Combined Thermal and Neuromuscular Stimulations for Stroke- Related Dysphagia: A Pilot Randomized Clinical Trial

The incidence of stroke escalates with age in both genders, with nearly 50% and 30% of cases reported in individuals over the ages of 75 and 85 years, respectively. This pilot randomized clinical trial was designed to explore the effects of combined thermal and neuromuscular stimulations on dysphagia improvement. It also aimed to identify the most efficient dysphagia management plan for acute stroke patients.
In this pilot randomized clinical trial study, twelve acute stroke patients were randomly and concurrently allocated into two groups. The control group received routine medical treatment without speech therapy counseling, while the intervention group underwent superficial and deep thermal neuromuscular stimulations. In the intervention group, one patient received treatment for two weeks, three patients for three weeks, and two patients for five weeks (five times a week). Patients in the intervention group were re-evaluated each week after five days of therapy using the Motility Function (MF) and Mann’s Assessment of Swallowing Ability (MASA) tests to monitor consistent improvement. Based on the cutoff point of the MASA test, treatment was either continued or terminated. Accordingly, different follow-up periods were considered for the patients: one received treatment for two weeks, three for three weeks, and two for five weeks.
The results indicated a significant difference between the two groups regarding the mean MASA score after a 21-day intervention. The intervention group scored 166.5±3.53, while the control group scored 163±10.02 after 35 days (P=0.03). Furthermore, the intervention group reached the cutoff MASA score in the sixth MASA assessment after a 35-day intervention.
According to the protocol proposed by speech-language pathologists, it is recommended to perform stimulations for approximately 21-35 days. Given the significant results obtained from this preliminary study, it is suggested that this protocol be implemented in a larger sample size.