Eletroestimulação neuromuscular na reabilitação da disfagia orofaringea na doença de Parkinson

Abstract

During the aging process, subtle reductions in sensory acuity, such as, visual, auditory, gustatory and/or olfactory can be observed. Therefore, physiological changes can occur during the process of deglutition of the elderlyies, in consequence the occurrence of dysphagia process. Parkinson's disease is commonly associated with dysphagia due to the degeneration of dopaminergic neurons responsible for the regulation of muscular movements. Objective: To describe the results of a previous study on the efficacy of Neuromuscular Electro-Stimulation in oropharyngeal dysphagia in patients with Parkinson's disease. Casuistics and Method: The eligible individuals of this study were previously evaluated and submitted to the experiment, after completing the inclusion and exclusion criteria. Subjects who met the criteria of the third, fourth, and fifth stages of the Hoehn and Yahr Disability Stages Scale, and those who fulfilled the criteria of the Unified Scale for the Assessment of Parkinson's Disease participated in the study. A randomized clinical trial comprising two experimental groups: control group and study group was performed. Individuals underwent pre-therapy evaluation in which functional assessment protocols, EAT 10, and an objective evaluation of deglutition, deglutogram, pre and post therapeutic intervention were applied. Non-parametric Mann-Whitney and and Wilcoxon tests were used for comparison of paired samples. Results: The control group comprised four participants, of whom three were male and one were female. The group was aged between 59 and 80 years, a mean age of 71 years (standard deviation of 10.7 years). The study group comprised of 11 participants, of whom seven males and four were females. According this group, the ages ranged from 51 to 82 years, a mean of 69 years. Regarding the self-evaluation of food, it was verified that the total score for the 10 items that make up the EAT-10 instrument reveal similar characteristics between the groups, reinforcing the randomization used in the groups composition. The responses obtained before and after the Oral Functional Ingestion Scale (OFIS), as well as, the Dysphagia Outcome and Severity Scale (DOSS) were compared. The nonparametric Wilcoxon test was used for paired samples, the results of which has provided an indicative of a significant difference between the pre-assessment radiological evaluation of swallowing when compared to the post-test only in the study group. For the control group, the results remained practically unchanged. In the case of OFIS, there was in most cases an increase of one point on the rating scale. In the case of DOSS, the opposite occurred; there was a reduction of one point in the scale. Conclusion: We can infer that both conventional speech therapy and associated with the use of the Neuromuscular Electrostimulation method in the submental region have shown effectiveness in the treatment of oropharyngeal dysphagia in individuals with Parkinson's disease.