Question
My father has recently suffered a stroke and is currently having Vital Stim therapy used on him. I'm moving him to rehab and have been told he MUST continue with Vital Stim. Other speech therapists have indicated that traditional therapies are "the way t
Answer
First, I dislike the emphasis on 'must'. But, to understand my views, a little background on VitalStim is important. VitalStim is a commericial electrical stimulation system that provides a specific pattern of electrical stimulation to muscle groups from electrodes placed on the skin over those muscle groups. While clinical research in swallowing applications is only now emerging, 'estim' has a long history of effective use in physical therapy and sports medicine. The basic concept is that estim facilitates improved muscle contraction in the muscles being stimulated. That said, the application of VitalStim as a form of estim has a valid rationale. Furthermore, this same body of research suggests that estim works most effectively when applied in conjunction with a well developed exercise-based intervention program. The reason that I object to the term 'must' is that our own research suggests a wide degree of clinical application of the VitalStim units. Some clinicians use estim in isolation, others use it with various, but all different, swallowing maneuvers and/or compensations. Some clinicians report using estim with a sensory approach to swallowing therapy. Given this variability in application it makes absolutely no sense to mandate that any patient 'must' receive VitalStim therapy without knowing what the underlying 'therapy' will be. Then and only then can any clinician determine if the application of any estim will support the basic therapy approach.
Our laboratory and others have been evaluating estim effects on swallowing. In our laboratory we have developed a specific, exercise-based therapy approach which uses adjunctive estim. We have termed this approach the 'McNeill Dysphagia Therapy Program" or MDTP. We have tested this approach on stroke patients and patients with dysphagia following treatment for head/neck cancer. Even in chronic cases we have been able to obtain positive results. Bottom line...the application of the VitalStim unit for electrical stimulation combined with a systematic therapy program can produce effective results even in severe, chronic dysphagia.
Given this perspective, I would suggest that you ask the treating clinicians to describe the underlying problems in your father's swallow, how they propose to treat those problems, and how the application of any estim will potentially benefit your father's swallowing ability. This clinical modality has much promise, but as a profession, we have much to learn toward the successful application of estim.
Michael Crary is a Professor of Speech-Language Pathology at the University of Florida Health Science Center. He directs the Swallowing Research Laboratory housed within the medical center. More information on the activities of the Swallowing Research Laboratory may be found at their website srl.phhp.ufl.edu
