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Dysphagia Management: An Analysis of Patient Outcomes Using VitalStim™ Therapy Compared to Traditional Swallow Therapy

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Abstract

This study compares the outcomes using VitalStim™ therapy to outcomes using traditional swallowing therapy for deglutition disorders. Twenty-two patients had an initial and a followup videofluoroscopic swallowing study or fiberoptic endoscopic evaluation of swallowing and were divided into an experimental group that received VitalStim treatments and a control group that received traditional swallowing therapy. Outcomes were analyzed for changes in oral and pharyngeal phase dysphagia severity, dietary consistency restrictions, and progression from nonoral to oral intake. Results of χ2 analysis showed no statistically significant difference in outcomes between the experimental and control groups.

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Author information

Authors and Affiliations

  1. Whitaker Rehabilitation Center, Winston-Salem, USA

    Mary Kiger MS-CCC/SLP & Lynn Watkins MSPT

  2. Thomasville Medical Center, Thomasville, North Carolina, USA

    Catherine S. Brown PhD, CCC/SLP

  3. Forsyth Rehabilitation Center, 3333 Silas Creek Parkway, Winston-Salem, NC, 27103, USA

    Mary Kiger MS-CCC/SLP

Authors
  1. Mary Kiger MS-CCC/SLP
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  2. Catherine S. Brown PhD, CCC/SLP
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  3. Lynn Watkins MSPT
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Corresponding author

Correspondence to Mary Kiger MS-CCC/SLP.

Additional information

This work was performed at the Forsyth Rehabilitation Center locations, Winston-Salem, NC 27103

Appendices

Appendix A. Procedure for Videofluoroscopic Swallowing Study (VFSS)

  1. A.

    Statement of Procedure:

    1. 1.

      ASSESS ANATOMY AND PHYSIOLOGY through an oral mechanism examination

Assess swallowing using thin liquid barium, nectar thick liquid barium, honey thick liquid barium, pudding consistency barium and a solid (cookie).

*The order of consistencies and the total amount of food/liquid may vary according to patient’s diet order and clinical judgment. Increase amount with each presentation unless evidence of aspiration occurs.

Table 7  
Full size table
  1. B.

    COMPENSATORY STRATEGIES used at discretion of examiner, depending on patient’s physical and cognitive abilities. Examples of acceptable strategies include:

    1. 1.

      Chin tuck

    2. 2.

      Head turn (to right or left, depending on area of pharyngeal weakness)

    3. 3.

      Head tilt (to right or left, to aid transit on stronger side)

    4. 4.

      Supraglottic swallow (holding breath during swallow and exhale with cough, to aid in clearing airway)

    5. 5.

      Mendelsohn maneuver (prolongation of laryngeal elevation during the swallow to aid in clearance of bolus through cricopharyngeus opening)

    6. 6.

      Double swallow for each bolus

    7. 7.

      Cyclical ingestion (alternating liquid and solid boluses)

    8. 8.

      Thermal-gustatory stimulation (preceding bolus with lemon-ice)

    9. 9.

      Effortful swallow

    10. 10.

      If strategies are not useful (i.e., do not prevent aspiration or penetration) at any point in the examination, testing of that particular consistency does not need to continue . It is assumed that aspiration or penetration will occur with large amounts.

    11. 11.

      If a strategy is found useful (i.e., does indeed prevent aspiration or penetration), it can and should be used with the next larger amount.

    12. 12.

      See Table 4 for severity rating scale.

Appendix B. Procedure for Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

  1. C.

    Statement of Procedure:

    1. 1.

      ASSESS ANATOMY AND PHYSIOLOGY

    2. 2.

      Appearance of hypopharynx at rest

    3. 3.

      Look at symmetry

    4. 4.

      Swallowing secretions

    5. 5.

      Look for existing secretions in pharyngeal and laryngeal area

    6. 6.

      Ask for patient to swallow and assess ability to clear existing secretions

    7. 7.

      The following may be done if indicated:

      1. a.

        Respiration (Abduction)

      2. b.

        Observe patient’s laryngeal structures while breathing

      3. c.

        Ask patient to sniff – observe abduction of cords

      4. d.

        Airway Protection (Adduction)

      5. e.

        Ask patient to cough

      6. f.

        Ask patient to hold his/her breath – at the level of the throat (mouth open) as long as s/he can

      7. g.

        Phonation (Abduction/Adduction)

      8. h.

        Say “eee”

      9. i.

        Say “eee” in a very high pitch voice

Assess swallowing using green-dyed liquid, thickened juice, applesauce or other liquids or foods

* The order of consistencies and the total amount of food/liquid may vary according to patient’s diet order and clinical judgment. Increase amount with each presentation unless evidence of aspiration occurs.

Table 8  
Full size table
  1. D.

    COMPENSATORY STRATEGIES used at discretion of examiner, depending on patient’s physical and cognitive abilities. Examples of acceptable strategies include:

    1. 1.

      Chin tuck

    2. 2.

      Head turn (to right or left, depending on area of pharyngeal weakness)

    3. 3.

      Head tilt (to right or left, to aid transit on stronger side)

    4. 4.

      Supraglottic swallow (holding breath during swallow and exhale with cough, to aid in clearing airway)

    5. 5.

      Mendelsohn maneuver (prolongation of laryngeal elevation during the swallow to aid in clearance of bolus through cricopharyngeus opening)

    6. 6.

      Double swallow for each bolus

    7. 7.

      Cyclical ingestion (alternating liquid and solid boluses)

    8. 8.

      Thermal-gustatory stimulation (preceding bolus with lemon-ice)

    9. 9.

      Effortful swallow

    10. 10.

      If strategies are not useful (i.e. do not prevent aspiration or penetration) at any point in the examination, testing of that particular consistency does not need to continue . It is assumed that aspiration or penetration will occur with large amounts.

    11. 11.

      If a strategy is found useful (i.e., does indeed prevent aspiration or penetration), it can and should be used with the next larger amount.

    12. 12.

      See Table 4 for severity scale ratings.

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Kiger, M., Brown, C.S. & Watkins, L. Dysphagia Management: An Analysis of Patient Outcomes Using VitalStim™ Therapy Compared to Traditional Swallow Therapy. Dysphagia 21, 243–253 (2006). https://doi.org/10.1007/s00455-006-9056-1

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