Evidence Matters: NMES for dysphagia


Clearing the Confusion

This is a fact; There is more than enough evidence to support the use of electrical stimulation for dysphagia. 


There were 134 peer reviewed journal articles on electrical stimulation and dysphagia just between the years 2000-2017

65 articles that met the criteria for analysis of outcomes were reviewed


Breakdown of the 65 Studies

1 Survey

5 Case Studies

4 Retrospective Studies

42 Prospective Studies

13 Meta-Analysis or Literature Reviews

Evidence Matters



45/65 69% demonstrated a positive effect 

14/65 22% demonstrated a mixed effect

6/65 9% demonstrated no effect

In summary nearly 70% of the studies using electrical stimulation to treat dysphagia reported it worked significantly well.

22% reported it worked somewhat 

Less than 10% reported it didn't work


Why do some people still insist it doesn't work?

1.  They rely on what they hear or believe what certain people say without actually checking the facts.  

2. They have their own agenda.

3. They are not interested in the truth.

4. They fail to understand the complexities of the modality and the associated stimulation parameters. 


What do the real experts say?


An article published in 2014, Miller and colleagues identified 180 studies for effects of NMES on facial and laryngeal paresis, dysphonia and dysphagia and stated “Evidence collected to date is encouraging; particularly for the treatment of certain forms of dysphagia and laryngeal paresis”  

Tim Watson author of Electrotherapy: Evidence Based Practice states:

"Dose and treatment parameters must be taken into consideration. Many research publications that have identified a lack of effect of intervention X, yet other researchers have shown it to work at a different dose"


Evidence Matters


More from the electrotherapy experts

The Yale Journal of Biology and Medicine reported:

 "The delivery of electrical stimulation can be customized to reduce fatigue and optimize force output by adjusting the associated stimulation parameters. A full understanding of the settings is vital for the safety of the patient and the success of the intervention. Consideration should be given to the frequency, pulse width/duration, duty cycle, intensity/amplitude, ramp time, pulse pattern, program duration, program frequency, and muscle group activated."  (Doucet, Lam and Griffin, 2012) 

A clinician must understand the fundamental principles of the various parameters of NMES and know how, when and why to change them to customize the protocol for the desired outcome. That is what The Biber Protocol® has alway taught. 


The Politics of Science

New York Times Science writer George Johnson writes:

"Viewed from afar, the world seems almost on the brink of conceding that there are no truths, only competing ideologies - narratives fighting narratives. In this epistemological warfare, those with the most power are accused of imposing their versions of reality - the "dominant paradigm" - on the rest, leaving the weaker to fight back with formulations of their own. Everything becomes a version"  

When one group in power tries to unduly influence the conversation with "evidence" that is contrary to hundreds of other studies, textbooks and experts, it is not only arrogant but also intentionally misleading and highly suspicious for ulterior motives. 


Just the Facts

The first recorded paper on electrical stimulation and swallowing was in 1893 by Fredrick Rethi a scientist from Germany.

The first peer reviewed journal article on surface electrical stimulation for the treatment of dysphagia in humans was published in 1973 by George Larsen.  

The use of neuromuscular electrical stimulation for the treatment of dysphagia has been investigated more than any other intervention and meets the legal criteria of preponderance of evidence. To suggest anything otherwise is simply denial of the truth. 

The standards for delivery of electrical stimulation have long been established and can be externally validated by multiple sources. Not all electrical stimulation protocols are the same and therefore must be evaluated for adherence to the established standards in the industry. 

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