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https://codas.org.br/article/doi/10.1590/2317-1782/20182018100
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Case Reports

Immediate effect of neuromuscular electrical stimulation on deglutition after treatment of laryngeal cancer: a case report

Efeito imediato da estimulação elétrica neuromuscular na deglutição após tratamento do câncer de laringe: relato de caso

Danila Rodrigues Costa; Marcela Maria Alves da Silva-Arone; Cassia Maria Fischer Rubira; Paulo Sérgio da Silva Santos; Giédre Berretin-Felix.

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Abstract

The objective of this study was to verify the immediate effect of sensory and motor neuromuscular electrical stimulation (NMES), in the oral and pharyngeal phases of deglutition, in a 64 year male patient after laryngeal cancer treatment. Videofluoroscopy was performed during deglutition of 5 ml of honey and pudding, under three conditions: without stimulation, with sensory NMES, with motor NMES, randomly defined. The degree of dysfunction of deglutition (DOSS), the presence of food stasis (Eisenhuber scale), laryngeal penetration and laryngotracheal aspiration (PAS) and oral and pharyngeal transit time were evaluated. An evaluator without knowing about the applied stimulus. On the DOSS scale there was improvement with sensory and motor stimulation. In the PAS scale, there was improvement, both for the sensorial and motor stimulus in the honey consistency, but the worsening of the motor stimulus for the pudding consistency was observed. There was reduction of the residues in the base of the tongue with sensorial and motor stimulus for the consistency of pudding and honey; worsening motor stimulus in the posterior wall of the pharynx for honey consistency. There was no difference between stimulation levels regarding to oral and pharyngeal transit time. The results showed that NMES at the sensory and motor levels improved the degree of dysphagia in an individual after the treatment of laryngeal cancer, with greater benefits of the sensory level in relation to the motor regarding to the presence of penetration and residues

Keywords

Neoplasias Laríngeas; Quimioterapia; Radioterapia; Transtornos da Deglutição; Estimulação elétrica

Resumo

Este trabalho teve por objetivo verificar o efeito imediato da Estimulação Elétrica Neuromuscular (EENM) sensorial e motora, nas fases oral e faríngea da deglutição, em um homem de 64 anos, após tratamento de câncer de laringe. Foi realizado exame de videofluoroscopia durante a deglutição de 5 ml de mel e pudim, em três condições: sem estimulação, com EENM sensorial, com EENM motora, definidas de forma randomizada. Foi classificado o grau da disfunção da deglutição (DOSS), a presença de estase de alimentos (escala de Eisenhuber), de penetração laríngea e aspiração laringotraqueal (PAS), além da medida do tempo de trânsito oral e faríngeo, realizadas por uma avaliadora sem conhecimento sobre o estímulo aplicado. Na escala DOSS, houve melhora com a estimulação sensorial e motora. Na escala PAS, verificou-se melhora, tanto para o estímulo sensorial quanto motor na consistência mel, porém observou-se piora no estímulo motor para a consistência pudim. Houve diminuição dos resíduos em base de língua com estímulo sensorial e motor para as consistências pudim e mel; piora no estímulo motor na parede posterior da faringe para a consistência mel. Em relação ao tempo de trânsito oral e faríngeo, não foi observada diferença entre os níveis de estimulações. Os resultados demonstraram que a EENM em nível sensorial e motor melhorou o grau da disfagia em um indivíduo após o tratamento de câncer de laringe, com maiores benefícios do nível sensorial em relação ao motor no que diz respeito à presença de penetração e resíduos.

Palavras-chave

Laryngeal Neoplasms; Chemotherapy; Radiotherapy; Deglutition Disorders; Electric Stimulation

Referências

1 Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008;19(4):889-928, x. http://dx.doi.org/10.1016/j.pmr.2008.05.010. PMid:18940647. [ Links ]

2 van der Molen L, Van Rossum MA, Rasch CRN, Smeele LE, Hilgers FJM. Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otorhinolaryngol. 2014;271(5):1257-70. http://dx.doi.org/10.1007/s00405-013-2640-8. PMid:23892729. [ Links ]

3 Hutcheson KA, Bhayani MK, Beadle BM, Gold KA, Shinn EH, Lai SY, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg. 2013;139(11):1127-34. http://dx.doi.org/10.1001/jamaoto.2013.4715. PMid:24051544. [ Links ]

4 Humbert IA, Michou E, MacRae PR, Crujido L. Electrical stimulation and swallowing: how much do we know? Semin Speech Lang. 2012;33(3):203-16. http://dx.doi.org/10.1055/s-0032-1320040. PMid:22851342. [ Links ]

5 Poorjavad M, Talebian Moghadam S, Nakhostin Ansari N, Daemi M. Surface electrical stimulation for treating swallowing disorders after stroke: a review of the stimulation intensity levels and the electrode placements. Stroke Res Treat. 2014;2014:918057. http://dx.doi.org/10.1155/2014/918057. PMid:24804147. [ Links ]

6 Ryu JS, Kang JY, Park JY, Nam SY, Choi SH, Roh JL, et al. The effect of electrical stimulation therapy on dysphagia following treatment for head and neck cancer. Oral Oncol. 2009;45(8):665-8. http://dx.doi.org/10.1016/j.oraloncology.2008.10.005. PMid:19095492. [ Links ]

7 Bhatt AD, Cash NGE, Bhatt G, Silverman CL, Spanos WJ, Bumpous JM, et al. Impact of transcutaneous neuromuscular electrical stimulation on dysphagia in head and neck cancer patients treated with definitive chemoradiation. Head Neck. 2015;37(7):1051-6. http://dx.doi.org/10.1002/hed.23708. PMid:24710791. [ Links ]

8 Langmore SE, McCulloch TM, Krisciunas GP, Lazarus CL, Van Daele DJ, Pauloski BR, et al. Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: a randomized clinical trial. Head Neck. 2016;38(1, Suppl 1):1221-31. http://dx.doi.org/10.1002/hed.24197. PMid:26469360. [ Links ]

9 Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919-24. http://dx.doi.org/10.1177/000348940811701210. PMid:19140539. [ Links ]

10 Berretin-Felix G, Sia I, Barikroo A, Carnaby GD, Crary MA. Immediate effects of transcutaneous electrical stimulation on physiological swallowing effort in older versus young adults. Gerodontology. 2016;33(3):348-55. http://dx.doi.org/10.1111/ger.12166. PMid:25393704. [ Links ]

11 O’Neil KH, Purdy M, Falk J, Gallo L. The dysphagia outcome and severity scale. Dysphagia. 1999;14(3):139-45. http://dx.doi.org/10.1007/PL00009595. PMid:10341109. [ Links ]

12 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8. http://dx.doi.org/10.1007/BF00417897. PMid:8721066. [ Links ]

13 Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, et al. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. AJR Am J Roentgenol. 2002;178(2):393-8. http://dx.doi.org/10.2214/ajr.178.2.1780393. PMid:11804901. [ Links ]

14 Shaw GY, Sechtem PR, Searl J, Keller K, Rawi TA, Dowdy E. Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality? Ann Otol Rhinol Laryngol. 2007;116(1):36-44. http://dx.doi.org/10.1177/000348940711600107. PMid:17305276. [ Links ]

15 Lin PH, Hsiao TY, Chang YC, Ting LL, Chen WS, Chen SC, et al. Effects of functional electrical stimulation on dysphagia caused by radiation therapy in patients with nasopharyngeal carcinoma. Support Care Cancer. 2011;19(1):91-9. http://dx.doi.org/10.1007/s00520-009-0792-2. PMid:20091057. [ Links ]

16 Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Crujido L, Wright-Harp W, et al. The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol. 2006;101(6):1657-63. http://dx.doi.org/10.1152/japplphysiol.00348.2006. PMid:16873602. [ Links ]

17 Humbert IA, Michou E, MacRae PR, Crujido L. Electrical stimulation and swallowing: how much do we know? Semin Speech Lang. 2012;33(3):203-16. http://dx.doi.org/10.1055/s-0032-1320040. PMid:22851342. [ Links ]


Submetido em:
21/08/2018

Aceito em:
23/10/2018

5d16197a0e8825bd6b5a3d52 codas Articles

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