Neuromuscular Electrical Stimulation for Dysphonia and Dysarthria: A Systematic Review
Authors:   nstitute of Pathology, Faculty of Medicine, Ludwig-Maximilians University Munich, Thalkirchner Straße 36, 80337 Munich, Germany, Schreiber Franziska ,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, de Lima Froio Nayara ,   Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815 -Bela Vista, São Paulo -SP, 01323-020, Brazil,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Coll-Fernández Roser ,   Rehabilitation Department, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Queiroz Petrus Fernanda ,   School of Medicine, Pontifical Catholic University of Paraná (PUCPR), Av. Jockei Club, 485, Hípica, Londrina, PR, Brazil,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Soares dos Santos Bethânia ,   D'Or Institute Research and Education (IDOR) -Rio de Janeiro, 22281-100, Brazil,   Department of Clinical Research, Brazilian National Cancer In-stitute (INCA) -Rio de Janeiro, 20560-121, Brazil,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Flores Flores Angélica ,   Laboratory of Immunopharmacology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas", Calz. de Tlalpan 4502, Belisario Domínguez Secc 16, Tlalpan, 14080 Ciudad de México, CDMX,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Morales Ojeda Luis A. ,   University of Southern California (USC), Institute of Urology, Keck School of Medicine 1975 Zonal Ave. Los Angeles, CA, 90033,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, de Leon Benedetti Laura ,   Departmentof Radiology, Children’s hospital of Philadelphia, Philadelphia, USA,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Trindade Vinicius ,   University of São Paulo Medical School, Department of Neurology, Division of Neurosurgery-255 Dr Eneas de Carvalho Aguiar st, Pinheiros, Sao Paulo, SP, Brazil,   AC Camargo Cancer Center, Rua Tamandaré, 753 -Liberdade, Sao Paulo -SP, Brazil, ZIP Code 01525-001,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Dodurgali Mustafa Reha ,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, dos Santos Barros Claudia Renata ,   Butantan Institute, 210 Universidade avenue, Sao Paulo -Brazil -CEP 05508-040,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Parron Fernandes Bianca Barros ,   Pontificia Universidade Catolica do Paraná (PUCPR),   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Tapia Argudo Christiany M. ,   DOCS Urgent Care, Orange, Connecticut, 06477, USA,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Stephan Cristina ,   Step Medical Affairs Consulting, Barata Ribeiro st, Bela Vista, São Paulo, Brazil, Zip Code: 01308-000,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA, Buffone Francesca ,   Division of Paediatric, Manima Non-Profit Organization Social Assistance and Healthcare, 20125 Milan, Italy,   Department of Research, SOMA—Istituto Osteopatia Milano, 20126 Milan, Italy,   PPCR, Harvard T. H. Chan School of Public Health – ECPE, Boston, MA, USA
Published: July 2023

Introduction: People with speech disorders such as dysarthria and dysphonia have difficulty producing speech, which is often related to speech muscle dysfunction. Neuromuscular electrical stimulation (NMES) can activate motor units and improve their tropism and functionality. Therefore, this systematic review aimed to evaluate the effects of NMES on the phonation, voice quality, intelligibility, speech muscle strength, and quality of life of patients with dysarthria and dysphonia. Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In September 2022, we searched the EMBASE, Pub-Med, and Cochrane databases for studies that evaluated the effect of NMES on dysarthria and dysphonia. Randomized controlled trials, observational studies, case series, and case reports were included in the search strategy. The risk of bias in each study was assessed using the ROBINS-I tool. Results: This review included four studies designed as case studies or non-randomized trials with a low risk of bias. NMES showed a positive effect on voice quality and phonation in patients with dysarthria and/or dysphonia. Reported improvements included restored function of the muscles responsible for laryngeal elevation, a reduction in voice breathiness and strain, and enhanced articulation. Discussion: NMES seems to be a promising tool for the rehabilitation of patients with speech disorders. Randomized clinical trials should be conducted to confirm these benefits.