According to the ASHA, as many as 15 million Americans are annually diagnosed with dysphagia, or difficulty swallowing. While some causes are age related such as strokes or muscle weakness, it can impact people of any age. Anyone coping with post-surgical head and neck cancer issues, neurological trauma, or degenerative diseases such as ALS or MS is at risk. Dysphagia can lead to minor embarrassments such as drooling, or major illnesses such as aspiration pneumonia. It can also lead to weight loss, choking, dehydration, changes in a person's voice, and asphyxia. Many times, a patient ends up on a feeding tube (PEG) and in some cases, a tracheostomy. Both cause drastic changes in lifestyle. In turn, the likelihood of depression is increased.
Previously, therapies for dysphagia included compensation strategies such as diet changes (soft or pureed foods) and attempts to strengthen the muscles used in swallowing.
New technologies provide alternatives. The VitalStim Therapy System is a neuromuscular electronic stimulation system cleared by the FDA to strengthen the patient's throat muscles while stimulating the neural pathways to the cerebral cortex. It's a noninvasive and painless tool to be used as an adjunct to the traditional exercises. 80% of patients with moderate dysphagia were able to discontinue use of PEG tubes after treatment. The ability for patients with mild dysphagia to eat a wider variety of foods (not pureed or restricted to soft ones) also reportedly increased.
A specially trained clinician evaluates the patient's ability to swallow, and chooses the set of muscles that need to be strengthened. Next, the clinician cleans the patient's skin in the chosen area with a little alcohol to ensure good contact, and applies the electrodes. Then the clinician turns on the unit, and leads the patient through a series of exercises. A low current stimulates the muscles while sending signals to the brain, helping to re-educate the neural pathways. The VitalStim can be used for sessions up to sixty minutes at a time. While many patients report an almost immediate improvement in swallowing, it usually takes six to 20 treatment sessions for the best results.
The VitalStim is cost effective. For example, the use and care of a PEG feeding tube runs about $31,000 a year. The restored functioning of the head and neck muscles keeps a patient out of the ER and prevents hospital readmissions, ER trips and institutional care, reducing insurance costs. A three-year follow up study submitted to the FDA showed that the improvements in swallowing were maintained. Another study demonstrated lasting positive effects in a group of patients for whom previous dysphagia therapies had failed.
Patients aren't the only ones whose lives are improved by use of the VitalStim. Their caregivers are freed from making special modifications to meals, or from the preparation and maintenance of meal replacements for PEG tubes.
Caution needs to be used in patients with implanted electronics such as pacemakers or who have seizure disorders. The VitalStim may not work as well in people with compromised cognitive functioning.
For many others, however, the VitalStim provides a chance to improve and maintain quality of life.
Fran Jablway
and
Hulet Smith, OT
