Electrode Placement

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The Submental Region

The submental region is the anatomical location for the suprahyoid muscles. It is the suprahyoid muscles that are responsible for hyolaryngeal excursion. Placement of two electrodes in this area results in a visible and palpable movement of the hyolaryngeal complex in a normally functioning system. There is no other biologically plausible site to place electrodes. Placement on the infrahyoids results in laryngeal depression.  Simultaneous stimulation of infrahyoids and suprahyoids "locks" the larynx and inhibits any movement. 

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Rationale

True use of NMES dictates that the excitation of the nerves must result in an action potential i.e. muscle contraction. The contraction or movement pattern that is elicited by the electrical peripheral stimulus must also represent a movement pattern that is analogous with the movement pattern that is executed in normally functioning system.  

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Biological Response

The external peripheral electrical stimulation of the suprahyoid muscles evoke a movement pattern that is the exact replication of the movement pattern that occurs when we swallow; the upward and forward motion of the hyolaryngeal complex. This repetitive movement combined with task specific swallowing results in cortical reorganization and neuromuscular re-education. 

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