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The Science of Swallowing

Electrical stimulation combined with traditional therapy restores swallowing to patients with dysphagia

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Social occasions center on food and nobody's more aware of that than those who have lost their ability to swallow.

"People who can't eat become isolated because nobody wants to eat in front of them," said Karol Waro, MS, CCC-SLP, speech-language pathologist at Sentara Home Health. "They're relegated to the bedroom or the den and feel out of the loop."

Sentara Home Health in Virginia Beach is one of a select number of area facilities offering an improved quality of life to patients with dysphagia. This adjunctive modality to traditional exercise unites electrical stimulation with the benefits of swallowing exercises. The combination allows clinicians to accelerate strengthening, restore function and help the brain remap the swallow. Research has demonstrated that combining these therapies results in better outcomes than using either one alone. Sentara offers this therapy in home health, as well as the hospital setting.

Though electrical stimulation has been around for decades in physical and occupational therapy, it's a relative newcomer to patients for dysphagia. The stimulation has existed in some form for approximately 10 years and the placement of electrodes was refined over time.

Speech-language pathologists are in charge of placing electrodes on the patient's throat. Sometimes doctors order a barium swallow test. Otherwise, nurses assess for coughing, drooling, weight loss and other signs of difficulty swallowing, and work with families to uncover the cause.

Supporting Swallowing

Often, both the speech-language pathologist and nurse help patients find the perfect therapy equation for the electrical stimulation. When combined with traditional therapy, the module is suitable for most patients, except those with advanced Lou Gehrig's disease, a pacemaker or a great deal of scar tissue in the throat due to intense radiation.

Commonly, patients with MS or Parkinson's, or those who've had a stroke or even just a bad fall, are candidates for the combined therapy.

"Swallowing muscles atrophy in 2 hours," Waro said. "If you stop swallowing because you're using an IV, those muscles become weak very fast."

With the electrical stimulation, clinicians find the patient's weak area and place two electrodes in different places, such as the throat, tongue or larynx. While the electrodes are increasing from 0 to 25 incrementally, frequencies are also slowly increased to a level of 10-13. Muscles contract after 2 minutes, then relax, then contract again.

Concurrently, patients are performing oral exercises by producing a hard and fast swallow, followed by a dry swallow. If they can tolerate it, patients may swallow ice chips. If the patient is classified as high risk for pneumonia, a quick spray of water on the tongue also activates the saliva glands.

Though success rates are very high, not all patients are open to the idea.

"Usually, it's a matter of sharing success stories," confided Melanie Englan, BSN, RN, director of Sentara Home Health's Virginia Beach branch. "It doesn't hurt, but feels like ants are crawling on them. Knowing that gives patients a certain piece of mind. If the intensity is too high, it can always be reduced.

If patients still have concerns, Englan offers to let them try the electrical stimulation on the hand first.

Even babies have undergone the therapy. Waro recalls one infant who was fed by a tube but constantly was choking and coughing. Once the pediatric electrode therapy started, the baby giggled and was then able to handle secretion.

Each session lasts just under an hour. Waro said it usually only take five or six tries before results start to appear in most patients.

Thickening Therapy

The luckiest patients regain full eating capabilities, but others only get to increase the consistency of their food. While they may never again know the guilty pleasure of a greasy cheeseburger, Waro said many are thrilled to even sip coffee again.

"If I had the choice between pureed foods or finely chopped, I'd rather have the finely chopped and at least know what I'm eating," she rationalized.

Nurses are actively involved in helping patients adjust to the food consistency they're most comfortable with. Whether it's a matter of teaching patients to sit up during and after meals, or instructing families on adding a powder to the patient's liquids to achieve a pudding-like consistency, they can instantly see patients are making steps in the right direction.

"Patients who can't swallow feel very awkward because they're afraid they'll drool their food or choke," said Englan. "I've worked with a patient who was thrilled to have her muscles strengthened to the point where she could smile at her grandchildren again. Another gentleman missed coffee and we got him to the point where he could enjoy a whole cup. It's really returning a certain quality of life and independence to the patients."

 

Robin Hocevar is senior regional editor at ADVANCE.

 


 

Can you send me the research you mentioned in the article?

Alison Bute,  SLP,  MorrisSeptember 05, 2012
Morris, IL



Does anyone know of any research based articles that support the use of electrical stimulation for increasing swallow function in pediatrics, particularly with complex cases?

Melissa ,  Speech language pathologistAugust 23, 2012
IL



Hello Jennifer,
Thanks for your interest. If you send me an email (rhocevar@Merion.com) with your direct contact info, I'll pass along your question and see to it that you get an answer.

Robin HocevarAugust 22, 2012
King of Prussia



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