Treatment for Dysphagia
The ability to eat is often taken for granted. For most people, it is a task
that requires little conscious thought. However, when an injury or illness
decreases one's ability to eat safely, regaining that function becomes vitally
important to that person's health and quality of life. When a person has
difficulty swallowing, referred to as dysphagia, it can include complaints of
food sticking in the throat area, frequent coughing on food or liquids, frequent
lung congestion, taking a long time to eat, and/or unintended weight loss.
People can have difficulty swallowing for many reasons including a stroke, brain
injury, progressive neurological diseases (dementia, ALS, MS, Parkinsons
disease, etc.), oral or laryngeal cancer, medicine side effects, or multiple
medical problems.
Traditional therapy to improve swallow function includes diet modifications
(changing the consistency of the food or liquid), swallowing exercises, and/or
positional changes. In an attempt to enhance these therapy techniques, a
Speech-Language Pathologist, Marcy Freed, developed VitalStim®
Therapy which is a form of neuromuscular electrical stimulation (NMES).
NMES is the use of electrical stimulation to activate a muscle response through
the nerves that supply the swallowing muscles.
The major goals of VitalStim® Therapy are
to strengthen and improve control of the swallowing muscles. Neuromuscular
electrical stimulation is a well known treatment that has been used by Physical
and Occupational Therapists to improve muscle response primarily in the larger
muscles of the legs and arms. However, the use of NMES (via VitalStim) for
improving function of the smaller muscles that control swallowing is a
relativley new, though controversial, treatment method used by some Speech
Pathologists.
VitalStim® Therapy which was
approved by the FDA in 2001 uses a small hand held device that was specifically
designed for the smaller muscles that control swallow function. This device is
attached to four electrodes that are placed on appropriate areas on the front of
the neck based on specific areas of weakness determined by the speech
pathologist. In order to determine those main areas of weakness, it is
recommended to perform a formal swallow study under radiological evaluation
prior to the initiation of VitalStim®
Therapy. Some of the situations in which VitalStim®
Therapy is not appropriate would include people with severe dementia,
reflux of tube feedings, dysphagia due to drug toxicity, areas of active tumor
growth or infection, areas of peripheral vascular disease, dysphagia due to a
structural problem, staples or metal in the throat/neck area, or individuals
with severe oral motor dysfunction. In addition, there are certain precautions
that should be taken with individuals with pacemakers or implanted cadioverter
defibrillators, areas of scar tissue, a history of seizures, open wounds, and
patients who are unable to give clear and reliable feedback.
Once candidacy is determined by the Speech Pathologist and physician, then
therapy can be initiated by a Speech Pathologist certified in providing
VitalStim® Therapy. Therapy consists of
initial placement of the electrodes and achieving a level of electrical
stimulation that elicits a strong muscle contraction. The device is then left at
this level for a one hour session or two thirty minute sessions a day. During
this session, a Speech Pathologist is present and will provide additional
treatment during a meal and/or with traditional swallowing exercises (with a
goal of performing 70-80 swallowing exercises per session). Typical number of
sessions is 10-14 over a 2-3 weeks period. At the end of treatment, a repeat
evaluation of the swallow is recommended to assess progress. No adverse effects
of VitalStim® Therapy were reported by the
initial study performed by Marcy Freed which involved over 800 patients.
Since this is a relatively new treatment method and research is somewhat
limited, the level of acceptance of VitalStim®
Therapy is varied among medical providers. Further research is being
performed nationwide and is expected to provide further objective
information regarding outcomes. In the meantime, VitalStim®
Therapy may be an option for certain individuals who are suffering from
dysphagia that should be discussed with your medical provider.
By: Lysa Scheirer MS, CCC-SLP, Profesional Therapy Services, Inc.
|
