I love the ASHA convention. Why? It gives me an opportunity to not only see all the new products and offerings in the world of Speech Pathology, but a chance to sit down with the company reps to ask my questions and to actually try the product. NMES or E-Stim has been dominated in the world of dysphagia by VitalStim.
Ampcare is not new in the sense that they just started the company. Ampcare has actually been around and researching NMES (Neuromuscular Electrical Stimulation) for swallowing rehabilitation since 1993.
I actually touched on Ampcare in a previous post regarding electrodes for NMES, however at that time, they were working on FDA approval of the device, so there was little information available. I had received an email from Ampcare discussing their product, however it was very nice to sit down with Russ and Rick and to have them explain why they are superior in the NMES market.
The AmpCare electrodes are larger than other available electrodes. The reason for this is the smaller electrodes concentrate on a smaller area, creating a “hot-spot” which can be painful for our patients. The larger electrodes not only even the distribution of the stimulation, increasing patient comfort, they are made to fit directly over those submental muscles that target hyolaryngeal elevation and that anterior movement of the hyoid.
The electrodes offer low impedance (10 Ohms). The electrodes are latex-free. The VitalStim Electrodes offer impedance of 30 Ohms or less. This means more current running to a smaller area.
The electrodes were comfortable and I was able to tolerate a higher intensity of stim with the electrodes in place.
The electrodes can be placed as shown above or on the face to target the muscles of the jaw.
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!
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)
The Posture Device:
The posture device alone costs $100.00
The posture device was created to help those who need a little assistance in achieving and/or maintaining good posture while eating. The Restorative Posture Device (RPD) is indicated for those patients with :
- Head and neck alignment issue causing increased swallowing difficulty.
- Forward head on neck posture resulting in decreased range of motion.
- Weakness in the neck musculature.
This can also be used as a resistive device for a chin down exercise, similar to the Shaker or using the Neckline Slimmer as an alternative to the Shaker.
The NMES Device:
The biggest difference in Ampcare, to me, is the actual device. The device actually allows you to set your own parameters. The comparison between the Ampcare device and the VitalStim device is below.
Treatment Time 5-30 minutes up to 60 minutes
Ramp 1 second ?
Output 0-100 mAmps 25 mAmps
Frequency 5-50 Hz 80 Hz
Channel Single or Co-Contraction Dual
Phase Duration 50-250 MicroSeconds 300 MicroSeconds
Cycle Time 5/15, 5/20, 5/25 59/1
The main differences between the devices is the frequency, which can be adjusted for comfort level and to increase the mAmps with the Ampcare device.
The other difference is the Cycle time. VitalStim cycles 59 seconds on, 1 second off. This means a muscle contraction of 59 seconds. Ampcare has variable cycles with the time on always at 5 seconds. You can adjust the stim off from 25 to 20 to 15. The theory with this is that we are targeting Type II muscles, those fast-twitch muscles that contract and relax rapidly and fatigue easily. Contracting a muscle for 59 seconds is not a natural activity. A muscle contraction of 5 seconds is longer than the normal contraction time of the muscle during a swallow.
Ampcare teaches and uses what they call ESP (Effective Swallowing Protocol). This protocol involves 30 minutes of stimulation including 30 minutes of Mendelsohn Maneuver, Effortful Swallow and chin down (Shaker) exercise using the RPD. All swallows with stimulation on are completed with dry swallows.
When I asked AmpCare about the progress and maintenance of skills they see with patients, 3 of 5 patients they case studied were increased from NPO to an oral diet with no decrease in function since the end of therapy. They also have a video that they demonstrate showing the effect of the stim with the fluoro on with tremendous movement of the hyoid causing increased laryngeal elevation.
In summary, the differences of AmpCare:
- A 5 second “on” stimulation, mimicking more of the Type II muscle contraction.
- During the 5 seconds of stimulation, the patient exercises using a dry swallow as resistance.
- Food is presented to the patient during the “off” time of the cycle (time without stim)
- A posture device is used for a chin down resistive exercise, comparable to the Shaker
- Electrodes are place above the hyoid only, without the downward pull on the suprahyoids
- Frequency is lower, presenting increased comfort for the patient
- Electrodes are larger, targeting a larger area with larger dispersion of the stimulation
If you have any questions, the company can be reached by email.
Trainings are available by searching the website. Training costs just over $300 and includes freebies (One package of FDA 501k cleared Ampcare E-Series Electrodes, One posture device and the course material). *Prices are subject to change*
Want more information on Ampcare, the course or the device? Go to the Ampcare website to find out more!
**I do not currently use the Ampcare system, nor do I endorse it at this time. I have taken the training twice and HIGHLY recommend it!!!
Sproson, L., Pownall, S., Enderby, P., & Freeman, J. (2018). Combined electrical stimulation and exercise for swallow rehabilitation post‐stroke: a pilot randomized control trial. International journal of language & communication disorders, 53(2), 405-417.
Beavan, J. (2015). Update on management options for dysphagia after acute stroke. British Journal of Neuroscience Nursing, 11(Sup2), 10-19.
Watts, C. R. (2013). Measurement of hyolaryngeal muscle activation using surface electromyography for comparison of two rehabilitative dysphagia exercises. Archives of physical medicine and rehabilitation, 94(12), 2542-2548.
Martindale, N., Stephenson, J., & Pownall, S. (2019). Neuromuscular Electrical Stimulation Plus Rehabilitative Exercise as a Treatment for Dysphagia in Stroke and Non-Stroke Patients in an NHS Setting: Feasibility and Outcomes. Geriatrics, 4(4), 53.
Diéguez-Pérez, I., & Leirós-Rodríguez, R. (2020). Effectiveness of Different Application Parameters of Neuromuscular Electrical Stimulation for the Treatment of Dysphagia after a Stroke: A Systematic Review. Journal of Clinical Medicine, 9(8), 2618.