What is dysphagia?
Swallowing difficulties, also referred to as “dysphagia,” may arise from many different etiologies such as:
Pharyngeal Nerve Damage (traumatic extubation, surgery)
Food spillage from lips
Food spillage from lips
Coughing and choking
Taking a long time to eat
Poor chewing ability
Food sticking in the throat
Poor oral hygiene
Repeated chest infections
How is dysphagia treated?
There are traditional treatments where a speech/swallowing therapist teaches compensatory strategies, strengthening techniques, and diet modifications. In addition to these modalities, there is neuromuscular electrical stimulation (NMES) intended to re-educate muscles through application of external stimulation to the muscles necessary for pharyngeal contraction.
Is NMES dangerous and how does it work?
NMES is considered a non-invasive technique, involving application of an electrical current to the targeted muscle groups via the skin using electrodes placed on the skin surface. The source of the electrical current is from a battery powered stimulator with a waveform that slowly contracts the muscle, holds it, slowly releases it, and then repeats. Treatments are designed to rehabilitate muscles not block pain, which is different from a T.E.N.S unit. Optimal treatment frequency is 4x a week for 4 weeks with 60 minute treatments. Anecdotal evidence of improvement has been observed on schedules of 2 to 3 times a week for approximately 8 weeks.
When NMES is combined with traditional swallow exercises, the simultaneous recruitment of both types I and II muscle fibers during the combined therapy is thought to generate larger swallowing muscle force and enhance the therapeutic effect above that of NMES or exercise alone in dysphagia treatment. NMES is contraindicated for those that have a: cardiac condition, pacemaker, facial skin cancer, or diminished cognitive function.
Will NMES repair my swallow and is this an evidence based practice (EBP)?
Transcutaneous neuromuscular electrical stimulation is a relatively new therapeutic intervention for the treatment of swallowing disorders and was first approved by the Food and Drug Administration in 2001 as a treatment for dysphagia. Many interventions are designed to minimize symptoms of dysphagia rather than aimed at restoring physiological deficits. Successful rehabilitation of the pharyngeal phase impairments remains a unique challenge to clinicians. Research into electrical stimulation techniques is gaining interest due to its rehabilitation potential, especially for pharyngeal stage swallowing disorders, but there is paucity of EBP, especially when considering levels I, II, and III evidence. Anecdotally, clients have reported perceived improvements in not only swallowing, but also in voicing difficulties.