameters included time to maximum hyoid and laryngeal excursion, laryngeal vestibule closure (LVC) reaction and duration, pharyngeal constriction duration, pharyngoesophageal segment (PES) opening duration, and swallow duration. Swallow kinematic parameters encompassed hyoid and laryngeal excursions, pharyngeal constriction ratio, and maximum PES width. All variables were analyzed via videofluoroscopy. Paired t tests were used to examine the effect of ES on each outcome measure, with a significance threshold set at p &lt; 0.004., Results: The ES maneuver significantly increased the duration of LVC, pharyngeal constriction, PES opening, and overall swallow duration. It also improved the pharyngeal constriction ratio. However, there were no significant changes in hyoid and laryngeal excursions. Submental muscle activity showed a notable increase during ES., Conclusion: The study demonstrates that ES can effectively modify certain temporal and kinematic aspects of swallowing, particularly by prolonging key phases and enhancing pharyngeal constriction. These findings suggest the potential utility of ES in dysphagia rehabilitation, especially in cases that require prolonged pharyngeal constriction, LVC, and PES opening. However, the limited impact on hyoid and laryngeal excursions along with LVC reaction time indicates that ES may not address all aspects of dysphagia. The findings highlight the need for tailored therapeutic approaches in dysphagia management, considering individual physiological impairment profiles., (© 2024 S. Karger AG, Basel.)