I’ve been using VitalStim Therapy for about a year now. I have to say I was a bit skeptical at first. I have been wanting to learn VitalStim for several years, but had not found a company that allowed it’s use until I started with my current therapy in July of 2009. Not only do they support VitalStim, they paid for the course for me and bought me the course CD’s.
I went to the course and learned more about dysphagia than I ever have. The instructors made dysphagia completely make sense to me!! It was a great format and I use the manual in therapy daily.
I also went from being the first full-time SLP in our hospital, struggling to start and maintain a caseload, to the most productive therapist in our building. I was doing approximately 90-150 VitalStim sessions a month from approximately last April through December. My numbers have dropped a little, but I blame the unpredictable Indiana weather for that.
I also decided to gather some data on my therapy. I want to PROVE to others that VitalStim works and have some data that I might be able to use in the future. I’ve actually had a lot of people ask me about VitalStim, so I thought the easiest place to put the results would be here on my blog!
First, I would like to say that I don’t simply place the electrodes and have the patient sit for the hour that the machine runs. I put my patients through a circuit of exercises, depending on what they need. My patients are hooked up to VitalStim for the full 60 minutes, unless they are unable to tolerate that time, then I adjust as needed. I have them exercise, each exercise for 5 minutes in “circuits.” Exercises include lingual exercises with resistance (lateral, protrusion, depression, elevation), using the Mendelsohn maneuver with water, effortful swallow with differing consistencies, bolus manipulation tasks, tongue base exercises as needed (yawn, gargle, pull tongue back in mouth), sucking pudding through a straw (when patient is able, they have to use a coffee stirrer) followed by effortful swallow and TheraSip microresistant straws using a hard suck followed by effortful swallow. The exercises while electrodes are placed are followed by the Shaker exercise when appropriate.
My patients and results are as follow: (HLE-hyolaryngeal excursion, TBR=tongue base retraction, P.S.=pharyngeal squeeze, P.S.=pharyngeal squeeze. FOIS=Functional Oral Intake Scale)
Female, 52 y.o. CVA, dysarthria, oropharyngeal dysphagia. Presented initially with decreased HLE, decreased lingual strength and ROM, decreased TBR, decreased P.S., penetration of thin liquids. Following 21 therapy sessions using VitalStim placement 2b, repeat MBSS showed no dysfunction. She increased her FOIS score from 6 to 7, her Eat-10 score decreased from 14 on the EAT-20 to 2 on the EAT-10. She went from a 2 to a 1 on the Penetration-Aspiration Scale. She had no further dysarthria.
Male, 61 y.o., CVA/TIA x4, presents with pharyngeal dysphagia. Initial MBSS revealed decreased HLE, decreased TBR, decreased P.R. with aspiration of thin liquids. Following 42 therapy sessions, VitalStim placement 3a, final MBSS showed only trace penetration with large bolus of thin. Small bolus was WFL. Patient increased FOIS score from 6 to 7, and decreased EAT-20 from 33 to EAT-10 7 (4 months later EAT 10 was at 2.) and decreased from an 8 to a 2 on the Penetration-Aspiration Scale.
Male, 85 y.o., TIA, oropharyngeal dysphagia. Initial MBSS revealed decreased HLE, decreased lingual strength and ROM, decreased TBR, decreased P.S. and silent aspiration of thin liquids. Patient attended 36 therapy sessions, VitalStim place 3a, changing to 3b. Repeat MBSS after 24 sessions revealed decreased lingual strength, decreased TBR, decreased laryngeal elevation, decrease TBR and decreased PS. Patient refused a 3rd MBSS following 36 treatment sessions. At d/c, patient, per re-assessment and palpation, increased HLE, increased lingual strength and ROM. He went from a FOIS 6 to 7, EAT 20 score of 13 to an EAT 10 score of 6. Penetration-Aspiration Scale from 8 to 2.
Female, 57 y.o., GERD, Barrett’s Esophagus (both treated), pharyngeal dysphagia. Initial MBSS revealed decreased lingual strength, decreased TBR, decreased HLE, aspiration of thin liquids. Patient attended 23 sessions at VitalStim placement 3a. She started at a FOIS score of 5, EAT-20 score of 29 and Penetration-Aspiration Scale score of 8. Patient quit attending ST after 23 sessions and has not contacted therapist since therapy.
Female, 68 y.o., lung CA (CN X involvement), oropharyngeal dysphagia. Initial MBSS revealed decreased lingual strength and ROM, decreased TBR, decreased HLE with silent aspiration of thin liquids and mixed consistencies) and decreased P.S. Following 82 sessions VitalStim placement 3a, switching to 3b with myofascial release of the neck and larynx, repeat MBSS, patient with mild decreased TBR, mild decreased PS and trace penetration with thin with straws which cleared upon completion of the swallow. Patient increased FOIS from 5 to 7, EAT-20 at 16, EAT-10 decreased to 0 and Penetration-Aspiration Scale decreased from 8 to 2.
Female, 60 y.o. with hypothyroid and oropharyngeal dysphagia. Initial MBSS revealed decreased lingual strength and ROM, decreased TBR and decreased PS. Due to insurance restrictions, patient was only allotted 5 therapy sessions and the initial MBSS. After 5 sessions at VitalStim placement 3b, patient had no further overt, clinical s/s aspiration. She increased her FOIS from 6 to 7, EAT-10 score decreased from 10 to 1 and Penetration-Aspiration Scale remained at 1.
Male, 62 y.o. with peptic ulcer, treated GERD and oropharyngeal dysphagia. Initial MBSS revealed decreased lingual strength and ROM, swallow response delay, decreased TBR, decreased PS. Patient had 24 sessions, using VitalStim placement 3b. Final MBSS revealed swallow function WNL. FOIS increased from 6 to 7, EAT-10 decreased from 31 to 8. Penetration-Aspiration Scale remained at 1.
Female, 76 y.o. with recent left lower lobe pneumonia and oropharyngeal dysphagia. Initial MBSS revealed decreased lingual movement, decreased TBR, decreased HLE, decreased PS, penetration with Nectar thick liquids and silent aspiration with thin liquids and mixed consistencies. Patient had 43 sessions, at placement 3a changing to placement 3b after 2nd MBSS revealed some improvement with swallowing, however aspiration persisted. Final MBSS revealed slight decreased TBR (improved from before), and flash laryngeal penetration x1 of 4 trials of thin liquids. FOIS increased from 5-7, EAT-10 decreased from 21 to 0 and Penetration-Aspiration Scale decreased from 8 to 1.
Male, 85 y.o. s/p ilius, DM and pharyngeal dysphagia. Initial MBSS with decreased HLE, decreased UES opening, decreased PC with aspiration of thin liquids and residue of pudding. After 25 sessions, VitalStim placment 3b patient with no overt, clinical s/s aspiration (doctor refused repeat MBSS). FOIS increased from 3 to 7, EAT 10 decreased to 0. Penetration-Aspiration Scale went from 8 to 1.
Male, 65 y.o. with severe COPD and pharyngeal orodysphagia. Initial MBSS revealed decreased mastication of solids, decreased lingual ROM and strength, decreased TBR, decreased HLE and decreased PS, laryngeal penetration with all consistencies, patient with c/o coughing to the point of passing out on several occasions at home and at restaurants. 43 sessions later, VitalStim placement 3b, repeat MBSS revealed slight decreased TBR and trace penetration of thin liquids. FOIS increased from 5-7, EAT-10 decreased from 48 to 10. Penetration-Aspiration Scale remained at 2.
Approximately 5 other patients started dysphagia therapy, however did not continue due to various reasons.
Overall, I have seen a significant improvement in my patients. I have not yet had severe patients, but all patients above have increased in their perception of their eating, have decreased overt clinical s/s aspiration and have overall increased quality of life in regards to eating/drinking.
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