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J Neurophysiol (August 17, 2005). doi:10.1152/jn.00025.2005
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00025.2005v1
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Submitted on January 10, 2005
Accepted on August 5, 2005

Self-triggered functional electrical stimulation during swallowing

Theresa A. Burnett1, Eric A. Mann1, Joseph B. Stoklosa1, and Christy L. Ludlow1*

1 Laryngeal and Speech Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA

* To whom correspondence should be addressed. E-mail: ludlowc{at}ninds.nih.gov.

Hyolaryngeal elevation is essential for airway protection during swallowing and is mainly a reflexive response to oropharyngeal sensory stimulation. Targeted intramuscular electrical stimulation can elevate the resting larynx (Burnett et al. 2003) and, if applied during swallowing, may improve airway protection in dysphagic patients with inadequate hyolaryngeal motion. To be beneficial, patients must synchronize functional electrical stimulation (FES) with their reflexive swallowing and not adapt to FES by reducing the amplitude or duration of their own muscle activity. We evaluated the ability of 9 healthy adults to manually synchronize FES with hyolaryngeal muscle activity during discrete swallows, and tested for motor adaptation. Hooked-wire electrodes were placed into the mylohyoid and thyrohyoid muscles to record EMG activity from one side of the neck and deliver monopolar FES for hyolaryngeal elevation to the other side. After performing baseline swallows, volunteers were instructed to trigger FES with a thumb switch in synchrony with their swallows for a series of trials. An experimenter surreptitiously disabled the thumb switch during the final attempt, creating a foil. From the outset, volunteers synchronized FES with the onset of swallow-related thyrohyoid activity (about 225 ms after mylohyoid activity onset), preserving the normal sequence of muscle activation. A comparison between average baseline and foil swallows failed to show significant adaptive changes in the amplitude, duration, or relative timing of activity for either muscle, indicating that the central pattern generator for hyolaryngeal elevation is immutable with short term stimulation that augments laryngeal elevation during the reflexive, pharyngeal phase of swallowing.




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