Improved speech an unexpected benefit
A noninvasive therapy involving electrical stimulation is showing promising results in patients who suffer from dysphagia, or difficulty swallowing. Dysphagia can be the result of a stroke, traumatic brain injury, cerebral palsy, cancer, Parkinson’s or Lou Gehrig’s disease, polio, or other degenerative or muscular conditions. Not only are tube feeding and the inability to swallow disheartening to patients and therapists, but complications such as pneumonia send thousands of patients to the hospital each year.
According to Manuela Corfar, MA, CCC, speech pathologist at St. Jude Hospital in Fullerton, CA, a relatively new therapy has shown quick, positive results in some of her patients. "We have had quite good results with it," she explains. "We have had patients, either stroke patients or post-polio syndrome patients, in whom we’ve been happy with the results."
Approved by the FDA in 2003, the neuromuscular electrical stimulation system [VitalStim, Chattanooga (TN) Group] uses surface electrodes to stimulate inactive swallowing musculature. During therapy, functional muscle-use patterns are created or relearned to initiate or reestablish swallowing.
Corfar describes a stroke patient who came to her department as an inpatient on a nasogastric tube, received the electrical stimulation therapy, and within two weeks was discharged home on a soft diet.
Electrical stimulation therapy is not new, and it’s used in several other conditions and for many other purposes. Some uses are invasive, while others are not, and researchers are steadily testing other uses for electrical stimulation of muscles and nerves.
A team at the University of Illinois at Chicago (UIC) is testing an implanted electronic device that could bring relief to patients who suffer chronic lower back pain, a common impediment to recovery. The device, already approved by the FDA, functions like a cardiac pacemaker, according to Konstantin Slavin, MD, assistant professor of neurosurgery at the UIC College of Medicine.
Slavin says the prevalence of chronic pain, and the extent to which it can cause disability, drives the need to research potential treatments, and in some patients, use of electrical stimulation can increase normal activities and reduce the need for medications.
But electricity is a tool that requires special care in administering, just like a drug, Corfar says. "The good news is that the company [that sells the VitalStim device] does it in a very controlled way," she says. "You don’t just order it, get it, and use it. You have to be certified to use it."
The device is calibrated for specific uses by physical therapists, occupational therapists, and speech therapists; and its settings are fixed, so that the only adjustment therapists can make during use is to change the intensity at which the current is delivered.
According to Corfar, the unit is FDA-approved only for treating patients with swallowing disorders, but there have been reports of other benefits. "There are incidental reports that patients who have lost speech capabilities have gained increased vocal intensity [as a result of the therapy]," she explains. "And that makes sense, when you look at it, because you’re stimulating the area around the larynx."
Corfar says St. Jude has experienced no difficulties in getting insurance coverage for treatment using the electrical stimulation unit, though she has heard reports from other centers that have encountered resistance.
Not all dysphagia patients will benefit from the electrical stimulation therapy, but good results in patients with stroke, post-polio syndrome, cerebrovascular accidents, cancer, and head injuries have made believers out of the staff at St. Jude-Fullerton, she notes. "We had a patient with post-polio syndrome who has been battling swallowing for 50 years, and has been admitted several times with pneumonia," she says. "He had six sessions and was able to take a regular diet and thin liquids; and in six months, I don’t believe he’s been back."
The number of therapy sessions required depends on the patient and the severity of the dysphagia, Corfar explains. Some patients with stroke or head injuries show improvement after just a few sessions. For other patients, particularly those with chronic or degenerative conditions, it’s too early to tell. "In cases with patients with progressive diseases, sometimes it is necessary to come back [following the initial series of sessions] to get a few — two or four — tune-up treatments," she says. "But since we’ve been using the device for less than a year, I really can’t state specifics."
One aspect of the treatment Corfar is watching carefully is research into training able family members of patients who need ongoing therapy to do the stimulation therapy at home. "The family would lease the device and administer the treatment under the supervision of a speech pathologist," she says.
Appropriate selection of patients who receive electrical stimulation therapy is important, adds Corfar, because it won’t work for all forms of dysphagia. But among the patients who have had some of the best results are children with congenital syndromes or cerebral palsy. "It really makes a huge difference, when it works, in the quality of life for the patients," she says.
Need more information?
Manuela Corfar, MA, CCC, Speech Pathologist, St. Jude Medical Center, 101 E. Valencia Mesa Drive, Fullerton, CA 92835. Phone: (714) 992-3000.
Konstantin Slavin, MD, Assistant Professor, University of Illinois-Chicago College of Medicine, Department of Neurosurgery, 912 S. Wood St. (MC 799), Chicago, IL 60612. Phone: (312) 996-4842. E-mail: firstname.lastname@example.org.
The Chattanooga Group, 4717 Adams Road, P.O. Box 489, Hixson, TN 37343. Phone: (800) 447-6920. Web: www.vitalstimtherapy.com.