الفهرس 
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Abstract
Post-stroke pharyngeal dysphagia is one of the most considerable health concerns and a leading cause of morbidity and mortality as it carries the risk of dehydration, malnutrition, and the very serious outcome of aspiration pneumonia. Moreover, it leads to social withdrawal, and it negatively affects the quality of life.
The field of dysphagia therapy has long been an interest to clinicians and researchers. Therapy modalities includes mainly behavioural therapy that involves bolus modification, swallowing manoeuvres, swallowing exercises and postural adjustments. Other therapy modalities are used as biofeedback, pharmacological therapy, and surgical treatment.
Nowadays new rehabilitation modalities have obtained the attention of clinicians because of their supposed potential to boost dysphagia recovery. One of these methods is transcutaneous Neuromuscular Electrical Stimulation of swallowing musculature.
This method had been first introduced by Freed et al. in 2001. They used NMES to deliver electric current to the swallowing muscles using neck electrodes. The current intensity was adjusted at the motor level aiming at stimulation of the muscle contraction to strengthen the swallowing muscles preventing disuse atrophy and enhancing muscle re-education. Many studies and meta- analyses followed to verify the efficacy and safety of this method, but the results remained controversial. And the recommendations were directed towards conducting more research in this field with controlled trials.
The aim of this work was to study the efficacy of transcutaneous Neuromuscular Electrical Stimulation (NMES) as a single therapy or as an adjuvant to traditional dysphagia therapy in rehabilitation of patients with chronic post stroke pharyngeal dysphagia.
This study was a single centre with balanced randomization [1:1:1] double blind, placebo controlled, carried out on forty eight chronic (> one month) post-stroke dysphagic adult patients attending the unit of Phoniatrics, Alexandria Main University Hospitals.
The patients were assessed using patient interview, clinical and neurological examination, screening using the three-ounce water swallow test. The outcome measures were Penetration Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS) depending on the findings of FEES and /or VFSS and Arabic dysphagia handicap index (A-DHI), all done pre-therapy and post therapy. Patients were randomized to three groups: group (I) received conventional dysphagia therapy in the form of bolus modification, swallowing exercises, swallowing manoeuvres and postural adjustments. group (II) received combined therapy of tNMES and conventional therapy as described for group (I). group (III) received NMES therapy alone.