Dysphagia: How to Tackle the Difficult Pill to Swallow


What is dysphagia?


Dysphagia is a disorder of the swallowing system causing difficulty or inability to form bolus or to move bolus safely from the mouth to the stomach, potentially compromising both the efficacy and safety of swallowing.


Dysphagia can kill


This is not just an inconvenience. Impaired safety can cause severe complications such as aspiration pneumonia which is the main cause of mortality in stroke patients one year after discharge1 and also the main cause of death in neurodegenerative diseases such as Parkinson’s and ALS2.


Managing dysphagia


Dysphagia management strategies often focus on protecting the patient’s safety through compensatory strategies. However, compensatory methods lack efficacy in the long term. By comparing compensatory strategies with treatment strategies, we can see a more complete picture of how to manage dysphagia.
 

Treatment versus Compensation


•    Treatment approaches aim to restore lost function through interventions that produce muscle activity and facilitation.
•    Compensation approaches primarily aim to ensure the patient’s safety through strategies which minimize the impact of lost function.



Treatment Strategies Include:


• Oral intake trials
• Electrotherapy (NMES, intrapharyngeal stimulation, TDCS, rTMS)
• Biofeedback (sEMG, pressure)
• Effortful swallow
• Shaker exercise
• Oromotor exercise
• Thermotactile stim
• Mendelsohn
• Masako
 

Compensation Strategies Include:


• Head turn
• Chin tuck
• Diet modifications
• Supraglottic swallow

Compensatory strategies perpetuate and often reinforce the underlying impairments. The more a patient compensates, the less naturally they move, and the less the swallowing muscles are used.


Compensatory swallowing techniques instigate a safer swallow, but they put the swallowing muscles in a shortened position which disadvantages the muscle when contracting. In the long term this can have consequences.
 

Vicious Circle
 

Disuse of the muscles will only perpetuate the weakness.



Treatment interventions that produce muscle activity and facilitation will address the ‘weakness’ and have the potential to break the vicious circle and restore functional swallowing.


 

NMES Treatment Tool
 

The clinician needs tools that can help overcome the weakness without exposing the patient to unnecessary risk. NMES is such a tool - one that can deliver a therapeutically meaningful intensity of exercise.
 

The role of NMES in dysphagia treatment is to:
•    Increase swallow frequency.
•    Increase intensity of effort.
•    Increase facilitation of volitional effort through sensory stimulation.

 

 

VitalStim Plus – All in One
 

VitalStim Plus is an effective neuromuscular electrical stimulation device which helps recruit and re-educate muscles in the process of swallowing. Under the guidance of a clinician, patients partner in an interactive therapy that aids muscle strengthening to rehabilitate swallowing. Preset or customized programs allow the provider to truly customize treatments while biofeedback and visuals create a patient focused experience that encourages engagement and achievement of goals.
 

The VitalStim Plus Electrotherapy and sEMG Biofeedback System projects live treatment progress onto a computer or tablet screen. The Screen Mirroring technology allows clinicians to guide patients through personalized, targeted swallowing exercises. sEMG biofeedback helps to increase effort and duration of swallowing attempts and to improve coordination. It also offers the potential for objective evaluation of swallowing function and patterns.
 

Interested? Find everything on VitalStim at the Chattanooga International website.  
 

Admittedly, you need to be motivated to find our Chattanooga Intl website, but we want to change this. We’re working on a dedicated VitalStim one-stop shop. But VitalStim’s not the only thing we do: why not check out the other great information available on the website?

 


Training


As well as tools, the therapist needs to have the skills to know when and how to use NMES while managing patient-safety. Therapists can acquire this proficiency through the official training program organized by Chattanooga International Academy. If you are interested in acquiring training, please contact Francine Van Steenkiste at:

 

Francine.VanSteenkiste@DJOglobal.com



Reference list


1 Ickenstein GW. Diagnosis and Treatment of Neurogenic Dysphagia. Bremen: UNI-MED Verlag AG, 2011.
2Troche MS et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010 Nov 23;75(21):1912-9.