Costa Danila Rodrigues, Santos Paulo Sérgio da Silva, Fischer Rubira Cássia Maria, Berretin-Felix Giédre
Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
Department of Surgery, Stomatology, Pathology and Radiology of Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
SAGE Open Med. 2020 Dec 14;8:2050312120974152. doi: 10.1177/2050312120974152. eCollection 2020.
To analyze the immediate effect of sensory and motor neuromuscular electrical stimulation, in oral and pharyngeal stages of swallowing, in individuals after oral and oropharyngeal cancer therapy.
The study was conducted on 10 individuals (mean age of 58 years) submitted to oral and oropharyngeal cancer therapy. The individuals were submitted to videofluoroscopy, during which they were randomly asked to swallow 5 mL of liquid, honey, and pudding, in three conditions: without stimulation, with sensory neuromuscular electrical stimulation, and with motor neuromuscular electrical stimulation. The degree of swallowing dysfunction was scored (Dysphagia Outcome and Severity Scale), as well as the presence of food stasis (Eisenhuber scale), and measurement of the oral and pharyngeal transit time. The results were statistically analyzed by the Friedman test or analysis of variance for repeated measures.
The Dysphagia Outcome and Severity Scale revealed improvement for one individual with both sensory and motor stimuli, and worsening in two individuals, being one with motor and one with sensory stimulus. In the Eisenhuber scale, the neuromuscular electrical stimulation changed the presence of residues to variable extents. Concerning the oral and pharyngeal transit time, no difference was observed between the different stimulation levels for the consistencies tested (p > 0.05).
Both sensory and motor neuromuscular electrical stimulations presented a varied immediate impact on the oral and pharyngeal stages of swallowing in individuals after oral and oropharyngeal cancer therapy. Thus, the results of the immediate effect suggest that the technique is not indicated, evidencing the need of caution in the use of neuromuscular electrical stimulation for the rehabilitation of dysphagia, after HNC treatment.
分析感觉和运动神经肌肉电刺激对口腔和口咽癌治疗后个体吞咽的口腔期和咽期的即时效果。
对10名接受口腔和口咽癌治疗的个体（平均年龄58岁）进行了研究。这些个体接受了视频荧光吞咽造影检查，在此期间，他们被随机要求在三种情况下吞咽5毫升液体、蜂蜜和布丁：无刺激、感觉神经肌肉电刺激和运动神经肌肉电刺激。对吞咽功能障碍程度进行评分（吞咽结果和严重程度量表），以及食物残留情况（艾森胡伯量表），并测量口腔和咽部通过时间。结果采用Friedman检验或重复测量方差分析进行统计学分析。
吞咽结果和严重程度量表显示，一名个体在感觉和运动刺激下均有改善，两名个体恶化，一名是运动刺激导致，一名是感觉刺激导致。在艾森胡伯量表中，神经肌肉电刺激在不同程度上改变了残留物的存在情况。关于口腔和咽部通过时间，在所测试的不同稠度的刺激水平之间未观察到差异（p>0.05）。
感觉和运动神经肌肉电刺激对口腔和口咽癌治疗后个体吞咽的口腔期和咽期均呈现出不同的即时影响。因此，即时效果的结果表明该技术不适用，这证明在头颈部癌症治疗后使用神经肌肉电刺激进行吞咽困难康复时需要谨慎。
