Application of 4-channel neuromuscular electrical stimulation in a chronic stroke patient with dysphagia: A case report

Rationale: Dysphagia is a frequent complication after stroke, often resulting in aspiration, malnutrition, and diminished quality of life. Conventional swallowing rehabilitation, including 2-channel neuromuscular electrical stimulation (NMES), may have limited benefits in chronic cases. A newly developed 4-channel NMES delivers sequential stimulation to mimic physiological swallowing. Patient concerns: A 63-year-old man experienced persistent dysphagia 25 months after a left hemispheric infarction. Despite prolonged conventional swallowing rehabilitation combined with 2-channel NMES, he remained restricted to pureed foods (International Dysphagia Diet Standardisation Initiative level 4), required frequent suctioning, and showed severe aspiration on videofluoroscopic swallowing study (penetration-aspiration scale score up to 8). Diagnoses: The patient was diagnosed with chronic poststroke dysphagia with severe aspiration confirmed by videofluoroscopic swallowing study. Interventions: The patient underwent an 8-week course of 4-channel NMES applied twice daily in combination with conventional swallowing rehabilitation. Outcomes: Following the intervention, the patient’s diet advanced to International Dysphagia Diet Standardisation Initiative level 6, penetration-aspiration scale scores improved to 1 to 3, suctioning was no longer required, and both the Eating Assessment Tool-10 and Swallowing Quality of Life Questionnaire scores markedly improved. Lessons: This case suggests that 4-channel NMES may be a promising treatment option for chronic poststroke dysphagia refractory to conventional swallowing rehabilitation and warrants further validation in larger studies.