During the last year we have completed the intake of 8 patients and 12 month follow-up for the initial feasibility study aimed at comparing the effects of neuromuscular stimulation to augment airway protection during swallowing compared to sensory (vibratory) stimulation alone during swallowing retraining in chronic severe dysphagia. The purpose of this study was to determine the degree to which motor augmentation with sensory stimulation due to muscle contraction can enhance swallowing retraining over sensory stimulation alone during retraining. All patients had been PEG tube dependent for at least 6 months and for many years in most cases, had failed traditional therapy and in some cases surface electrical stimulation for dysphagia and were unable to take nourishment by mouth. These patients could not control their own secretions and all had developed severe dysphagia as the result of a neurological disorder. Patients were randomized to the two groups;one group received an implanted device which stimulated 8 hyo-laryngeal muscles simultaneously aimed at increasing hyo-laryngeal elevation during swallowing to improve airway protection. The other group received a non-invasive device which was a vibrator placed over the thyroid cartilage. All participants received training on using their device to self-train daily for at least 60 swallows and wore the device while awake with stimulation at regular intervals (every 3 to 5 minutes) to attempt to control their saliva. Three outcome measures were employed, the Functional Oral Intake Scale (FOIS), The SWAL-QUAL, a quality of life scale pertaining to swallowing and eating intake and the Swallowing Safety Scale a multidimensional rating scale of swallowing physiology including penetration, aspiration, residual and esophageal entry during swallowingall ratings were performed with both subject identity and treatment type masked. The groups were equivalent on intake with both groups having mean FOIS scores of 1.2 while post 12 months of treatment both groups had a mean score of 3.7 on the FOIS. Compliance with following the daily training regimen varied in both groups with one patient in each not conducting their training;neither non-compliant patient showed improvement. On the other hand, one patient in each group was able to have their PEG tube removed and resume an oral diet. Others improved their oral intake to varying degrees in each group. Similarly no marked differences occurred in change in quality of life between the two groups (both improved) by 9 months. Data analyses on changes in swallowing physiology based on the Swallowing Safety Scale are ongoing. In conclusion, in chronic severe dysphagia secondary to brain injury, devices that allow for long term intensive daily self swallowing retraining by patients can improve oral intake and saliva control in patients with longstanding chronic dysphagia. We are now exploring the degree to which sensory stimulation plays a role in these long term training benefits or whether it is simply the daily training regimen that was responsible for improvement of patients in both groups. During this last year the Section closed with the departure of Dr. Ludlow to James Madison University in late July. Each of the postdoctoral fellows relocated to establish new laboratories of their own at various universities including Michigan State University, Wake Forest University and Mount Sinai Medical School.
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