title: Is non-invasive neuromuscular electrical stimulation effective in severe chronic neurogenic dysphagia? Reporton a post-traumatic brain injury patient.
abstract: BACKGROUND
  Neurogenic dysphagia is a difficulty in swallowing induced by nervous system disease. It often causes serious complications, which are preventable if dysphagia is properly managed. There is growing debate concerning the usefulness of non-invasive neuromuscular electrical stimulation (NMES) in treating swallowing dysfunction.
  
  
  OBJECTIVE
  Aim of this study was to assess the effectiveness of Vitalstim© device, and to investigate the neurophysiological mechanisms underlying functional recovery.
  
  
  METHODS
  A 34-year-old man, affected by severe chronic dysphagia following traumatic brain injury, underwent two different intensive rehabilitation trainings, including either conventional rehabilitation alone or coupled to Vitalstim training. We evaluated patient swallowing function in two separate sessions (i.e. before and after the two trainings) by means of ad hoc swallowing function scales and electrophysiological parameters (rapid paired associative stimulation). The overall Vitalstim program was articulated in 6 weekly sessions for 6 weeks.
  
  
  RESULTS
  The patient did not report any side-effect either during or following both the intensive rehabilitation trainings. We observed an important improvement in swallowing function only after Vitalstim training. In fact, the patient was eventually able to safely eat even solid food.
  
  
  CONCLUSIONS
  This is the first report objectively suggesting (by means of rPAS) a correlation between the brain neuroplastic changes induced by Vitalstim and the swallowing function improvement. It is hypothesizable that Vitalstim may have targeted cortical (and maybe subcortical) brain areas that are recruited during the highly coordinated function of swallowing, and it may have thus potentiated the well-known neuroplastic changes induced by repetitive and intensive swallowing exercises, probably thanks to metaplasticity phenomena.
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Messina, Italy.
authors.forename: Rocco Salvatore
authors.initials: RS
authors.lastname: Calabrò
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Messina, Italy.
authors.forename: Valeria Conti
authors.initials: VC
authors.lastname: Nibali
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Naro
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Messina, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Floridia
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Messina, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Pizzimenti
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Messina, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Salmeri
authors.affiliation: Department of Otorinolaringoiatry, University of Messina, Messina, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salviera
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Messina, Italy.
authors.forename: Placido
authors.initials: P
authors.lastname: Bramanti
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D002908:Chronic Disease; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Metaplasticity; NMES; PAS; neurogenic dysphagia; vitalstim