None listed
Conditions
Brief summary
Swallowing disorders can occur due to neurologic or anatomic injury, such as stroke or head and neck cancer. It can lead to severe health problems, including chest infections, caused by misdirected food entering the lungs, malnutrition and dehydration. Therefore, effective treatment protocols are required to reduce the burden of swallowing disorders. In physical rehabilitation, the use of non-invasive brain stimulation has been shown to offer promising results in enhancing motor function and motor learning. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation. This technique uses a low electrical current to induce changes in brain excitability. Wet sponge electrodes are placed on participants’ heads overlying the targeted brain region. Applying tDCS over the cerebellum has been shown to enhance motor skill-learning in limb rehabilitation. The cerebellum is responsible for the coordination and precision of movement. However, it is not known whether similar beneficial effects are evident for more reflexive behaviours, such as swallowing. The proposed research will investigate the effects of excitatory tDCS over the cerebellum on motor learning in patients with swallowing disorders. Comparison between swallowing training with and without tDCS will provide information about potential benefits of tDCS on motor learning over traditional swallowing therapy. These findings will be used to determine optimal stimulation parameters, by investigating dose, the duration of skill retention, and electrode placement. This information will guide the development of novel and innovative rehabilitation protocols for swallowing disorders.
Interventions
The study is an interventional case series investigation that will evaluate the influence of cerebellar tDCS on motor skill acquisition as a component of rehabilitation in patients with swallowing disorders (dysphagia).
Two previously published skill training treatment procedures will be used to restore swallowing function: Biofeedback in Strength and Skill Training (BiSSkiT) (Athukorala et al., 2014) or mis-sequencing therapy using manometry (Huckabee et al., 2014).
The BiSSkiT protocol invol
The study is an interventional case series investigation that will evaluate the influence of cerebellar tDCS on motor skill acquisition as a component of rehabilitation in patients with swallowing disorders (dysphagia). Two previously published skill training treatment procedures will be used to restore swallowing function: Biofeedback in Strength and Skill Training (BiSSkiT) (Athukorala et al., 2014) or mis-sequencing therapy using manometry (Huckabee et al., 2014). The BiSSkiT protocol involves one treatment session daily for up to an hour maximum. The patient will be verbally guided to control temporal and amplitude characteristics of the floor-of-mouth muscles such that the observed sEMG waveform gets as close to a target on the screen during swallowing as possible. The manometry treatment will be twice daily for up to an hour maximum for each session. It involves measurement of pharyngeal pressure using low-resolution manometry. The skill based rehabilitation approach will be assigned based on their evaluation of swallowing function. The treatment will be administered by a qualified and trained Speech-language therapist. Cerebellar tDCS will be applied during these usual treatment procedures at the EATS (Evaluation and Treatment of Swallowing) Clinic, situated at the University of Canterbury Rose Centre for Stroke Recovery and Research. Cerebellar tDCS will be applied for 20 min during the skill training protocol in daily, or twice daily, treatment sessions for two weeks (weekdays only). Stimulation will be applied at 2 mA, delivered via three rectangular saline-soaked sponge electrodes (5×5 cm, surface area 25 cm^2). Stimulation via these parameters induces a current at a density of 0.08 mA/cm^2, which is considered to be safe for human participants (Iyer et al., 2005).
Sponsors
The University of Canterbury Rose Centre for Stroke Recovery and Research
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
This study will include patients with oropharyngeal dysphagia, aged 18 years or older, who have not resumed functional oral intake following previous swallowing treatment.
Exclusion criteria
Patients that have undergone recent brain surgery (within the last 6 month), metallic implants in the skull, and a history of drug use will be excluded. Further exclusion criteria for participation include difficulties following instructions because of cognitive impairment, or limitations in visual function (acuity in both eyes < 6/12).
Outcome results
None listed