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.
Most companies will require certification in use of their equipment to be able to purchase an NMES device or the electrodes. You will input your number or code that is unique to you.
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 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.
*From the website* 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.
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.
- 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 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
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.
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 ofcurrent 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 tothe same amount of current concentration as what the VitalStim electrode withstandsduring 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.
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
I have not personally had the opportunity to use these electrodes.
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
*From the website
Many electrode manufacturers sacrifice quality for economy – not us. All electrodes supplied by Alternative Electrodes 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.
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 “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
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.
The electrodes are also cost-effective. There are 4 electrodes per package. Which, if used in only one placement, hyoid or face can last 10 sessions. The cost for 10 packages of electrodes (40 electrodes) will be $119.50. To buy 400 electrodes or 100 packages the cost would be: $895. That would be 400 electrodes or 2000 sessions!
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.
Freedom Electrodes: 12 Electrodes, single use $159 ($13.25 each)
Vital Stim Electrodes: 12 Electrodes, single use $209.00 ($17.42 each)
Alternative Electrodes: 40 Electrodes, single use $ 108.50 ($2.71 each)
AmpCare Electrodes: 40 Electrodes, Use 5 times $119.50 ($1.20 each or with 5 uses-.24 cents each)
*Prices may be different than what is listed here as prices are subject to change.*