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No evidence was identified relating to any form of restorative exercises in dysphagic patients post-TBI other
than two studies concerning neuromuscular electrical stimulation (NMES) (a technique involving electrical
stimulation of relevant peripheral nerves with the aim of improving swallowing function). One very small
non-comparative study including only one participant with TBI concludes that NMES can be an effective
treatment for chronic pharyngeal dysphagia. 142 One systematic review concludes that some aspects of NMES
might be beneficial for dysphagia treatment, but further research is required. 143 Only one study included
in the review included patients with TBI, and the authors noted that the studies reviewed were generally
poor quality with a high risk of bias. Neuromuscular electrical stimulation is used widely in the US but is a
little-used technique in the Uk and the Royal College of Speech and Language Therapists does not endorse
its use.
There is insufficient evidence to support a recommendation on restorative exercises to improve outcome
in dysphagia post TBI.
7.3 oRAl HyGIENE
7 • Communication and swallowing
Rigorous oral hygiene forms part of the routine care of patients with dysphagia, although physical deficits
and problems with patient compliance can make it difficult to carry out satisfactorily. No evidence was
identified that oral hygiene programmes reduce the incidence and severity of aspiration-associated chest
infection and pneumonia in patients with TBI. One methodologically poor RCT considered oral hygiene post
TBI but not in relation to dysphagia and aspiration pneumonia. 144
It is not possible to make a recommendation on the basis of the evidence. However, common sense dictates
that thorough oral hygiene in TBI patients would be beneficial for oral comfort and dental health.
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