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The Value of Adding Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) to Traditional Therapy for Poststroke Dysphagia

A Randomized Controlled Trial

Li, Lejun, MD, PhD; Li, Yumei, BSc; Wu, Xiaohong, MSc; Wang, Guohua, MD, PhD; Yi, Xiaojing, MSc; Zhao, Yichun, MSc; Guo, Mingjie, MSc; Pan, Muzhi, MSc; Tang, Chunlin, BSc

doi: 10.1097/TGR.0000000000000195
Special Feature

Background: Dysphagia may delay the functional recovery and substantially affects the quality of life after stroke, mainly if left untreated. Electrical stimulation has been reported as a treatment for pharyngeal dysphagia in recent studies, but the therapeutic effect of neuromuscular electrical stimulation (VitalStim) therapy lacks convincing supporting evidence and needs further clinical investigation.

Methods: A total of 135 subjects were randomly divided into 3 groups: traditional swallowing therapy (n = 45), VitalStim therapy (n = 45), and VitalStim therapy plus traditional swallowing therapy (n = 45). The traditional swallowing therapy included basic training and direct food intake training. Electrical stimulation was applied by an occupational therapist, using a modified handheld battery-powered electrical stimulator (VitalStim Dual Channel Unit and electrodes, Chattanooga Group, Hixson, Tennessee). The surface electromyography (sEMG), standardized swallowing assessment (SSA), videofluoroscopic swallowing study (VFSS), and visual analog scale (VAS) were used to assess swallowing function before and 4 weeks after the treatment.

Results: A total of 118 subjects with dysphagia completed the study, 40 in the traditional swallowing group and VitalStim therapy group and 38 in the VitalStim and traditional swallowing therapy group. There were significant differences in sEMG values and SSA and VFSS scores in each group after the treatment (P < .001). After 4-week treatment, sEMG value (917.1; standard deviation [SD], 91.2), SSA value (21.8; SD, 3.5), oral transit time (0.4; SD, 0.1), and pharyngeal transit time (0.8; SD, 0.1) were significantly improved in the VitalStim and traditional swallowing therapy group than in the other 2 groups (P < .001).

Conclusions: Data suggest that VitalStim therapy coupled with traditional swallowing therapy may be beneficial for poststroke dysphagia.

Departments of Neurology (Drs Li and Wang, Mss Li, Wu, and Yi, and Messrs, Zhao, Guo, Pan, and Tang) and Rehabilitation (Dr Li, Mss Wu and Yi, and Messrs Zhao, Guo, Pan, and Tang), Wuxi Hospital Affiliated of Nanjing University of Chinese Medicine, Wuxi, China.

Correspondence: Lejun Li, MD, PhD, Department and Neurology, Wuxi Hospital Affiliated of Nanjing University of Chinese Medicine, 8W Zhongnanxi Rd, Wuxi 214071, China (

The authors would like to thank the staff of the Department of Neurology and Rehabilitation Medicine of Wuxi Hospital Affiliated of Nanjing University of Chinese Medicine for their assistance in recruiting patients and with the rehabilitation treatment for the study.

This study was financed by the Jiangsu Health International Exchange Program, China.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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