Dysphagia Treatment: Electric Stimulation

Dysphagia Treatment: Electric Stimulation

Why Use Electric Stimulation ?

The basic theoretical premise is that if the peripheral nerve can be stimulated, the resulting impulse will be transmitted along the nerve to the motor plates in the muscle, producing a muscle contraction.

Karissa Keating, Giuditta Marinotti & Audrey Ouellette

Advantages of Electric Stimulation

What is Electric Stimulation?

Non-invasive

Non-surgical

Stimulation of thyrohyoid and mylohyoid muscles

Helps post-stroke patients progress more rapidly from tube feeding to oral feeding (Lim et al., 2009).

E-Stim/ NMES/ TES

THE CONTROVERSY

Why is E-Stim so Controversial?

Let's take a closer look...

E-Stim involves the use of electrical current to stimulate the nerves or nerve endings that innervate muscles beneath the skin.

• Little research on E-Stim in relation to speech-language pathology.
• Very little evidence-based practice
• E-Stim causes unnatural stimulation of muscles that are typically contracted involuntarily
• Resulting actions from E-Stim may be antagonistic to those needed for swallowing
• Along with stimulating muscles necessary for swallowing, E-Stim can also stimulate muscles that are not involved in the swallowing process

Thank You!

What About Pediatric Patients?

• Pediatric clients have anatomical structures that are still developing.
• This gives SLPs an unclear protocol for administering E-Stim to this population.
• Infants and young children can not indicate to the administer of E-Stim if the intensity is too high.
• This may result in permanent damage to the infant/young child both physically and emotionally.

Risks of Electric Stimulation

Who do SLPs use E-Stim with?

Laryngeal spasm: brief spasm in the larynx that makes it difficult to speak or breathe

Glottic closure: involuntary closure of the vocal folds

Hypotension: Low blood pressure

Arrhythmia: Irregular heartbeat

E-Stim presents danger in the presence of sweat; may cause surface burns (Lim et al., 2009).

• Patients with central nervous system abnormalities but intact peripheral nerve function may be candidates for electrical stimulation.
• Primarily used to treat dysphagia.
• Used to produce muscle strength, endurance/functioning
• Tests sensory awareness and range of motion.

Is it our job?

• According the ASHA standards, this is not typically in our scope of practice as SLPs.

• ASHA’s National Center for Evidence-based Practice in Communication Disorders (N-CEP) is currently completing a systematic review of evidence on the effectiveness of E-Stim.

• Code of Ethics
• Principle I: RULE F
• Principle I: RULE G
• Principle II: RULE B

E-Stim & Swallowing

ECG

62

PROTOCOL

bpm

• The electrical current remains on, cycling off for 1 second every minute throughout 1 hour of therapy.

• Treating dysphagia with E-Stim usually involves the placement of surface electrodes on the neck using one of four different positions.

• Meanwhile, the patient is encouraged to repeatedly swallow hard using endogenous saliva.
• With progress, the patient is upgraded to swallowing ice chips and eventually solid foods during the protocol.

How does it work?

• Small surface electrodes are placed on specified regions of the neck to ensure a targeted delivery of a low-voltage current to peripheral nerve endings.
• Excitation of the motor nerves results in contraction of muscles close to the skin surface (Ludlow, 2008).
• This stimulation aims to strengthen the swallowing musculature or improve the related sensory pathways.

• The intensity level of the current is increased until the patient reports feeling a sensation of muscles grabbing. This is referred to as reaching motor levels of stimulation.

A system that unites the power of electrical stimulation with the benefits of swallowing exercises.