Dysphagia

Dysphagia is the common term for any issues with swallow function. If you are having trouble swallowing, if you feel like something gets caught in your throat when you eat, or if you have pneumonia from aspiration, you might benefit from an evaluation and treatment. Treatment options include techniques to improve strength of swallowing muscles as well as neuromuscular electrical stimulation (NMES) from the Effective Swallowing Protocol (ESP). ESP is an FDA-cleared specialized form of NMES administered through special skin electrodes.

 

Photo Credit Ampcare LLC

Photo Credit Ampcare LLC

Why ESP versus VITALSTIM?

After becoming certified in  both treatment methods, I have chosen to no longer provide VITALSTIM to my patients.

Effective Swallow Protocol (ESP)

  • Pulse current is changeable for comfort (begins at 50 microseconds and can be increased to 250 microseconds)
  • Pulses per second (frequency) are at 30Hz, resulting in the ability to increase intensity for the most appropriate muscle activation
  • Encourages Indirect Therapy where exercises are completed with no food/liquid trials and can be completed with a Restorative Posture Device (RPD) resulting in more muscle recruitment during each swallow. No food/liquid during the NMES charge keeps prevents an aspiration risk, and patients can sip or snack between currents.
  • Restorative Posture Device with resistive Chin to Chest exercise doubles the amount of muscle activation compared to a traditional head lift exercise
  • Electrodes are triangle shaped and fit under the chin, can be easily used with patients with small necks or children
  • Phase duration can be modified to progress the patient, as well as to modify for comfort
  • 30 minute treatment time

VITAL STIM

  • Pulse current cannot be changed, stays at 300 microseconds.
  • Pulses per second (frequency) cannot be changed and remain at 80Hz
  • Encourages Direct Therapy with food and liquid trials, however VITAL STIM administration pulls the hyoid bone forward and research has shown that anterior movement of the hyoid bone results in danger of aspiration because food may be propelled into the esophagus as the Upper Esophageal Sphincter is pulled open when the hyoid bone moves forward (Yokoyama et al, 2000)
  • VITAL STIM over the laryngeal and submental regions was shown to lower the hyoid bone and larynx reducing airway protection and placing some healthy volunteers and patients  at increased risk for aspiration (Humbert et al., 2006) Ludlow et al., 2007)
  • VITAL STIM over only the submental region showed no appreciable elevation in healthy volunteers at rest (Humbert et al., 2006)
  • Electrodes are large and shaped like dog bones, so small necks may be an issue
  • 1 hour treatment time

Here are some links to the research that shows promising outcomes from this intervention.

UK Swallowing Research Group-Presented in London-2014

Ampcare’s Posture Device Exercise Validation Article, C. Watts (TCU)-Presented in Torino, Italy-2013

European Society for Swallowing Disorders-Presented in Barcelona, Spain-2012

UK Swallowing Research Group-Presented in London-2010

Hard to Swallow-Review Article- 2008; Presented in New Orleans (ASHA) 2009

Deciphering Dysphagia with E-Stim-1998

Promoting Laryngeal Elevation with E-Stim-1998

 

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References: Yokoyama M, Mitomi N, Tetsuka N & Niimi S. (2000) Role of laryngeal movement and effect of aging on swallowing pressure in the pharynx and upper esophageal sphincter. Laryngoscope, 110:434-439.   

Humbert I, Poletto CJ, SAxon KG, Kearney PR, Crujido L, Wright-Harp W, Payne J, Jeffries N, Sonies BC & Ludlow CL. (2006) The effect of surface electrical stimulation on hyo-laryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol.,  101, 1657-1663.

Ludlow CL, Humbert I, Saxon KG, Poletto CJ, Sonies BC & Crujido L. (2007) Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia, 22, 1-10.

Watts, C. Measurement of Hyolaryngeal Muscle Activation Using Surface Electromyography for Comparison of Two Rehabilitative Dysphagia Exercises. 2013. Archives of Physical Medicine and Rehabilitation 2013.