Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C


OBJECTIVE: The objective of this selective EBM review is to determine whether or not electrical muscle stimulation is effective in the progression of oral feeding, for patients with dysphagia, caused by a stroke.

STUDY DESIGN: Review of 3 randomized controlled trials, published between 2008-2009.

DATA SOURCES: All 3 randomized controlled trials were found using the Cochrane database.

OUTCOMES MEASURED: All 3 studies measured subjective swallowing function pre- and post-treatment, however, each trial differed in the way they measured this. Permsirivanich et al used a functional oral intake scale (FOIS), or a 7-point scale reflecting the patient’s report of foods safely ingested by mouth, on a consistent basis. Bulow et al determined swallowing function using an alternate 7-point scale, called the actual nutrition scale (ANS). Lim et al measured
swallowing function using a third, unnamed, 7-point scale. The percentage of patients progressing from tube feeding to oral feeding was also measured in Lim et al.

RESULTS: Bulow et al concluded that no statistically significant difference was found in the therapy effects between neuromuscular electrical stimulation (NMES) and traditional therapy (TT) groups, however, when looking at both groups as a whole, there were significant improvements noted. In Permsirivanich et al, both rehabilitation swallowing therapy (RST) and NMES therapy (combined with diet modification and oral motor exercises) showed positive effects in the treatment of persistent dysphagia in stroke patients, but NMES therapy was significantly superior. Finally, in Lim et al, NMES combined with thermal tactile stimulation (TTS) had a significantly higher score change in swallowing measures (indicating a progression of oral feeding) than those receiving TTS alone.

CONCLUSION: As indicated by the 3 studies, NMES therapy, as an adjunct treatment to standard dysphagia treatment, is an effective intervention in the progression of oral feeding, in patients with dysphagia, caused by a stroke. Further studies should be performed to determine if NMES is a valuable therapy alone, or only advantageous when paired with a traditional therapy.