Rapid Swallow Improvement Following Pharyngeal Electrical Stimulation In a COVID-19 Patient With Long-Term Severe Neurogenic Dysphagia: A Case Report
Rapid Swallow Improvement Following Pharyngeal Electrical Stimulation In a COVID-19 Patient With Long-Term Severe Neurogenic Dysphagia: A Case Report
Catherine Blakemore, BSc, Julia Hunter, BSc and Bhaskar Basu, MBBS, Dip. Ortho. MRCS, FRCP
From the Intermediate Neurological Rehabilitation Unit, Trafford General Hospital, Moorside Road, Manchester, UK
Abstract
Objective:
Neurogenic dysphagia and other neurological manifestations are increasingly described in patients with SARS-CoV-2 (COVID-19). We report here a case of successful treatment of SARS-CoV-2-induced severe neurogenic dysphagia, using pharyngeal electrical stimulation (PES) in addition to speech and language therapy.
Methods:
A 62-year-old male patient with COVID-19 pneumonitis, prolonged intubation- and stroke-related severe neurogenic dysphagia, confirmed by instrumental assessment and traditional swallowing therapies, was given novel PES treatment for 5 days.
Results:
Within 8 days of completing PES, a clear improvement in dysphagia dysfunction scores (increased Dysphagia Outcome and Severity Scale (DOSS), reduced Penetration-Aspiration Scale (PAS), increased Functional Independent and Assessment Measure (FIM+FAM), and increased Functional Oral Intake Scale (FOIS)) was evident, and further significant improvement occurred in the following 2 weeks. Forty-three days post-stimulation, the patient’s diet had recovered to normal fluids and solids. Using self-administered Swallowing Quality of Life (SWAL-QoL) questionnaires, the patient reported a highly noticeable reduction in dysphagia-associated burden, a greatly decreased risk of choking when eating or drinking, developing pneumonia, and a large increase in self-confidence (total score: 11 pre-PES to 55 directly post-PES).
Conclusion:
In a patient with COVID-19 presenting with stroke and intubation-related severe dysphagia, PES was safe and appeared to facilitate faster recovery.
Keywords: dysphagia; PES; COVID-19; stroke