{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:00:30Z","timestamp":1790647230888,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS\u20102026\u201025480530"],"award-info":[{"award-number":["RS\u20102026\u201025480530"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Oral Rehabilitation"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Sequential 4\u2010channel neuromuscular electrical stimulation (NMES) was originally developed to mimic the physiological activation sequence of the swallowing\u2010related muscles; however, its efficacy in older adults with sarcopenic dysphagia remains unclear. This study investigated the effects of sequential 4\u2010channel NMES on hyoid excursion, swallowing safety, and oral intake in older adults with sarcopenic dysphagia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Forty older adults with sarcopenic dysphagia were randomly assigned to either the sequential 4\u2010channel (\n n<\/jats:italic>\n \u2009=\u200920) or the conventional 2\u2010channel (\n n<\/jats:italic>\n \u2009=\u200920) NMES groups. Both groups received NMES intervention for 30\u2009min per session, five times per week, for 6\u2009weeks. Outcome measures included anterior and superior hyoid excursion assessed using the videofluoroscopic swallowing study (VFSS), penetration\u2013aspiration scale (PAS), and functional oral intake scale (FOIS). Two\u2010way repeated\u2010measures analysis of variance was conducted to evaluate group \u00d7 time interaction effects.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Significant group \u00d7 time interaction effects were observed for anterior hyoid excursion (\n F<\/jats:italic>\n \u2009=\u200918.46,\n p<\/jats:italic>\n \u2009<\u20090.001, \u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u2009=\u20090.327), superior hyoid excursion (\n F<\/jats:italic>\n \u2009=\u20096.94,\n p<\/jats:italic>\n \u2009=\u20090.012, \u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u2009=\u20090.154), PAS (\n F<\/jats:italic>\n \u2009=\u20097.96,\n p<\/jats:italic>\n \u2009=\u20090.008, \u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u2009=\u20090.173), and FOIS (\n F<\/jats:italic>\n \u2009=\u20098.66,\n p<\/jats:italic>\n \u2009=\u20090.006, \u03b7\n 2<\/jats:sup>\n p<\/jats:italic>\n \u2009=\u20090.186). Overall, the 4\u2010channel NMES group demonstrated greater improvements in hyoid excursion, swallowing safety, and oral intake function than the 2\u2010channel NMES group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n These findings support the use of physiologically\u2010sequenced stimulation as a promising rehabilitation strategy to address swallowing impairments associated with sarcopenic dysphagia.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/joor.70322","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:24:27Z","timestamp":1790645067000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Sequential 4\u2010Channel Neuromuscular Electrical Stimulation on Hyoid Excursion, Swallowing Safety and Oral Intake in Older Adults With Sarcopenic Dysphagia: A Randomized Controlled Trial"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7113-4792","authenticated-orcid":false,"given":"Ji\u2010Su","family":"Park","sequence":"first","affiliation":[{"name":"Research Institute for Korean Medicine, Pusan National University Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8105-8252","authenticated-orcid":false,"given":"Na\u2010Kyoung","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy Seoul Metropolitan Bukbu Hospital Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moon\u2010Young","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy Inje University Gimhae Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0969-4884","authenticated-orcid":false,"given":"Gihyoun","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Chonnam National University Yeosu Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.2147\/CIA.S107750","article-title":"European Society for Swallowing Disorders\u2013European Union Geriatric Medicine Society White Paper: Oropharyngeal Dysphagia as a Geriatric Syndrome","volume":"28","author":"Baijens L. W.","year":"2016","journal-title":"Clinical Interventions in Aging"},{"issue":"1","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1007\/s00455-014-9577-y","article-title":"Decreased Tongue Pressure Is Associated With Sarcopenia and Sarcopenic Dysphagia in the Elderly","volume":"30","author":"Maeda K.","year":"2015","journal-title":"Dysphagia"},{"issue":"2","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/ggi.13591","article-title":"Sarcopenia and Dysphagia: Position Paper by Four Professional Organizations","volume":"19","author":"Fujishima I.","year":"2019","journal-title":"Geriatrics & Gerontology International"},{"issue":"7","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1093\/gerona\/gls225","article-title":"Aging\u2010Related Geniohyoid Muscle Atrophy Is Related to Aspiration Status in Healthy Older Adults","volume":"68","author":"Feng X.","year":"2013","journal-title":"Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences"},{"issue":"1","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1749-4486.2010.02219.x","article-title":"The Relationship Between Hyoid and Laryngeal Displacement and Swallowing Impairment","volume":"36","author":"Steele C. M.","year":"2011","journal-title":"Clinical Otolaryngology"},{"issue":"4","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.pmr.2008.06.001","article-title":"Anatomy and Physiology of Feeding and Swallowing: Normal and Abnormal","volume":"19","author":"Matsuo K.","year":"2008","journal-title":"Physical Medicine and Rehabilitation Clinics of North America"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1163045","article-title":"Effects of Transcutaneous Neuromuscular Electrical Stimulation on Post\u2010Stroke Dysphagia: A Systematic Review and Meta\u2010Analysis","volume":"14","author":"Wang Y.","year":"2023","journal-title":"Frontiers in Neurology"},{"issue":"6","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1152\/japplphysiol.00348.2006","article-title":"The Effect of Surface Electrical Stimulation on Hyolaryngeal Movement in Normal Individuals at Rest and During Swallowing","volume":"101","author":"Humbert I. A.","year":"2006","journal-title":"Journal of Applied Physiology"},{"issue":"3","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/s00455-022-10520-7","article-title":"The Effect of Sensory Level Versus Motor Level Electrical Stimulation of Pharyngeal Muscles in Acute Stroke Patients With Dysphagia: A Randomized Trial: Melissa M. Howard Et\u00a0al.: The Effect of Sensory Level Versus Motor Level","volume":"38","author":"Howard M. M.","year":"2023","journal-title":"Dysphagia"},{"issue":"6","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1001\/archotol.133.6.564","article-title":"Examining the Evidence on Neuromuscular Electrical Stimulation for Swallowing: A Meta\u2010Analysis","volume":"133","author":"Carnaby\u2010Mann G. D.","year":"2007","journal-title":"Archives of Otolaryngology \u2013 Head & Neck Surgery"},{"issue":"1","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1177\/000348940711600107","article-title":"Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) Curative Therapy for Severe Dysphagia: Myth or Reality?","volume":"116","author":"Shaw G. Y.","year":"2007","journal-title":"Annals of Otology, Rhinology and Laryngology"},{"issue":"12","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1097\/PHM.0000000000001241","article-title":"The Effect of Four\u2010Channel Neuromuscular Electrical Stimulation on Swallowing Kinematics and Pressures: A Pilot Study","volume":"98","author":"Park D.","year":"2019","journal-title":"American Journal of Physical Medicine & Rehabilitation"},{"issue":"1","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s12984-021-00884-6","article-title":"Clinical Effectiveness of the Sequential 4\u2010Channel NMES Compared With That of the Conventional 2\u2010Channel NMES for the Treatment of Dysphagia in a Prospective Double\u2010Blind Randomized Controlled Study","volume":"18","author":"Seo K. H.","year":"2021","journal-title":"Journal of Neuroengineering and Rehabilitation"},{"issue":"9","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1177\/15459683211029891","article-title":"Compensatory Effects of Sequential 4\u2010Channel Neuromuscular Electrical Stimulation for the Treatment of Acute, Subacute, and Chronic Dysphagia in a Prospective, Double\u2010Blinded Randomized Clinical Trial","volume":"35","author":"Lee S. Y.","year":"2021","journal-title":"Neurorehabilitation and Neural Repair"},{"issue":"1","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"13445","DOI":"10.1038\/s41598-023-40359-3","article-title":"Kinematic Mechanism of the Rehabilitative Effect of 4\u2010Channel NMES: Post\u2010Hoc Analysis of a Prospective Randomized Controlled Study","volume":"13","author":"Lim J.","year":"2023","journal-title":"Scientific Reports"},{"issue":"1","key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12938-024-01269-1","article-title":"Residual Effect of Sequential 4\u2010Channel Neuromuscular Electrical Stimulation Evaluated by High\u2010Resolution Manometry","volume":"23","author":"Lim J.","year":"2024","journal-title":"Biomedical Engineering Online"},{"issue":"2","key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.17987\/jcsm-cr.v2i2.17","article-title":"Development, Reliability, and Validity of a Diagnostic Algorithm for Sarcopenic Dysphagia","volume":"2","author":"Mori T.","year":"2017","journal-title":"JCSM Clinical Reports"},{"issue":"1","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1080\/02648725.2023.2184044","article-title":"Exploration of Treatment Methods for Patients With Post\u2010Stroke Dysphagia: A Network Meta\u2010Analysis","volume":"40","author":"Zhuang Y.","year":"2024","journal-title":"Biotechnology and Genetic Engineering Reviews"},{"issue":"4","key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"637","DOI":"10.3233\/BMR-181133","article-title":"The Effect of Neuromuscular Electrical Stimulation With Different Electrode Positions on Swallowing in Stroke Patients With Oropharyngeal Dysphagia: A Randomized Trial","volume":"33","author":"Oh D. H.","year":"2020","journal-title":"Journal of Back and Musculoskeletal Rehabilitation"},{"issue":"6","key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1111\/joor.12390","article-title":"Effects of Neuromuscular Electrical Stimulation Combined With Effortful Swallowing on Post\u2010Stroke Oropharyngeal Dysphagia: A Randomised Controlled Trial","volume":"43","author":"Park J. S.","year":"2016","journal-title":"Journal of Oral Rehabilitation"},{"issue":"2","key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/BF00417897","article-title":"A Penetration\u2010Aspiration Scale","volume":"11","author":"Rosenbek J. C.","year":"1996","journal-title":"Dysphagia"},{"issue":"8","key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.apmr.2004.11.049","article-title":"Initial Psychometric Assessment of a Functional Oral Intake Scale for Dysphagia in Stroke Patients","volume":"86","author":"Crary M. A.","year":"2005","journal-title":"Archives of Physical Medicine and Rehabilitation"},{"issue":"4","key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s00455-011-9392-7","article-title":"Structural Analysis of Muscles Elevating the Hyolaryngeal Complex","volume":"27","author":"Pearson W. G.","year":"2012","journal-title":"Dysphagia"},{"issue":"21","key":"e_1_2_11_25_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000048947","article-title":"Application of 4\u2010Channel Neuromuscular Electrical Stimulation in a Chronic Stroke Patient With Dysphagia: A Case Report","volume":"105","author":"Suh J. H.","year":"2026","journal-title":"Medicine"},{"issue":"3","key":"e_1_2_11_26_1","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s00455-007-9135-y","article-title":"Maximum Hyoid Displacement in Normal Swallowing","volume":"23","author":"Kim Y.","year":"2008","journal-title":"Dysphagia"},{"issue":"5","key":"e_1_2_11_27_1","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s00455-018-9878-7","article-title":"Superior and Anterior Hyoid Displacement During Swallowing in Non\u2010Dysphagic Individuals","volume":"33","author":"Curtis J.","year":"2018","journal-title":"Dysphagia"},{"issue":"4","key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00455-010-9315-z","article-title":"Evaluating the Structural Properties of Suprahyoid Muscles and Their Potential for Moving the Hyoid","volume":"26","author":"Pearson W. G.","year":"2011","journal-title":"Dysphagia"}],"container-title":["Journal of Oral Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/joor.70322","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/joor.70322","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/joor.70322","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:24:32Z","timestamp":1790645072000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/joor.70322"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":27,"alternative-id":["10.1111\/joor.70322"],"URL":"https:\/\/doi.org\/10.1111\/joor.70322","archive":["Portico"],"relation":{},"ISSN":["0305-182X","1365-2842"],"issn-type":[{"value":"0305-182X","type":"print"},{"value":"1365-2842","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"2026-07-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"joor.70322"}}