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This article appeared in The Home News Tribune
Health & Fitness section.
March 27, 2007

Now here's a therapy that's easy to swallow

By Bervessa Morgan, MS

A few days after his stroke, a feeding tube was inserted in his stomach. His breakfast, lunch and dinner was a liquid the color of coffee ice cream poured into a thin rubber tube.

The man had become terribly depressed. Not only had the stroke robbed him of the use of his left arm and leg, but he had lost his ability to enjoy food. A tall, strapping man who had loved to eat, he often cheated, sneaking sips of soda or water despite the risk of choking. He was desperate to taste food again.

The man's condition is called dysphagia, a Greek word meaning difficulty eating. Dysphagia occurs when there is a problem with the many muscles involved in swallowing. Its symptoms can include coughing during or after swallowing, choking on food or liquid or shortness of breath while eating.

Dysphagia is common after a stroke. In fact, more than half of stroke patients have it. But dysphagia can also occur after radiation therapy for head and neck cancer, traumatic head or spinal cord injury, burns and meningitis. It is also common in people with degenerative neurological diseases such as Parkinson's disease, multiple sclerosis and cerebral palsy. The more serious side affects of dysphagia include choking, malnutrition and dehydration.

A common but serious consequence of dysphagia is aspiration pneumonia, which is caused when food or saliva go down the windpipe and into the lungs. Aspiration pneumonia accounts for more than a third of all stroke-related deaths and represents the third leading cause of death during the first month after stroke.

Until recently, dysphagia was treated by speech therapists using swallowing therapy, tongue and lip exercises, patient education and a change in diet and food preparation. But today there is a treatment called VitalStim that is helping many people with swallowing problems.

Normal swallowing is usually a smooth coordinated process that involves a complex series of voluntary and involuntary neuromuscular contractions. VitalStim is a specialized form of neuromuscular electric stimulation (NES) that essentially stimulates the inactive or atrophied swallowing muscles. As the muscles are stimulated, speech therapists use special exercises to help "re-educate" the muscles in the mouth, throat and neck.

Approved by the Food and Drug Administration in 2001, VitalStim is non-invasive. Its current, powered by two double A batteries, is delivered by four specially designed electrodes placed on the neck.

The current stimulates motor nerves in the throat while the patient practices swallowing exercises that cause the muscles to contract. With repeated therapy, muscles are "re-educated" and the quality of the swallowing function improves. VitalStim is usually administered under the direction of a VitalStim-certified speech language pathologist with experience treating dysphagia.

Most treatment sessions last about 60 minutes and begin with the electrodes placed on the skin at specific points on the neck. A patient generally receives about 12 sessions three times a week, with a reassessment following the last session. Therapy can be done while the patient is in the hospital or on an outpatient basis. We see the most progress in stroke patients who've receive the therapy within three to six months after their stroke.

My patient's daughter had heard about VitalStim and did some research on it. She had her father's physician prescribe the treatment. He received the therapy a few months after his stroke and we began to see progress after the first few sessions.

At first, the man said he experienced some discomfort. The current feels like a tingling or crawling sensation in the throat. As treatment progresses and the current increases, that tingling sensation feels like a vibration, then a warm feeling. Toward the end of the treatment, patients describe a squeezing feeling in the throat as their muscles contract. He gradually got used to the different sensations. After the first few treatments, the man could swallow pureed foods. As his therapy progressed and his muscles grew stronger, he was able to swallow thin liquids, which is more difficult for patients with swallowing problems.

The day his feeding tube was removed was one of the happiest days since my patient's stroke. It meant that he could eat by himself without the risk of choking or developing pneumonia. Because his dentures no longer fit him, he can't chew very well so he restricts his diet to mashed and pureed foods. But he is eating. Better still, he can sit at the table and have dinner with his family and friends.

Bervessa Morgan, MS, is a speech therapist and coordinator of the Speech-Language Pathology Department at Robert Wood Johnson University Hospital at Rahway. She can be reached at (732) 381-4200 extension 2115.

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