Journal of Human Sport and Exercise

Effect of transcranial direct current stimulation on dysphagia in patients with post thermal inhalation injury: A randomized controlled trial

Ahmed Ebrahim Elerian, Ayman M. Elmakaky, Nehad A. Abo-Zaid, Nabil Mahmoud Abdel-Aal

DOI: https://doi.org/10.14198/jhse.2021.16.Proc4.11

Abstract

Background: The most dangerous complications of post-thermal inhalation injury dysphagia are aspiration risks and the inability to efficiently manage solid food textures, which almost persist for weeks and even for months. Objectives: To investigate the effect of transcranial direct current stimulation (tDCS) to conventional therapy for treating post thermal inhalation injury dysphagia. Participants and Methodology: Sixty patients aged from 13 to 35, suffering from post-thermal inhalation injury dysphagia were randomly allocated into two equal groups. The experimental group(A) received 2-mA tDCS through 2 surface electrodes, three times/week for 3 weeks plus conventional physical therapy. While the control group (B) received sham tDCS as a placebo plus the same conventional physical therapy. The Mann Assessment of Swallowing Ability (MASA) as well as Video fluoroscopy Swallow Study (VFSS) were used to assess the swallowing ability in both groups before and after 3 weeks of intervention. Outcome measures included oral transportation time, hyoid elevation, laryngeal elevation, the oesophageal sphincter opens, and aspiration measured by VFSS as well as swallowing ability measured by the MASA. Results: Post-treatment results showed a significant decrease in the oral transportation time, hyoid elevation, laryngeal elevation, the oesophageal sphincter opens, and aspiration, as well as outcomes of the MASA in both groups in favour of the tDCS group(p < .05). Conclusion: Application of tDCS has a significant effect as an adjuvant strategy during swallowing training in patients with post thermal inhalation injury dysphagia.


Keywords

Post thermal inhalation dysphagia; Therapeutic exercises; Transcranial direct current stimulation

References

Aggarwal S., Smailes S.,& Dziewulski P.(2009). Tracheostomy in burns patients revisited. Burns: journal of the International Society for Burn Injuries. 35(7):962-6. https://doi.org/10.1016/j.burns.2009.03.005

Antonios N., Carnaby-Mann G., Crary M., Miller L., Hubbard H., & Hood K., (2010). Analysis of a physician tool for evaluating dysphagia on an inpatient stroke unit: the modified Mann Assessment of Swallowing Ability. J Stroke Cerebrovasc Dis. 19:49-57. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.03.007

Aziz Q., Rothwell J.C., & Barlow J. (1995). Modulation of esophageal responses to magnetic stimulation of the human brain by swallowing and by vagal stimulation. Gastroenterology. 109(5): 1437-1445. https://doi.org/10.1016/0016-5085(95)90628-2

Carnaby-Mann G., Clayton N., & Dubose C. (2007). Treatment and Management of Dysphagia in thermal burn and inhalation injury. Perspectives on Swallowing and Swallowing Disorders Dysphagia. 10:2-6. https://doi.org/10.1044/sasd16.3.2

Casper J.K., Clark W.R., & Kelley R.T. (2002) Laryngeal and phonatory status after burn/inhalation injury: a long term follow-up study. J Burn Care Rehabil. 23(4):235-43.

Clayton N., Kennedy P., & Maitz P. (2010). The severe burns patient with tracheostomy: implications for management of dysphagia, dysphonia, and laryngotracheal pathology. Burns: journal of the international Society for Burn Injuries. 36(6):850-5. https://doi.org/10.1016/j.burns.2009.12.006

Doeltgen S.H., & Huckabee M.L. (2012). Swallowing neurorehabilitation: from the research laboratory to routine clinical application. Arch. Phys. Med. Rehabil. 93: 207-213. https://doi.org/10.1016/j.apmr.2011.08.030

Doeltgen S.H., Bradnam L.V., & Young J.A.( 2015). Transcranial non-invasive brain stimulation in swallowing rehabilitation following stroke - A review of the literature. Physiology & Behavior. 143:1-9. https://doi.org/10.1016/j.physbeh.2015.02.025

DuBose C.M., Groher M.G., & Mann G.C. (2005). Pattern of dysphagia recovery after thermal burn injury. J Burn Care Rehabil. 26(3):233-7.

Ekberg O. (2012) Dysphagia Diagnosis and Treatment (Medical Radiology). Dordrecht: Springer. https://doi.org/10.1007/978-3-642-17887-0

Ghandehari K., Erfani M., & Kiadarbandsari E. (2016). Transcranial direct current stimulation in post- stroke dysphagia: a systematic review of randomized controlled trials. Rev Clin Med. 3(3):117-121.

Ikonomidis C., Lang F., & Radu A. (2012). Standardizing the Diagnosis of Inhalation Injury Using a Descriptive Score Based on Mucosal Injury Criteria. Burns: journal of the International Society for Burn Injuries. 38(4):513-19. https://doi.org/10.1016/j.burns.2011.11.009

Macht M., Wimbish T., & Clark B.J. (2011). Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Critical care. 15 (5):231. https://doi.org/10.1186/cc10472

Mann G. (2002). The Mann Assessment of Swallowing Ability MASA. Vol. 1 New York, NY: Cengage Learning Mann G., Hankey G.J., & Cameron D. (2000). Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis. 10: 380-386. https://doi.org/10.1159/000016094

Nitsche M.A., & Paulus W.( 2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 527(3):633-639. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00633.x

Nitsche M.A., Seeber A., & Frommann K. (2005). Modulating parameters of excitability during and after Transcranial direct current stimulation of the human motor cortex. J Physiol. 568(1):291-303. https://doi.org/10.1113/jphysiol.2005.092429

Paulus W. (2003). Transcranial direct current stimulation (tDCS).SupplClinNeurophysiol. 31(56):249-254. https://doi.org/10.1016/S1567-424X(09)70229-6

Rofes L., Arreola V., & Lopez I. (2013). Effect of surface sensory and motor electrical stimulation on chronic poststroke oropharyngeal dysfunction. Neurogastroenterol. Motil. 25: 888-e701. https://doi.org/10.1111/nmo.12211

Rumbach A.F., Ward E.C., & Cornwell P.L. (2011). Incidence and predictive factors for dysphagia after thermal burn injury: a prospective cohort study. J Burn Care Res: official publication of the American Burn Association. 32(6):608-16. https://doi.org/10.1097/BCR.0b013e318231c126

Rumbach A.F., Ward E.C., & Cornwell P.L. (2012). Clinical progression and outcome of dysphagia following thermal burn injury: a prospective cohort study. Journal of burn care &research: official publication of the American Burn Association. 33(3):336-46. https://doi.org/10.1097/BCR.0b013e3182356143

Saghaei M., (2004). Random allocation software for parallel-group randomized trials. BMC Med Res Methodol;4:26. https://doi.org/10.1186/1471-2288-4-26

Simons A., &Hamdy S. (2017). The Use of Brain Stimulation in Dysphagia Management. Dysphagia. 32(2):209-215. https://doi.org/10.1007/s00455-017-9789-z

Teismann I.K., Suntrup S., Warnecke T. (2011). Cortical swallowing processing in early subacute stroke. BMC Neurol. 11: 34-39. https://doi.org/10.1186/1471-2377-11-34

Valdez T.A., Desai U., & Ruhl C.M. ( 2006). Early laryngeal inhalation injury and its correlation with late sequelae. The Laryngoscope. 116(2):283-7. https://doi.org/10.1097/01.mlg.0000197932.09386.0e

Valeria P., Alberto P., & Alberto M. (2018). Dual Transcranial Direct Current Stimulation for Post-stroke Dysphagia: A Randomized Controlled Trial.Neurorehabilitation and Neural Repair. 32(6-7): 635- 644. https://doi.org/10.1177/1545968318782743

Vilardell N., Rofes L., & Ortega O. (2016). Development of post-stroke swallowing function and factors associated with its recovery at three months.Eur. Stroke J. 1(1): 599-612.

Ward E.C., Uriarte M., & Sppath B. ( 2001). Duration of dysphagic symptoms and swallowing outcomes after thermal burn injury. J Burn Care Rehabil. 22(6):441-53.

Woodson L. ( 2009). Diagnosis and grading of inhalation injury. J Burn Care Res. 30(1):143-5. https://doi.org/10.1097/BCR.0b013e3181923b71

Woodson L., Talon M., & Traber D. (2012). Diagnosis and treatment of inhalation injury. In: Herndon DN, ed. Total Burn Care. 4th ed: Elsevier Ltd. https://doi.org/10.1016/B978-1-4377-2786-9.00019-9




DOI: https://doi.org/10.14198/jhse.2021.16.Proc4.11





Copyright (c) 2021 Journal of Human Sport and Exercise

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.