Are All Electrodes the Same for NMES in Dysphagia Therapy?

NMES—Neuromuscular Electrical Stimulation—continues to be one of the most hotly debated tools in dysphagia therapy. While its use has been widely studied, the results of NMES research are mixed and interpretation varies across clinicians and facilities.

Whether you actively use NMES in your clinical practice or remain skeptical, it’s essential to understand the differences in electrode design, especially if you’re using NMES with the intent to drive improved swallowing outcomes.

NMES and Swallowing: What It Is—and Isn’t

NMES is not a cure for dysphagia. Slapping electrodes on a patient and flipping the switch will not magically restore safe, efficient swallowing. It’s a modality—a tool to be used in conjunction with exercise principles, based on neuroplasticity, and paired with functional swallowing tasks (Clark, 2003; Robbins et al., 2008).

Importantly, NMES primarily targets Type II (fast-twitch) muscle fibers, which are predominant in the pharynx and fatigue more quickly (Leelamanit et al., 2002).

That means electrode selection matters.

Why Electrode Design Matters

Most NMES devices for dysphagia require specific electrodes—often only sold after a provider completes a certification course. While price is a factor, so is impedance, current dispersion, adhesion, and comfort. Poor adherence may interfere with current delivery and make therapy uncomfortable or ineffective.

Here’s a breakdown of several electrode options currently available for dysphagia therapy.

---

Electrode Comparisons

🔹 Freedom Stim™ Electrodes

• Compatible with: VitalStim and Guardian units
• Patient Feedback: Feels similar to VitalStim electrodes
• Features:
  • Silver-coated carbon for low impedance
  • Uniform current dispersion
  • Dual-layer gel for improved adhesion
  • Latex-free
• Cost:
  • 12 for $159 ($13.25 each)
  • 50 for $595 ($11.90 each)

➡️ Pros: Excellent dispersion and gel quality
➡️ Cons: Similar adhesion challenges as VitalStim—may need taping

---

🔹 VitalStim Electrodes

• Industry Standard: Developed for dysphagia-specific NMES
• Requires Certification: VitalStim provider number needed
• Features:
  • Carbon + silver layer to decrease impedance (<30 Ohms)
  • Single-use design
  • Custom gel withstands full 60-minute sessions
• Cost:
  • 12 for $209 ($17.42 each)
  • 100 for $1,300 ($13.00 each)

➡️ Pros: Time-tested; consistent output
➡️ Cons: High cost; known for peeling during movement

---

🔹 Alternative Electrodes

• Reusable (Same Patient): Come in packs of 40
• Variety of Connectors: Mini-snap or pigtail
• Features:
  • Pure silver inner layer
  • Even signal dispersion
  • High conductivity
• Cost:
  • Butterfly with mini-snap: $108.50 for 40 ($2.71 each)

➡️ Pros: Affordable; reusable
➡️ Cons: Limited user feedback; uncertain clinical performance

---

🔹 ESwallow (ELI Premium Ag+)

• Patient Feedback: Thin tape, flexible but may peel
• Features:
  • Silver-carbon-silver construction
  • Ultra-low impedance
  • 35 mil gel for comfort and adherence
  • Designed for up to 3 uses
• Special Option: Solitary Plus for independent electrode placement

➡️ Pros: Strong dispersion, multiple-use design
➡️ Cons: Adhesion may still require wrapping

---

🔹 Ampcare Electrodes

• Comes with: Ampcare protocol & Restorative Posture Device (RPD)
• Features:
  • Pie-shaped electrode matches jaw curvature
  • Extremely low impedance (10 Ohms)
  • Reusable (single patient use, up to 10 sessions)
  • Latex-free, ISO certified
• Cost:
  • 40 electrodes for $119.50 (~$1.20 each, $0.24 per use if reused 5x)

➡️ Pros: Jaw-specific design, posture support, excellent value
➡️ Cons: Requires Ampcare protocol training for full benefit

---

🔹 Guardian Electrodes

• Similar to: VitalStim, ESwallow, Freedom
• Features:
  • Reusable design
  • Multiple sizes available
• Adhesion: Still may require wrapping for active patients

➡️ Pros: Familiar design
➡️ Cons: Similar adherence issues; limited differentiation

---

Price Summary (Approximate)

💡 Note: Prices are subject to change. Always verify with the supplier.

---

Final Thoughts

If you’re investing in NMES for swallowing therapy, don’t let cost be your only consideration. Look at how each electrode performs in terms of adherence, impedance, current dispersion, comfort, and versatility.

And remember: NMES is only as effective as the protocol, patient engagement, and exercises you pair it with. Functional, effortful swallows matter more than device settings alone.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

---

References

• Clark, H. M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology, 12(4), 400–415. https://doi.org/10.1044/1058-0360(2003/084)
• Robbins, J., Gangnon, R. E., Theis, S. M., Kays, S. A., Hewitt, A. L., & Hind, J. A. (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatrics Society, 53(9), 1483–1489. https://doi.org/10.1111/j.1532-5415.2005.53467.x
• Robbins, J., Butler, S. G., Daniels, S. K., Gross, R. D., Langmore, S., Lazarus, C. L., … & Palmer, P. M. (2008). Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. Journal of Speech, Language, and Hearing Research, 51(1), S276–S300. https://doi.org/10.1044/1092-4388(2008/021)
• Leelamanit, V., Limsakul, C., & Geater, A. (2002). Synchronized electrical stimulation in treating pharyngeal dysphagia. The Laryngoscope, 112(12), 2204–2210. https://doi.org/10.1097/00005537-200212000-00030