SpeechPathology.com Phone: 800-242-5183


eLuma Online Therapy - Own Boss - May 2023

NMES and Myasthenia Gravis

Nancye Roussel, Ph.D

March 9, 2009

Share:

Question

Would you use Neuromuscular Electrical Stimulation (NMES) as part of oral motor/swallowing therapy with myasthenia gravis?

Answer

No, I would not recommend the use of NMES for a person with swallowing disorders associated with myasthenia gravis. Myasthenia gravis is an autoimmune disease associated with disorders of the thymus gland that affects the neuromuscular junction i.e. the synapse between nerves and muscle fibers. In individuals with the disease, antibodies destroy or block receptor sites along the muscle fibers that receive the neurotransmitter acetylcholine. It is the reception of acetylcholine that triggers muscle contraction by the lower motor neuron. When the number of receptors receiving activation is reduced, the muscle contractions become weaker. The result is rapid fatigue and weakness with continued activity, but improvement in muscle contraction strength with rest. Direct exercise as in oral motor therapy is contraindicated in these cases as continued contraction of the muscles of swallowing actually makes the symptoms worse. While it is my understanding that NMES causes contraction of the muscles through electrical stimulation rather than neurotransmitter activation and might not trigger the blockage or destruction of the receptor sites, this treatment does not actually target the underlying etiology of the swallowing problem and therefore would not produce functional change i.e. return to more normal swallow. Though I am not trained in NMES, my understanding of the technique is that it is typically coupled with an active swallow attempt by the patient and may help strengthen muscles that are atrophied from disuse. While the person may experience an improved swallow while using NMES because of the direct muscle stimulation, they would still exhibit the progressive fatigue when stimulation was not used. Most sources recommend medical treatment for the underlying disorder coupled with compensatory strategies for swallowing management. Logemann recommends diet consistency changes and eating more frequent but smaller meals throughout the day to avoid the muscle fatigue associated with repeated contraction. Conventional wisdom is to avoid active exercise.

Dr. Nancye Roussel is an Associate Professor and Head of the Dept. of Communicative Disorders at the University of Louisiana, Lafayette. She is a certified speech-language pathologist and has practiced in both hospital and school settings prior to her employment at the University. Dr. Roussel has taught a graduate course in dysphagia for the past 12 years. In addition, she teaches graduate courses focusing on motor speech disorders in adults and children, voice disorders, and speech science.


nancye roussel

Nancye Roussel, Ph.D


Related Courses

Thickened Liquids in Clinical Practice: The Plot “Thickens”
Presented by Angela Mansolillo, MA, CCC-SLP, BCS-S
Video

Presenter

Angela Mansolillo, MA, CCC-SLP, BCS-S
Course: #10497Level: Intermediate1 Hour
  'Appreciated a presentation that agreed with I have felt over many years of clinical practice'   Read Reviews
Clinicians who utilize thickened liquids in their clinical practice are aware of their benefits, but what about the risks and contraindications? Advantages and disadvantages of thickened liquids are reviewed in this course with a focus on clinical outcomes, including impacts on medication administration, lung health, and hydration. Product types are evaluated to facilitate appropriate choices for individual clients.

Dysphagia in Neurodegenerative Disease
Presented by Debra M. Suiter, PhD, CCC-SLP, BCS-S
Video

Presenter

Debra M. Suiter, PhD, CCC-SLP, BCS-S
Course: #9732Level: Intermediate1 Hour
  'I Liked the length and amount of info presented'   Read Reviews
Dysphagia is common in individuals with amyotrophic lateral sclerosis (ALS) and Parkinson’s disease. This course discusses the underlying pathophysiology and appropriate treatment programs for each disease, as well as use of alternate methods of nutrition/hydration.

20Q: In the Thick of It - The International Dysphagia Diet Standardization Initiative (IDDSI)
Presented by Jennifer Raminick, MA, CCC-SLP, BCS-S, Danielle Ward, MA, CCC-SLP
Text

Presenters

Jennifer Raminick, MA, CCC-SLP, BCS-SDanielle Ward, MA, CCC-SLP
Course: #10756Level: Intermediate1 Hour
  'relevant to my workplace setting'   Read Reviews
The importance of using IDSSI to provide standardized language when speaking about texture modification is discussed in this course. Comparisons of IDDSI and the National Dysphagia Diet (NDD), as well as IDDSI standards for pediatric vs. adult patients are presented. Additionally, potential barriers, solutions, and frequently asked questions related to implementation of IDDSI are described.

Back to Basics: Swallow Screening: How, when, and who
Presented by Angela Mansolillo, MA, CCC-SLP, BCS-S
Video

Presenter

Angela Mansolillo, MA, CCC-SLP, BCS-S
Course: #8969Level: Introductory1 Hour
  'Very knowledgable and provided research to support the information'   Read Reviews
Screening of swallow function is a well-regarded tool to identify individuals who are potentially at risk of dysphagia and in need of full swallow assessment, but the options are many and varied. This "back to basics" course will teach participants to make informed, evidence-based choices regarding appropriate screening tools specific to their particular patient populations and settings.

ALS: Medications and Oral Care
Presented by Denise Dougherty, MA, SLP
Video

Presenter

Denise Dougherty, MA, SLP
Course: #8717Level: Intermediate1 Hour
  'This course provided pertinent and applicable information regarding medications and oral care related to ALS'   Read Reviews
This is Part 1 of a three-part series on amyotrophic lateral sclerosis (ALS). This course will identify medication and complementary alternative medicine that may be used by patients to treat ALS. The importance of saliva management and mouth care as a critical component of their daily care will be discussed, along with strategies. (Part 2: Course #8719, Part 3: #8720)

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.