Neuromuscular Electrical Stimulation as a Novel Treatment of Dysphagia: A Meta-Analysis of Efficacy and Safety

Main Article Content

Arnold Keane
Derren David Christian Homenta Rampengan
Josh Nathaniel Jowono
Jessie Laurencia Afaratu


Introduction: Dysphagia is a common and debilitating condition that impairs normal swallowing function. Research indicates that 15-22% of adults over 50 experience it, with hospital and long-term care facilities showing an increased rate of 40-60%. Dysphagia can cause malnutrition, dehydration, aspiration pneumonia, and social isolation, significantly reducing the patient's quality of life. However, current treatment approaches, including compensatory strategies, postural adjustments, and exercises, have limited efficacy. As a result, alternative therapies are being explored, yet no systematic review or meta-analysis evaluating neuromuscular electrical stimulation as a treatment for dysphagia.

Objectives: To determine the effectivity of neuromuscular electrical stimulation for improving swallowing function in dysphagia patient.

Method: This study was conducted using the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA). We systematically searched PubMed, Cochrane, Embase, and ScienceDirect for literature up to 4 April 2023. The included documents were screened and assessed for risk of bias using the Cochrane Risk of Bias 2.0. Effect estimates were pooled using random-effects meta-analysis using Review Manager 5.4.

Results: Fourteen studies culminating a total of 743 participants were included with low risk of bias. Neuromuscular electrical stimulation (NMES) depicts a significant swallowing function recorded by Penetration-Aspiration Scale (PAS) (HR = 1.97; Z = 4.21; p=0.002; 95% CI: 0.39-9.86) and Functional Oral Intake Scale (FOIS) (HR = 2.79; Z = 4.1; p = 0.0002; 95% CI: 1.29-6.03). Moreover, NMES also improved patient life in general by lowering the pain score and increasing the quality of life.

Conclusion: NMES therapy shows a more significant improvement in oral function on dysphagia patients compared to traditional therapy. Therefore, NMES are proven efficacious for dysphagia therapy and recommended to be used in guidelines as supportive non-pharmacological therapy.

Article Details

How to Cite
Keane, A., David Christian Homenta Rampengan, D., Nathaniel Jowono, J. and Afaratu, J. L. (2023) “Neuromuscular Electrical Stimulation as a Novel Treatment of Dysphagia: A Meta-Analysis of Efficacy and Safety”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia. Available at: (Accessed: 21May2024).
Scientific Posters (AMSC 2023 Taiwan)


Aslam M, Vaezi MF. Dysphagia in the elderly. Gastroenterol Hepatol [Internet]. 2013 Dec 1 [cited 2023 Apr 12];9(12):784–95. Available from:

Suiter DM, Gosa MM. ssessing and treating dysphagia: a lifespan perspective. [Internet]. Thieme. 2019 [cited 2023 Apr 12]. Available from:

Bahat G, Yilmaz O, Durmazoglu S, Kilic C, Tascioglu C, Karan MA. Association between dysphagia and frailty in community dwelling older adults. J Nutr Health Aging [Internet]. 2019 Apr 22 [cited 2021 Apr 11];23(6):571–7. Available from:

Alagiakrishnan K, Bhanji RA, Kurian M. Evaluation and management of oropharyngeal dysphagia in different types of dementia: A systematic review. Arch Gerontol Geriatr [Internet]. 2013 Jan [cited 2023 Apr 12];56(1):1–9. Available from:

Cheng I, Sasegbon A, Hamdy S. Dysphagia treatments in parkinson’s disease: a systematic review and meta‐analysis. Neurogastroenterol Motil [Internet]. 2022 Dec 22 [cited 2023 Apr 12];00:e14517. Available from:

Carnaby GD, LaGorio L, Silliman S, Michael C. Exercise‐based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post stroke: A double blind placebo‐controlled trial. J Oral Rehabil. 2019;46(10):972-980. doi: 10.1111/joor.12928.

Sproson L, Pownall S, Enderby P, Freeman J. Combined electrical stimulation and exercise for swallow rehabilitation post-stroke: a pilot randomized control trial. Int J Lang Commun Disord. 2018;53(2):405-417. doi: 10.1111/1460-6984.12359.

Arreola V, Ortega O, Álvarez-Berdugo D, Rofes L, Tomsen N, Cabib C, Clavé P. Effect of Transcutaneous Electrical Stimulation in Chronic Poststroke Patients with Oropharyngeal Dysphagia: 1-Year Results of a Randomized Controlled Trial. Neurorehabil Neural Repair. 2021;35(9):778-789. doi: 10.1177/15459683211023187.

Simonelli M, Ruoppolo I G, Iosa M, Morone G, Fusco A, Grasso MG, Paolucci S. A stimulus for eating. The use of neuromuscular transcutaneous electrical stimulation in patients affected by severe dysphagia after subacute stroke: A pilot randomized controlled trial. NeuroRehabilitation. 2019;44(3):377-384. doi: 10.3233/NRE-182526.

Cola PC, Onofri SMM, Rubira CJ, Pedroni CR, Clavé P, da Silva RG. Electrical, taste, and temperature stimulation in patients with chronic dysphagia after stroke: a randomized controlled pilot trial. Acta Neurol Belg. 2021;121(5):1331-1341. doi: 10.1007/s13760-021-01624-2.

Zhang YW, Dou ZL, Zhao F, Xie CQ, Shi J, Yang C, Wan GF, Wen HM, Chen PR, Tang ZM. Neuromuscular electrical stimulation improves swallowing initiation in patients with post-stroke dysphagia. Front Neurosci. 2022 Nov 14;16:1011824. doi: 10.3389/fnins.2022.1011824.

Oh DH, Park JS, Kim HJ, Chang MY, Hwang NK. The effect of neuromuscular electrical stimulation with different electrode positions on swallowing in stroke patients with oropharyngeal dysphagia: A randomized trial. J Back Musculoskelet Rehabil. 2019;32(1):65-72. doi: 10.3233/BMR-181133.

Park JS, Oh DH, Hwang NK, Lee JH. Effects of neuromuscular electrical stimulation in patients with Parkinson's disease and dysphagia: A randomized, single-blind, placebo-controlled trial. NeuroRehabilitation. 2018;42(4):457-463. doi: 10.3233/NRE-172306.

Huh JW, Park E, Min YS, Kim AR, Yang WJ, Oh HM, Nam TW, Jung TD. Optimal placement of electrodes for treatment of post-stroke dysphagia by neuromuscular electrical stimulation combined with effortful swallowing. Singapore Med J. 2020;61(9):487-491 doi: 10.11622/smedj.2019135.

Dziewas R, Stellato R, van der Tweel I, Walther E, Werner CJ, Braun T, et al. Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol. 2018;17(10):849-859. doi: 10.1016/S1474-4422(18)30255-2.

Umay E, Gurcay E, Ozturk EA, Unlu Akyuz E. Is sensory-level electrical stimulation effective in cerebral palsy children with dysphagia? A randomized controlled clinical trial. Acta Neurol Belg. 2019;119(1):25-31. doi: 10.1007/s13760-018-01071-6.

Cabib C, Nascimento W, Rofes L, Arreola V, Tomsen N, Mundet L, Ortega O. Short-term neurophysiological effects of sensory pathway neurorehabilitation strategies on chronic poststroke oropharyngeal dysphagia. Neurogastroenterol Motil. 2020;32(9):e13900. doi: 10.1111/nmo.13887.

Zhang C, Zheng X, Lu R, Yun W, Yun H, Zhou X. Repetitive transcranial magnetic stimulation in combination with neuromuscular electrical stimulation for treatment of post-stroke dysphagia. J Int Med Res. 2019;47(2):634-641. doi: 10.1177/0300060518807340.

Speyer R, Sutt AL, Bergström L, Hamdy S, Heijnen BJ, Remijn L, et al. Neurostimulation in people with oropharyngeal dysphagia: a systematic review and meta-analyses of randomized controlled trials-Part I: Pharyngeal and Neuromuscular Electrical Stimulation. J Clin Med. 2022;11(3):776. doi: 10.3390/jcm11030776.

Bath PM, Lee HS, Everton LF. Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database Syst Rev. 2018;10(10):CD000323. doi: 10.1002/14651858.CD000323.pub3.