I am interested in finding out about electrical stimulation therapy for swallowing.
Electric stimulation therapy for swallowing rehabilitation has received much popular press attention recently. Both patients and practitioners have been contacting us to ask for more information. Here is what we know to date.
E-stim is a technique in which a small electric current is passed across the skin into the muscles in the anterior neck. Presumably, these muscle groups would include the submental muscles (suprahyoid) and the infrahyoid group. It is not known how deep the electrical current will travel so it is unknown whether pharyngeal constrictors are involved. Some advocates have suggested that this technique may facilitate laryngeal elevation and pharyngeal contraction, but we have not seen convincing evidence of that on a clinical population.
Stimulation by electrical current tends to facilitate muscle contraction. In simple terms, it may serve to provide a pseudo-exercise to stimulated muscle groups. This activity may create a facilitatory environment in which functionally impaired muscle groups may enjoy enhanced rehabilitation. However, the presence of e-stim alone is not likely to provide maximum rehabilitative outcome. Electrical stimulation should produce the greatest positive outcome when paired with an appropriate and focused functional therapy program.
Current limitations of the e-stim approach include limited training options (to our knowledge only two groups have offered training programs on this approach for dysphagia); limited clinical research (research in existence is of poor quality but new studies are underway); and the potential for misuse of the approach (it is reasonable to assume that no approach is appropriate for all patients and much like the old "00" mirrors of the early 80's, we must be cautious in the application of any new technique pending appropriate clinical research findings). We must support efforts that evaluate a variety of swallowing therapy protocols in combination with the e-stim approach and we must be willing to evaluate a variety of e-stim parameters and applications.
Electrical stimulation has a long history in basic research and in rehabilitation within other professions. We need to cautiously move forward and gather experience and data simultaneously to better understand the full spectrum of opportunities of this approach applied to our patients.
Michael A. Crary, PhD., is a Professor of Speech-Language Pathology and Director of the Florida Dysphagia Institute at the University of Florida Health Science Center. Dr. Crary's current clinical and research interests revolve around disorders of swallowing, specifically improving assessment and treatment strategies. Current research projects include studies of the clinical and instrumental evaluation of dysphagia and outcomes of various treatments. He has a long history as a practicing clinician and remains active in patient care. He has written and lectured extensively, including internationally, on these topics. His latest project is the text "The Introduction to Adult Swallowing Disorders" with Michael Groher. He has served as assistant director of the ASHA Special Interest Division #13: Dysphagia. He is a former nominee for the DiCarlo award from ASHA, a recipient of the Outstanding Clinical Achievement Award from ASHA, and has been elected as a Fellow of ASHA.