Comparison of NMES, tDCS, and TMS Treatments in Post-Stroke Dysphagia

Comparative Effects of NMES, tDCS, and TMS Added to Conventional Dysphagia Therapy in Acute Post-Stroke Dysphagia: A Randomized Controlled Trial

This randomized, single-blind, controlled clinical trial aims to compare the effectiveness of neuromuscular electrical stimulation (NMES) administered alone or in combination with transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS) in adults with post-stroke dysphagia.

A total of 40 participants will be randomly assigned to four parallel groups, with 10 participants in each group: NMES combined with sham tDCS, NMES combined with sham TMS, active tDCS combined with NMES, and active TMS combined with NMES. Each participant will receive 10 treatment sessions.

Swallowing function will be assessed before and after treatment using clinical swallowing assessments and videofluoroscopic swallowing examinations. Treatment effectiveness will be evaluated using the Toronto Bedside Swallowing Screening Test, Functional Oral Intake Scale, Penetration-Aspiration Scale, Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) and Bolus Residue Scale. The study seeks to determine whether combining central stimulation methods with NMES provides greater improvements in swallowing safety, dysphagia severity, pharyngeal residue, and oral intake than NMES-based control interventions.

Inclusion Criteria:

• Aged 18 years or older
• Diagnosis of ischemic or hemorrhagic stroke
• Diagnosis of hemispheric stroke
• Presence of swallowing difficulty or symptoms of dysphagia
• Ability to cooperate and follow instructions
• Absence of skin problems or abnormal tissue growth that would interfere with electrode placement

Exclusion Criteria:

• Presence of typical neurological findings suggestive of brainstem stroke
• Inadequate sitting balance or inability to maintain the head in an upright position, with or without support
• Presence of a neoplastic disease in the head and neck region or a history of radiotherapy to this region
• Presence of an additional musculoskeletal disorder that may cause swallowing impairment
• Presence of a neurological disorder other than stroke that may cause swallowing impairment, including traumatic brain injury, Parkinson's disease, dementia, amyotrophic lateral sclerosis, or multiple sclerosis
• Presence of a cardiac pacemaker, deep brain stimulator, or ear tube
• History of epileptic seizures
• Presence of a metallic implant in the body or skull