Catherine Blakemore, Julia Hunter, Bhaskar Basu
Neuro Rehabilitation, Salford Royal Foundation Trust, Salford, United Kingdom.
DOI: 10.2340/20030711-1000073

Objective: Neurogenic dysphagia and other neurological manifestations are increasingly described in patients with SARS-CoV-2 (COVID-19). We report here a case of successful treatment of SARS-CoV-2-induced severe neurogenic dysphagia, using pharyngeal electrical stimulation (PES) in addition to speech and language therapy.
Methods: A 62-year-old male patient with COVID-19 pneumonitis, prolonged intubation- and stroke-related severe neurogenic dysphagia, confirmed by instrumental assessment and traditional swallowing therapies, was given novel PES treatment for 5 days.
Results: Within 8 days of completing PES, a clear improvement in dysphagia dysfunction scores (increased Dysphagia Outcome and Severity Scale (DOSS), reduced Penetration-Aspiration Scale (PAS), increased Functional Independent and Assessment Measure (FIM+FAM), and increased Functional Oral Intake Scale (FOIS)) was evident, and further significant improvement occurred in the following 2 weeks. Forty-three days post-stimulation, the patient’s diet had recovered to normal fluids and solids. Using self-administered Swallowing Quality of Life (SWAL-QoL) questionnaires, the patient reported a highly noticeable reduction in dysphagia-associated burden, a greatly decreased risk of choking when eating or drinking, developing pneumonia, and a large increase in self-confidence (total score: 11 pre-PES to 55 directly post-PES).
Conclusion: In a patient with COVID-19 presenting with stroke and intubation-related severe dysphagia, PES was safe and appeared to facilitate faster recovery.

This case report details the rehabilitation and outcome of a 62-year-old man with severe swallowing impairment, caused by COVID-19 pneumonitis, prolonged intubation, and a stroke. Traditional swallowing therapies in addition to a novel approach using pharyngeal electrical stimulation therapy (PES) over 5 days were the chosen treatment approach.
Recovery was monitored using objective instrumental assessments (i.e. fibreoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy) in addition to bedside swallowing assessments. At the start of the rehabilitation, swallowing impairment was severe, with the patient being dependent on tube feeding to meet nutrition, hydration, and medication needs. Within 43 days of commencing treatment the patient had returned to normal fluids and diet and no longer required support via a feeding tube or supplements to manage nutrition and hydration. Quality of life measures indicated significant improvement. PES treatment was safe and appeared to facilitate a faster recovery.

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