Surface Electromyography (sEMG) has been used in dysphagia therapy for several years with research to support its use. sEMG has been called one of the oldest treatments used with dysphagia.
sEMG is a use of visual biofeedback. Electrodes are attached to the submental muscles, or those hyolaryngeal complex elevators. This is measuring the “strength” or muscle contraction of the swallow as you have your patient swallow, then swallow with greater effort.
The electrodes are attached to a box or computer that gives a visual output and measures the strength of the swallow, allowing the patient to see their effort, rather than relying on simply feeling the effort.
The Promethius Group is one of the companies that manufactures and sells sEMG devices.
ACP (Accelerated Care Plus) has been around for quite some time. They supply neuromuscular electrical stimulation (estim) equipment for PT and OT in Skilled Nursing Facilities (SNF) and rehabilitation centers. They are also the company that provides the Omnicycle and OmniVR (similar to the Wii with rehabilitation goals programmed into the product.
ASHA Convention 2014
ACP was at the 2014 ASHA Convention with a brand new product!! Synchrony was introduced as ACP’s new contribution to sEMG in dysphagia therapy.
Components of Synchrony
One of the components of Synchrony is Omnistim FX: Patterned Electrical Neuromuscular Stimulation (PENS). This is the ACP brand of estim for dysphagia.
Synchrony also offers OmnisEMG, which is a great way to let your patient visualize the length of time they hold a Mendelsohn Maneuver or the increased strength they apply to the effortful swallow.
You are able to evaluate your patient’s swallow using Synchrony to start your baseline data to create your treatment plan.
There are various screens from which your patient can work.
What Does the System Include?
ACP states that the system includes:
“System Installation and Speech Language Pathologist Training”
- Initial installation includes basic system operation.
- All subsequent training includes CEU-Approved Education and Lab Training.
- A 5-hour “on-site” course around ACP’s OmnisEMG system.
- A 7-hour “seminar-style” course can be provided for multiple facilities.
- A 2.5 hour “on-site” course for the Omnistim FX2 PENS system is provided
- ACP is an ASHA Approved Continuing Education Provider
With extensive training and support provided, the OmnisEMG seems like a viable option for sEMG.
I was most impressed with the size of the screen, which allows our patients with decreased vision or visual deficits to be able to see the graphs and images on the screen.
The system seemed incredibly easy to use and easy to learn. If you work in a facility that utilizes ACP equipment, it may be worthwhile looking into the Synchrony system for sEMG.
First you take the electrode and apply it to the patient:
Enter the patient history:
You can choose assessment or exercise. Assessment allows you to set the baseline and measure progress.
You can select the muscle group which you will measure contraction.
There are 4 ways to visual the exercises. Bar graph, line graph, Work-rest cycle and Kangaroo Exercise:
You also set the parameters.
References for sEMG:
Yoshida, M., Groher, M. E., Crary, M. A., Mann, G. C., & Akagawa, Y. (2007). Comparison of surface electromyographic (sEMG) activity of submental muscles between the head lift and tongue press exercises as a therapeutic exercise for pharyngeal dysphagia. Gerodontology, 24(2), 111-116.
Crary, M. A., Carnaby, G. D., & Groher, M. E. (2007). Identification of swallowing events from sEMG signals obtained from healthy adults. Dysphagia, 22(2), 94-99.
Crary, M. A., & Baldwin, B. O. (1997). Surface electromyographic characteristics of swallowing in dysphagia secondary to brainstem stroke. Dysphagia, 12(4), 180-187.
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.
Crary, M. A., & Groher, M. E. (2000). Basic concepts of surface electromyographic biofeedback in the treatment of dysphagia: a tutorial. American Journal of Speech-Language Pathology, 9(2), 116-125.
Benfield, J. K., Everton, L. F., Bath, P. M., & England, T. J. (2019). Does therapy with biofeedback improve swallowing in adults with dysphagia? A systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 100(3), 551-561.
Stepp, C. E., Britton, D., Chang, C., Merati, A. L., & Matsuoka, Y. (2011, April). Feasibility of game-based electromyographic biofeedback for dysphagia rehabilitation. In 2011 5th International IEEE/EMBS Conference on Neural Engineering (pp. 233-236). IEEE.
Yoon, T. L. (2018). Surface Electromyography Evaluation Method for Dysphagia: A Literature Review. Swallowing Rehabilitation, 1(2), 35-40.
Crary, M. A., Carnaby, G. D., & Groher, M. E. (2006). Biomechanical correlates of surface electromyography signals obtained during swallowing by healthy adults. Journal of Speech, Language, and Hearing Research.