VitalStim Therapy

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.

Rosenbek, JC, Robbins, J, Roecker EV, Coyle, JL, & Woods, JL.  A Penetration-Aspiration Scale.  Dysphagia  11:93-98, 1996.

 Crary MA, Carnaby Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake
scale for dysphagia in stroke patients. Arch Phys Med Rehabil 2005;86:1516-20.

9 thoughts on “VitalStim Therapy

  1. Great post! I have been skeptical e-stim for dysphagia for a while but I hear lots of positive anecdotal evidence, such as you provided, including a grad school friend of mine whose current building considers it best practice. I would most definitely be willing to take the course, but its timely and costly…neither of which are qualities that my current job finds appealing 🙂 Do you know of any literature or references that discuss e-stim that isn't associated with Vital Stim?

  2. This is a great post…but of course there is no “control” group that did not have Vital Stim. Obviously you did this before you used Vital Stim. Have you thought of having a control group of sorts (or documenting what you have seen without Vital Stim) to see the difference between using strategies with and without Vital Stim?

  3. @Nisha, this is just basically what I've had with my VitalStim. Not really doing a study, but everyone keeps asking me how I like Vitalstim and what kind of results I've seen with it. Just posted on here to make it easier for everyone to access.

  4. Hi,
    Can you do Vitalstim treatment on young babies? as our daughter was born with no suck or swallow her secretions are terrible and she is unable to swallow them. We were wondering whether we should look into vitalstim treatment. SHe is 6 months old is this too young ? Thanks Mark

  5. I know a lot of therapists are certified and do VitalStim with babies in the NICU. I would search on the VitalStim website for a therapist who is trained near you to discuss and set up an evaluation. I personally don't use VitalStim with peds, mainly because I'm not certified with peds and I generally don't work with peds. Hope this helps!

  6. Very cool site. You are certainly doing due diligence in documenting outcomes with VST. I've been using it for 8 years and have had much success…overall.
    I work in an acute hospital and outpatient center in Missouri. I am very interested in how you are marketing dysphagia services with VST…90 to 150 sessions a! what are you doing to draw them in??
    Jim in Missouri.

  7. Great Site!
    My son is 17 months and is eating blended food only. Aspirates on thin liquids. He has a developmentally delays and we started vital stim ( 3 sessions for 3 weeks). He showed some improvement and my question to the experts is:
    1. Is there an optimal ampereage (current)/pulse strength that is recommended for childrens.
    2. Can the ampereage (current( / pulse strength be taken upto 25 milli amperes or more or is it on a case to case basis?
    3. What are the risks of increasing the current / pulse strength in children? will the child regress?

    A desperate parent looking for guidance, input, advise, thoughts and comments.

    Thank you in advance.

  8. So far my patients have maintained from several months to several years. VitalStim is not a cure. It's the exercise and work they did. VitalStim was simply a modality we used to get them better. I stop the VitalStim before they are discharged. In fact, many patients use VitalStim for a few weeks, then we work without the stim. Most of the lasting effects are from the muscle changes from correct swallow technique and strengthening exercises.

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