Combined Conventional Speech Therapy and Functional Electrical Stimulation in Dysphagia Following Stroke
Condition: Dysphagia, Oropharyngeal; Stroke, Ischemic
MeSH terms: Deglutition Disorders; Stroke; Ischemic Stroke
Study type: Interventional

Summary: 
      This study will evaluate the effectiveness of conventional speech therapy associated with
      functional electrical stimulation in patients with dysphagia after ischemic stroke. Included
      patients will be divided into two groups, where in the intervention group the speech therapy
      is associated to functional electrical stimulation, and in the control group, the patients
      will receive the conventional speech therapy with electrical stimulation Placebo with
      intensity 0hz.
    

Detailed description: 
      Since the 1980's, electrical stimulation has been used for therapeutic purposes in Brazil,
      and, since 1990's, it has been used as a relevant therapeutic tool in the cases of
      oropharyngeal dysphagia in addition to speech therapy. Positive results have been observed in
      the treatment of swallowing disorders, including in patients that carry neurological
      diseases. However, there is no substantial evidences for this interventions.

      In this study, the electrotherapy will be used as a complement to conventional speech therapy
      and performed the application of electrical stimulation protocol in dysphagia, through the
      apparatus Neurodyn Portable TENS/FES (transcutaneous electrical neurostimulation/ functional
      electrical stimulation), which is a transcutaneous neuromuscular stimulator flow TENS/FES
      from two channels with independent intensity adjustment. It is about a non-invasive technique
      with no systemic effect, causing no dependence or undesirable side effects, and consists by
      gentle application in electrical stimulation, through electrodes placed in body areas
      affected by pain or to activate skeletal muscles and produce movements. A channel of
      electrodes will be placed in the submental region and the other channel on the thyroid
      cartilage., in formation of a T. The explication of the procedure in the patient treatment,
      is describing the sensations that he should expect that happened during the stimulation. The
      intensity of necessary flow to apply in the treatment, will depend in the sensation of the
      patient, therefore, it is applicable until the tolerance level or desirable muscular
      contraction. Thus, the treatment should be initiated with minimal levels of intensity, by
      being carefully raised if appropriate effects are achieved on the procedure and according to
      the patient report.
    

Intervention name(s): Functional Electrical Stimulation; Conventional Speech Therapy
Intervention type(s): Other; Other
Intervention description(s): Functional electrical stimulation device obeying the following steps:
Muscle heating - 2 min, 10 Hz, 250 μm; Potentiation of muscle fibers type I - 8 min, 30 Hz, 250 μm; Potentiation of muscle fibers type II - 8 min, 80 Hz, 300 μm; Toning - 8 min, 30 Hz, 300 μm; Muscle Relaxation - 4 min, 5 Hz, 200 μm One channel of electrodes will be placed in the submental region and the other in the thyroid. Treatment should be started at minimum levels of intensity, increasing carefully until appropriate effects are achieved in the procedure; Conventional speech therapy with laryngeal elevation exercises, stimulation of oral reflexes such as swallowing reflex, tongue movements, lips and cheeks, gustatory therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment