Electrodes…..Are they really all the same??

One of the biggest controversies in dysphagia therapy has to be NMES or Neuromuscular Electrical Stimulation, to use it or to not use it.  It has been extensively researched, although results of the research vary.

Whether you believe in NMES for dysphagia or use NMES, you need to understand the facts between the electrodes.  It’s not just about cost, the construct, impedance and versatility are also important.

One important thing to remember is that if the electrodes pull away from the patient, not only can it be uncomfortable for the patient but can interfere with your treatment.

VitalStim is the only company I’m aware that will only sell their electrodes given a certified clinician number, meaning that you HAVE to be certified in the modality to purchase the equipment.

The only training I have attended is VitalStim, which was worth every penny.  Whether you use the modality or not, the training is priceless with all the valuable information you gain.

One thing to remember is that NMES is not a cure.  Slapping the electrodes on a patient and turning on the machine will not make them swallow.  It is a modality, meaning that it may help improve the swallow when paired with swallowing exercises.

NMES stimulates Type II muscles, those fast twitch muscles predominant in the pharynx.  These are also the muscles that fatigue at a faster rate.

I have compiled information from websites (as available) regarding each of the electrodes available (of which I’m aware) for dysphagia therapy.

I do not endorse any of the electrodes.

Freedom Electrodes

Freedom Electrodes are distributed by North Coast Medical.  These electrodes are very much comparable to the VitalStim electrodes and work with the VitalStim and Guardian units.  

The tape holding the electrodes feels much like the VitalStim tape and the build of the electrode is much the same.

My patient who has used the eSwallow, VitalStim and Freedom electrodes stated that the Freedom Electrodes feel much like the VS electrodes.

The uniform current eliminates hot spots and provides maximum treatment across the entire electrode surface.
  • Freedom Stim™ Dysphagia Electrodes work with existing NMES devices for the treatment of dysphagia. 
  • Silver (Ag) coated carbon film for reduced impedance, greater conductivity and uniform current dispersion. 
  • Higher posts allow better adherence to the lead wires during treatment.
  • High quality, dual layer of gel formulated will adhere better during treatment. 
  • Gel does not separate from carbon. 
  • Latex Free.
Each kit contains:
  • (2) Tan Foam 2″ x 3.5″ (5cm x 9cm) Butterfly w/Snap Electrode.
  • (3) Skin-Barrier Wipes.
  • (3) Lotion Packets.

Freedom Stim™ 
Dysphagia Electrodes




Why Choose 
Freedom Stim™ Electrodes


  • Silver (Ag) Coated Carbon Film for Reduced Impedance, 
    Greater Conductivity and Uniform Current Dispersion.
  • Extra Long 6” Pure Copper Lead Wires with Dispersive Heads. 
    Helps to Prevent Wire Pull-Out from Body of Electrode.
  • High Quality Gel for Optimal Skin Adhesion.
  • Gel Does Not Separate from Carbon.
  • Excellent Customer Support.
  • Prompt Turnaround Time on Orders.
  • Competitive Pricing.



Freedom Stim™ Electrode Conduction





Freedom Stim™ Electrode Current Dispersion


  • The unique manufacturing processes and material used in Freedom Stim™ electrodes provide a uniform current dispersion throughout the desired treatment site of each electrode. This uniform current dispersion eliminates “hot spots” and provides the maximum treatment to the entire electrode surface.

  • A leading brand electrode and a Freedom Stim™ electrode are placed on a “Current Dispersion Meter”. An electrical current is passed through each electrode for a period of 60 seconds. The electrical voltage output is identical for each electrode. Results are shown at right.

  • The Freedom Stim™ electrode displays optimal current dispersion while the leading brand treats less than 50% of the surface, mainly where the wire is placed.


The difference is clear…


Current is concentrated in a small area, creating a “hot spot” that is less effective.


Freedom Stim™ electrodes are able to fully disperse the electrical current throughout the entire surface of the electrode.

The cost:  12 electrodes for $159 or $13.25/each
                30 electrodes for $379.95 or $12.65/each
                 50 electrodes for $595.00 or $11.90/each


VitalStim Electrodes

From personal experience, I have to wrap the VS electrodes or whenever the patient moves, they do tend to pull away from the skin.

The VitalStim electrodes are designed for single use. 

VitalStim virtually pioneered the NMES drive for dysphagia therapy.  It’s become the branded name, not unlike Kleenex or Coke.  

When ordering VS electrodes, you have to have a VS number to order, preventing untrained clinicians from ordering supplies.

From the electrode fact sheet:


The VitalStim electrode was specifically engineered to cope with this challenge of the 
dysphagia therapy environment. 

The conductive carbon film is covered by a layer of silver to decrease impedance. The snap is 
secured to the carbon by a patented conductive bond tape. This assembly is 
covered by the foam cover and finally the tape patch that connects the electrode pair. 



Impedance 

To ensure low impedance, an extra layer of silver was added between the carbon and the 
gel. In addition, a special gel was used that could withstand a full 60 minutes of current 
flow. The gel was later improved to provide better adhesion. This construction results in a 
consistent impedance rating of 30 Ohms or less (excellent). 

The impedance (resistance to current flow) of an electrode increases with the amount of 
current that flows through it.   Each square inch of the VitalStim electrode is exposed to a current load that is 20 x higher than an electrode that is used during a typical NMES protocol. In other words, only after 20 
typical NMES treatment sessions will the typical NMES electrode have been exposed to 
the same amount of current concentration as what the VitalStim electrode withstands 
during a single session. The electrode used during VitalStim Therapy must therefore be 
one that is able to carry this current load without increasing in impedance.

The cost:    12 for $209.00 or $17.42/each
                  30 for $450.00 or $15.00/each
                  50 for $675.00 or $13.50/each
                  100 for $1300.00 or $13.00/each

Alternative Electrodes

I have not personally had the opportunity to use these electrodes.  

There is not a lot of information on the website, so I hope to soon receive a sample pack to try the electrodes.  On myself, not my patients!

All shipments are in bags that contain ten 4-packs, or 40 individual electrodes. These are reusable electrodes (on the same patient).

All electrode orders include paper tape.  Skin prep pads are included with snap electrodes only.  Additional tape and pads are available if needed.

Save money on shipping by ordering more than one bag.  Shipping and handling is $8.95 per order (regardless of the size of your order). Shipments are made by Fed-X or UPS Ground (no PO Boxes please). Shipments are usually made within 24 hours of receipt of your order, depending on inventory.

Overnight shipping is available upon special request at $35.00 per order. 

1.   .8″ round electrode with mini-snap connector            $98.50 per bag*
2.   1″ round electrode with mini-snap connector             $102.50 per bag*

3.    Butterfly electrode with min-snap connector              $108.50 per bag*

4.    .8″ round electrode with pigtail connector                   $72.50 per bag*
5.   1″ round electrode with pigtail connector                     $75.00 per bag*

* each bag contains ten 4-packs, or a total of 40 electrodes


Quality Construction

                           
             AlternativeElectrodes          Most competitive electrodes

Many electrode manufacturers sacrifice quality for economy – not us.  All electrodes supplied by AlternativeElectrodes use a high-performance, specially applied layer of pure silver inside our electrodes. This highly-conductive layer of pure silver disperses the electrical signal quickly and evenly over the entire surface of the electrode resulting in a more comfortable and more effective treatment for the patient.


The tape material holding the ESwallow electrodes is thin and a bit more flexible, however I still had to wrap the neck to ensure that the material did not pull away from the patient as they moved and ate.

With the thinner tape holding the electrodes, the actual electrode pulled away from the tape upon removal of the electrode after the session was over.

The ELI Premium Ag+ has a bold new look and even better performance.  The newly re-formulated electrode may be used for up to 3 treatment sessions on an individual patient.  The extremely low impedance electrode features total surface dispursion.  This makes the ELI Premium Ag+ the most advanced electrode on the market, delivering improved therapeutic results and greater patient comfort.  2 electrodes are conveniently pre-positioned on each butterfly shaped electrode patch.

The solitary plus electrode kit features the same, high performance electrode used in the ELI Premium Ag+. But, each electrode resides on it’s own self-adhesive patch.  This allows the SLP to have maximum control over the exact placement of the electrodes. 

The ELI Premium Ag+ is manufactured from an advanced silver – carbon – silver film.  A layer of carbon is sandwiched between two layers of silver chloride for complete dispersion of current.  A high quality 35 mil gel (compared to competition’s 25 mil gel) ensures maximum conductivity between the electrode and target muscle.  The result is an electrode with extremely low impedance.  Lower impedance means improved therapeutic results and greater patient comfort.



Ampcare

This is a newer company to me.  I first learned of this company on Twitter.  I went to their website, which gave me virtually no information.  This company has designed an NMES system that conducts stim to the submental muscles.  They offer a protocol called ESP (Effective Swallowing Protocol).  

I could only find one piece of information on ESP through a Google search.  In this slide show which was presented, the “RX3ESP utilized a portable muscle stimulator using pulsed electrical current to depolarize nerve endings and produce a muscle contractions.”  5 patients were studied using this protocol.  Sessions were 30 minutes using 3 exercises 10 minutes each:  a modified Shaker using their posture device, the Mendelsohn Maneuver for 4 seconds followed by a swallow and the Effortful Swallow.  Of the 5 patients, 2 patients returned to full oral diet.

I have contacted the company multiple times with no response to date.  There is no information on the site regarding construct of the electrodes nor can I find any efficacy for use of this system.

**UPDATE:

Ampcare responded!

Unfortunately, they do no provide samples of their product.  You can receive their products when you attend the training.

Ampcare “utilizes any portable powered muscle stimulator that will house our parameters, Ampcare’s patented E-series FDA cleared pie shaped electrodes and a neuro-orthosis to address posture and add a resistive load to the exercise program.”

Ampcare began research in the US in 1997 with completion of a controlled trial in 2007.

The Ampcare electrodes are made to:

  •   Specifically designed to match the curvature of the jaw line.
  •   Made with a unique composition and highest quality materials.
  •   Extremely low impedance (10 Ohms) with total surface dispersion.
  •   Reusable, pre –gelled, self adhering, single patient use electrodes.
  •   Latex free, ISO Certified, made in the USA and up to 5 times cost
    savings.

Ampcare also offers a Restorative Posture Device (RPD)

AMPCARE Restorative Posture Device (RPD) is indicated for patients that present with poor neck posture. This includes any individual with a:

  •   Head and neck alignment issue causing increased swallowing difficulty.
  •   Forward head on neck posture resulting in decreased range of motion.
  •   Weakness in their neck musculature.

Guardian

The Guardian electrodes, are made much the same as the other electrodes (Eswallow, VitalStim, Freedom) with a flexible tape, which still requires wrapping to ensure that the electrodes stick through movement.  

One difference with Guardian is that they advertise the electrodes as reusable.

The electrodes come in a variety of sizes as does Eswallow and Alternative electrodes.





        




Which electrodes do you believe work the best??

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