David Bowers, MD
Medical Director, Neurological Division
Patients are excited when we discuss the potential results with them. It assures them that as a facility we are on top of things.
We have long known that muscles are responsive to weight training, repetitive exercises, or electrical stimulation.
If you are treating patients with dysphagia, you obviously can't put weights on the swallowing muscles in your throat.
Repetitive swallowing exercises, which have been the treatment of choice, have their own drawbacks. Patients find it difficult to practice swallowing repeatedly if they have nothing to swallow, yet if you give them small amounts of food to exercise their swallowing, you run the risk that food will get into the wrong pipe and aspirate.
VitalStim® Therapy takes advantage of the third approach to strengthening muscles and in that respect, it is neither an unreasonable nor an unexpected idea. It has given us an effective way to treat dysphagia, one that is consistent with what we know about muscles and how they function. Our results have borne that out.
We had a 36-year-old patient who was being fed through a tube surgically placed that goes directly to the stomach (PEG). The brainstem stroke had deprived him completely of the ability to swallow. Within a month he was on a regular diet, drinking thin liquids safely, and off his feeding tube.
A 78-year-old woman, also a stroke patient, came here with PEG tube in place, unable to swallow, drooling saliva. Within a month she was on a soft diet and thin liquids. Her tube was also removed.
It might be argued that these patients may have improved anyway, but I am confident they would not have recovered their swallowing abilities nearly as quickly, leaving them dependent on the PEG tubes for much longer.
Despite the successes we have had with VitalStim Therapy, it is not for everyone. We prescribe it only for patients who have neurologically based problems, such as patients with stroke, brain injury, amyotrophic lateral sclerosis or multiple sclerosis.
We do not recommend it to patients with mechanical swallowing problems, strictures, esophageal spasms, and severe gastrointestinal reflux disease. Patients who cannot participate in the therapy include severely demented or cognitively impaired patients. Patients who have pacemakers use it with caution.
Some patients are somewhat concerned when we prescribe VitalStim Therapy, though mostly they want to know if it hurts. We tell them that, generally, it does not and that if they feel any discomfort, we can always adjust the strength of the electrical signals to suit their comfort level.
As a whole, however, patients are excited when we discuss the potential results with them. It assures them that as a facility we are on top of things. It also allows them to look forward to quickly getting away from coffee thickened to nectar consistency, pureed hamburgers, pureed eggs - my land, that's disgusting - and getting back to their normal foods.