Swallowing Physiology & Rehabilitation Research Laboratory, Speech Pathology and Audiology Program, Kent State University, Kent, OH, USA.
Speech Pathology & Audiology Program, School of Health Sciences, Kent State University, PO Box 5190, Kent, OH, 44242-0001, USA.
Dysphagia. 2022 Apr;37(2):277-285. doi: 10.1007/s00455-021-10276-6. Epub 2021 Mar 3.
Prior research in swallowing physiology has suggested that using submental transcutaneous electrical stimulation (TES) with short pulse duration (PD) (300 μs) may enhance the impact on deep extrinsic tongue muscles, thereby pulling the tongue down during swallowing. However, it was unclear whether that same TES protocol could have a differential impact on hyolaryngeal kinematics and timing. This study aimed to compare the effect of submental TES with varying PDs on anterior and superior hyolaryngeal kinematics and timing both at rest and during swallowing in healthy adults. Twenty-four healthy adults between the ages of 22 and 77 participated in this study. Anterior and superior hyolaryngeal excursion magnitude and duration measures were collected using videofluoroscopic swallowing study. Each subject swallowed three 10 ml pudding trials under three conditions: no TES, TES with short PD (300 μs), and TES with long PD (700 μs). TES was delivered using two-channel surface electrodes in the submental area. In both short and long PD conditions, TES amplitude was gradually increased until participants reached their maximum tolerance level. Videofluoroscopic data were analyzed using VideoPad Video Editor and Image J programs. One-way repeated measure ANOVAs were conducted to identify within-subject effect of TES condition. For hyoid movement, TES with short PD selectively placed the hyoid bone on a more anterior position at rest and reduced anterior hyoid excursion during swallowing compared with the no TES condition. Regarding laryngeal movement, both TES protocols resulted in the larynx taking on a more anterior position at rest and reduced anterior laryngeal excursions during swallowing when compared with the no TES condition. Varying PDs had no significant effect on the superior hyoid and laryngeal movements at rest and during swallowing. Both TES protocols induced shorter hyoid elevation duration during swallowing Findings suggest that though both TES protocols demonstrated a comparable impact on reducing anterior laryngeal excursions, the TES protocol with short PD had an enhanced effect on reducing anterior hyoid excursion during swallowing. This reduced range of motion may result from stimulating the deep submental muscles, which primarily place the hyoid and larynx into a more forward position before swallowing onset. Overall, the TES protocol with short PD may have an increased benefit in facilitating swallowing in patients with dysphagia.
先前的吞咽生理学研究表明，使用短脉冲持续时间（300μs）的颏下经皮电刺激（TES）可能会增强对外源性舌深部肌肉的影响，从而在吞咽时将舌头向下拉。然而，尚不清楚相同的 TES 方案是否会对舌骨和喉的运动学和时间产生不同的影响。本研究旨在比较不同 PD 的颏下 TES 对健康成年人静息和吞咽时舌骨和喉的前向和上向运动学和时间的影响。24 名年龄在 22 至 77 岁之间的健康成年人参与了这项研究。使用视频透视吞咽研究收集了前向和上向舌骨和喉的运动幅度和持续时间测量值。每个受试者在三种情况下吞咽三次 10ml 布丁试验：无 TES、短 PD（300μs）的 TES 和长 PD（700μs）的 TES。使用颏下区域的双通道表面电极进行 TES。在短和长 PD 两种情况下，逐渐增加 TES 幅度，直到参与者达到最大耐受水平。使用 VideoPad Video Editor 和 Image J 程序分析视频透视数据。使用单向重复测量方差分析来确定 TES 条件的个体内效应。对于舌骨运动，与无 TES 条件相比，短 PD 的 TES 选择性地将舌骨置于更靠前的位置，并减少吞咽时的前向舌骨运动。对于喉运动，与无 TES 条件相比，两种 TES 方案都导致喉在静息时处于更靠前的位置，并减少吞咽时的前向喉运动。在静息和吞咽时，PD 的变化对舌骨和喉的上向运动没有显著影响。两种 TES 方案均导致吞咽时舌骨抬高持续时间缩短。研究结果表明，尽管两种 TES 方案都显示出对减少前喉运动有类似的影响，但短 PD 的 TES 方案在吞咽时减少前舌骨运动的效果更强。这种运动范围的减小可能是由于刺激颏下深部肌肉所致，这些肌肉主要在吞咽开始前将舌骨和喉置于更靠前的位置。总的来说，短 PD 的 TES 方案可能会增加吞咽困难患者吞咽的益处。
