Effects of transcranial direct current stimulation (tDCS) on speech and quality of life of a total glossectomy patient: a case report
DOI:
https://doi.org/10.17267/2965-3738bis.2024.e5934Keywords:
Glossectomy , Speech, Transcranial Direct Current StimulationAbstract
INTRODUCTION: The tongue is essential for maintaining speech and swallowing, articulating vowels and consonants, and manipulating and ejecting the food bolus. Studies indicate that speech-language rehabilitation improves speech intelligibility by 18 to 42% in individuals who have undergone total glossectomy. Non-invasive brain stimulation techniques have been developed to promote neuroplasticity. Transcranial direct current stimulation (tDCS) applies low-intensity, safe, painless electrical stimulation, targeting neuronal excitability (anodal electrode) and hyperpolarization of the membrane potential (cathodal electrode). No study has addressed its effectiveness after treatment for head and neck cancer. OBJECTIVE: To evaluate the impact of tDCS associated with myofunctional exercises and articulatory compensation training on speech intelligibility and quality of life specifically regarding speech and swallowing in a total glossectomized subject previously submitted to speech-language therapy. METHODS: This exploratory, prospective, observational case report approached a total glossectomy participant previously submitted to traditional speech-language therapy for speech and swallowing rehabilitation. She underwent 14 sessions over 40 days, associating myofunctional exercises, articulatory training, and tDCS. The anodal electrode was positioned in the primary motor cortex (C3) and the cathodal electrode, in the right supraorbital region (Fp2), according to the International 10-20 System, providing 2 mA electrical stimuli for 20 minutes. The following instruments were applied on the 1st, 10th, and 14th days: Percentage of Consonants Correct (PCC), MD Anderson Dysphagia Questionnaire (MDADI), Speech Handicap Index (SHI), and auditory-perceptual evaluation based on automatisms, spontaneous speech, and naming through the phonological competence of the Child Language Test (ABFW). RESULTS: In the PCC naming domain, there was a 7% increase at the end of the intervention and an evolution from 96% to 99.2% in spontaneous speech. The participant acquired the precise production of unrounded vowels, consolidated the adequate compensation of the /k/, /z/, and /l/ phonemes, and reduced the omissions of the /r/ consonant group when produced in simple and complex onset. The SHI decreased from 37 points and self-assessed "average" speech before tDCS to 24 after 10 days of application and 31 at the end, with self-reported “good” speech quality on the 10th and 14th days of intervention. The MDADI score evolved from 48 points on day 1 to 63 points at the end of the study. CONCLUSION: The tDCS associated with myofunctional exercises and articulatory compensation training improved the speech-related quality of life, increased the PCC, and reduced the substitutions and omissions in speech. The improvements remained up to 30 days after the end of the intensive intervention. Moreover, the impact of dysphagia on the subject's quality of life decreased after the intervention.
References
(1) Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 218;68(6):394–424. https://doi.org/10.3322/caac.21492 DOI: https://doi.org/10.3322/caac.21492
(2) Instituto Nacional de Câncer (Brasil). Câncer da cavidade oral [Internet]. Rio de Janeiro: INCA, 2023. Available from: https://www.gov.br/inca/pt-br/assuntos/cancer/numeros/estimativa/sintese-de-resultados-e-comentarios.
(3) Tagliabue M, Belloni P, Berardinis R, Gandini S, Chu F, Zorzi S, et al. A systematic review and meta-analysis of the prognostic role of age in oral tongue cancer. Cancer Medicine. 2021;10(8):2566-2578. https://doi.org/10.1002/cam4.379 DOI: https://doi.org/10.1002/cam4.3795
(4) Almangush A, Heikkinen I, Mäkitie AA, Coletta RD, Läärä E, Leivo I, et al. Prognostic biomarkers for oral tongue squamous cell carcinoma: A systematic review and meta-analysis. Br J Cancer. 2017;117(6):856–66. https://doi.org/10.1038/bjc.2017.244 DOI: https://doi.org/10.1038/bjc.2017.244
(5) Wolff KD, Follmann M, Nast A. The Diagnosis and Treatment of Oral Cavity Cancer. Dtsch Arztebl Int. 2012;109(48):829-35. https://doi.org/10.3238/arztebl.2012.0829 DOI: https://doi.org/10.3238/arztebl.2012.0829
(6) Burnham AJ, Ottenstein L, Boyce BJ, Kaka AS, El-Deiry MW, Baddour HM, et al. Survival, functional, and quality of life outcomes between total glossectomy with and without total laryngectomy: A narrative review. American Journal of Otolaryngology. 2022;43(3). https://doi.org/10.1016/j.amjoto.2022.103440 DOI: https://doi.org/10.1016/j.amjoto.2022.103440
(7) Rihani J, Lee MR, Lee T, Ducic Y. Flap selection and functional outcomes in total glossectomy with laryngeal preservation. Otolaryngology - Head and Neck Surgery (United States). 2013;149(4):547–53. https://doi.org/10.1177/0194599813498063 DOI: https://doi.org/10.1177/0194599813498063
(8) Righini S, Festa BM, Bonanno MC, Colombo V, Luca N. Dynamic tongue reconstruction with innervated gracilis musculocutaneos flap after total glossectomy. Laryngoscope. 2019;129(1):76–81. https://doi.org/10.1002/lary.27176 DOI: https://doi.org/10.1002/lary.27176
(9) Blyth KM, McCabe P, Madill C, Ballard KJ. Speech and swallow rehabilitation following partial glossectomy: A systematic review. Int J Speech Lang Pathol. 2015;17(4):41–10. https://doi.org/10.3109/17549507.2014.979880 DOI: https://doi.org/10.3109/17549507.2014.979880
(10) Bryant M. Biofeedback in the treatment of a selected dysphagic patient. Dysphagia. 1991;6(3):140-4. https://doi.org/10.1007/bf02493516 DOI: https://doi.org/10.1007/BF02493516
(11) Denk DM, Swoboda H, Schima W, Eibenberger K. Prognostic factors for swallowing rehabilitation following head and neck cancer surgery. Acta Otolaryngol. 1997;117(5):769–74. https://doi.org/10.3109/00016489709113476 DOI: https://doi.org/10.3109/00016489709113476
(12) Zhen Y, Wang JG, Tao D, Wang HJ, Chen WL. Efficacy survey of swallowing function and quality of life in response to therapeutic intervention following rehabilitation treatment in dysphagic tongue cancer patients. European Journal of Oncology Nursing. 2012;16(1):54–8. https://doi.org/10.1016/j.ejon.2011.03.002 DOI: https://doi.org/10.1016/j.ejon.2011.03.002
(13) Furia CLB, Kowalski PL, Latorre MRDO, Angelis EC, Martins NM, Barros AP, et al. Speech Intelligibility After Glossectomy and Speech Rehabilitation [Internet]. Arch Otolaryngol Head Neck Surg. 2001;127(7):877-83. Available from: https://pubmed.ncbi.nlm.nih.gov/11448366/
(14) Dworkin JP. Glossectomy: a case report [Internet]. Arch Phys Med Rehabil. 1982;63(4):182-3. Available from: https://pubmed.ncbi.nlm.nih.gov/7082143/
(15) Meyerson MD, Johnson BH, Weitzman RS. Rehabilitation of a Patient with Complete Mandibulectomy and Partial Glossectomy. American Journal of Otolaryngology. 1980;1(3):256-61. https://doi.org/10.1016/s0196-0709(80)80097-4 DOI: https://doi.org/10.1016/S0196-0709(80)80097-4
(16)Skelly M, Spector DJ, Donaldson RC, Borodeur A, Palletta FX. Compensatory physiologic phonetics for the glossectomee. J Speech Hear Dis. 1971;36:11-112. https://doi.org/10.1044/jshd.3601.101 DOI: https://doi.org/10.1044/jshd.3601.101
(17) Hashemirad F, Zoghi M, Fitzgerald PB, Jaberzadeh S. The effect of anodal transcranial direct current stimulation on motor sequence learning in healthy individuals: A systematic review and meta-analysis. Brain Cogn. 2016;12:1–12. https://doi.org/10.1016/j.bandc.2015.11.005 DOI: https://doi.org/10.1016/j.bandc.2015.11.005
(18) Lametti DR, Smith HJ, Freidin PF, Watkins KE. Cortico-cerebellar Networks Drive Sensorimotor Learning in Speech. J Cogn Neurosci. 2018;30(4):540-551. https://doi.org/10.1162/jocn_a_01216 DOI: https://doi.org/10.1162/jocn_a_01216
(19) Mohammadi A. Induction of Neuroplasticity by Transcranial Direct Current Stimulation [Internet]. J Biomed Phys Eng. 2016;1;6(4):205-208. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5219570/
(20) Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000;527(3):633-9. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00633.x DOI: https://doi.org/10.1111/j.1469-7793.2000.t01-1-00633.x
(21) Palm U, Reisinger E, Keeser D, Kuo MF, Pogarell O, Leicht G, et al. Evaluation of sham transcranial direct current stimulation for randomized, placebo-controlled clinical trials. Brain Stimul. 2013;6(4):690–5. https://doi.org/10.1016/j.brs.2013.01.005 DOI: https://doi.org/10.1016/j.brs.2013.01.005
(22) Monti A, Ferrucci R, Fumagalli M, Mameli F, Cogiamanian F, Ardolino G, et al. Transcranial direct current stimulation (tDCS) and language. Journal of Neurology, Neurosurgery and Psychiatry. 2012;84(8):832-842. https://doi.org/10.1136/jnnp-2012-302825 DOI: https://doi.org/10.1136/jnnp-2012-302825
(23) Wong MN, Baig FN, Chan YK, Manwa LNG, Zhu FF, Kwan JSK. Transcranial direct current stimulation over the primary motor cortex improves speech production in post-stroke dysarthric speakers: A randomized pilot study. PLoS One. 2022;17. https://doi.org/10.1371/journal.pone.0275779 DOI: https://doi.org/10.1371/journal.pone.0275779
(24) Krishnan C, Santos L, Peterson MD, Ehinger M. Safety of noninvasive brain stimulation in children and adolescents. Brain Stimulation. 2015;8(1):76–87. doi.org/10.1016/j.brs.2014.10.012 DOI: https://doi.org/10.1016/j.brs.2014.10.012
(25) Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, et al. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimulation. 2016;9(5):641–61. https://doi.org/10.1016/j.brs.2016.06.004 DOI: https://doi.org/10.1016/j.brs.2016.06.004
(26) Buchwald A, Khosa N, Rimikis S, Duncan ES. Behavioral and neurological effects of tDCS on speech motor recovery: A single-subject intervention study. Brain Lang. 2020;210. https://doi.org/10.1016/j.bandl.2020.104849 DOI: https://doi.org/10.1016/j.bandl.2020.104849
(27) Guedes RLV. Plasticidade neural em pacientes glossectomizados [Internet]. [Mater’s thesis]. São Paulo: Fundação Antônio Prudente; 2016. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1178233
(28) Rinkel RN, Irma MV, Ellen JVR, Aaronson NK, Leemans CR. Speech Handicap Index in patients with oral and pharyngeal cancer: better understanding of patients' complaints. Head Neck. 2008;30(7):868-74. https://doi.org/10.1002/hed.20795 DOI: https://doi.org/10.1002/hed.20795
(29) Souza DHB. Validação dos questionários “Speech Handicap Index” e “Dysphagia Handicap Index” para o português – Brasil [Internet]. [Mater’s thesis]. São Paulo: Fundação Antônio Prudente; 2014. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/sus-32419
(30) Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory [Internet]. Arch Otolaryngol Head Neck Surg. 2001;127:870–6. Available from: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/482382
(31) Guedes RL, Angelis EC, Chen AY, Kowalski LP, Vartanian JG. Validation and application of the M.D. Anderson Dysphagia Inventory in patients treated for head and neck cancer in Brazil. Dysphagia. 2013;28:24-32. https://doi.org/10.1007/s00455-012-9409-x DOI: https://doi.org/10.1007/s00455-012-9409-x
(32) Andrade CRF, Béfi-Lopes DM, Fernandes FDM, Wertzner WH. ABFW: Teste de linguagem infantil nas áreas de Fonologia, Vocabulário, Fluência e Pragmática. Carapicuiba: Pró–Fono; 2000.
(33) Carbonieri J, Lúcio PS. Vocabulary assessment in Brazilian children: A systematic review with three instruments. Codas. 2020;32(3):1–11. https://doi.org/10.1590/2317-1782/20202018245 DOI: https://doi.org/10.1590/2317-1782/20202018245
(34) Shriberg LD, Kwiatkowski J. Phonological disorders I: a diagnostic classification system. J Speech Hear Disord. 1982;47(3):226-41. https://doi.org/10.1044/jshd.4703.226 DOI: https://doi.org/10.1044/jshd.4703.226
(35) Wertzner HF, Amaro L, Teramoto SS. Gravidade do distúrbio fonológico: julgamento perceptivo e porcentagem de consoantes corretas. Pró-Fono. 2005;17(2):185-94. https://doi.org/10.1590/S0104-56872005000200007 DOI: https://doi.org/10.1590/S0104-56872005000200007
(36) Shriberg LD, Austi, D, Lewis BA, McSweeny JL, Wilson DL. The percentage of consonants correct (PCC) metric extensions and reliability data. J. Speech Lang. Hear. Res. 1997;708-722. https://doi.org/10.1044/jslhr.4004.708 DOI: https://doi.org/10.1044/jslhr.4004.708
(37) Homan RW, Herman J, Purdy P. Cerebral location of international 10-20 system electrode placement. Electroencephalography and Clinical Neurophysiology. 1987;66(4):376-382. https://doi.org/10.1016/0013-4694(87)90206-9 DOI: https://doi.org/10.1016/0013-4694(87)90206-9
(38) Costa MCL, Maher CG, McAuley JH, Hancock MJ, Oliveira WDM, Azevedo DC, et al. The Brazilian-Portuguese versions of the McGill Pain Questionnaire were reproducible, valid, and responsive in patients with musculoskeletal pain. J Clin Epidemiol. 2011;64(8):93–12. https://doi.org/10.1016/j.jclinepi.2010.12.009 DOI: https://doi.org/10.1016/j.jclinepi.2010.12.009
(39) Guimarães I, Sousa AR, Gonçalves MF. Speech handicap index: cross-cultural adaptation and validation in European Portuguese speakers with oral and oropharyngeal cancer. Logoped Phoniatr Vocol. 2021;46(1):11–6. https://doi.org/10.1080/14015439.2019.1711163 DOI: https://doi.org/10.1080/14015439.2019.1711163
(40) Kaipa R, Robb MP, O’Beirne GA, Allison RS. Recovery of speech following total glossectomy: An acoustic and perceptual appraisal. Int J Speech Lang Pathol. 2012;14(1):24–34. https://doi.org/10.3109/17549507.2011.623326 DOI: https://doi.org/10.3109/17549507.2011.623326
(41) Greven AJ, Meijer MF, Tiwari RM. Articulation after total glossectomy: A clinical study of speech in six patients. Int J Lang Commun Disord. 1994;29(1):85–93. https://doi.org/10.3109/13682829409041484 DOI: https://doi.org/10.3109/13682829409041484
(42) Stelzle F, Oetter N, Goellner LT, Adler W, Rohde M, Maier A, et al. Speech intelligibility in patients with oral cancer: An objective baseline evaluation of pretreatment function and impairment. Head Neck. 2019;41(4):1063–1069. https://doi.org/10.1002/hed.25527 DOI: https://doi.org/10.1002/hed.25527
(43) Guo K, Xiao Y, Deng W, Zhao G, Zhang J, Liang Y, et al. Speech disorders in patients with Tongue squamous cell carcinoma: A longitudinal observational study based on a questionnaire and acoustic analysis. BMC Oral Health. 2023;23(1):192. https://doi.org/10.1186/s12903-023-02888-1 DOI: https://doi.org/10.1186/s12903-023-02888-1
(44) Pacheco-Barrios K, Cardenas-Rojas A, Thibaut A, Costa B, Ferreira I, Caumo W, et al. Methods and strategies of tDCS for the treatment of pain: current status and future directions. Expert Review of Medical Devices. 2020;17(9):879–98. https://doi.org/10.1080/17434440.2020.1816168 DOI: https://doi.org/10.1080/17434440.2020.1816168
(45) Deng W, Zhao G, Li Z, Yang L, Xiao Y, Zhang S, et al. Recovery pattern analysis of swallowing function in patients undergoing total glossectomy and hemiglossectomy. Oral Oncol. 2022;132. https://doi.org/10.1016/j.oraloncology.2022.105981 DOI: https://doi.org/10.1016/j.oraloncology.2022.105981
(46) Mcilwaine A, Madill C, McCabe P. Voice therapy prepractice and the principles of motor learning. Acquir Knowl Speech Lang Hear. 2010;12(1):29-32. https://www.researchgate.net/publication/233425131_Voice_Therapy_Prepractice_and_the_Principles_of_Motor_Learning
(47) Fregnani JHTG, Carvalho AL, Paranhos FRL, Viana LS, Serrano SV, Cárcano F, et al. Eticidade do uso de placebo em pesquisa clínica: proposta de algoritmos decisórios. Revista Bioética. 2015;23(3):456–467. https://doi.org/10.1590/1983-80422015233082 DOI: https://doi.org/10.1590/1983-80422015233082
Downloads
Published
Issue
Section
License
Copyright (c) 2024 João Vitor Barbosa Pereira, Simone Aparecida Claudino da Silva Lopes, Roberta Ferreira Silva Santos, Elisabete Carrara-de Angelis
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
