VitalStim
VitalStim Therapy is a type of NMES (neuromuscular electrical stimulation, or e-stim) specifically for swallowing. Patterened after the electrical stimulation used by physical therapists for improving muscle function in the extremities, it is a relative newcomer to the field of dysphagia therapy. Currently, there is not a lot of research to support its use (although there are a number of studies in progress), but anecdotal evidence of remarkable improvements in swallowing function in a relatively short amount of time abounds. E-stim is currently one of the most controversial topics among speech pathologists, with a split between those who hesitate to use an unproven technique with little supporting research to date, and those who want another technique in the "bag of tricks," research or no research.
My take on VitalStim? I think it has potential. I think it certainly deserves further study. I think there is probably something to at least some of the anecdotal reports (besides spontaneous recovery). However, I also think that, at least in some cases, there is a placebo effect, both for the patient who expects it to cause drastic improvements, as well as for the clinician who expects to see remarkable change. That said, if I were in a position to do so, I would likely become "certified" and offer it as an option to some of my patients on an experimental basis, with patients informed that it was still unproven, and I would keep careful records of all those on whom I trialed it -- more or less my own clinical trials.
With that said, I do not like how it has been marketed. At all. It seems to me that it was rushed to market with only one (very poorly done) study to back its use. Much of its support comes in the form of anecdotes. The general message from its proponents seems to be, "Everybody start using it now! Better evidence of efficacy will come along later." I think a lot of statements made about it are misleading or poorly informed. Just about everybody (with dysphagia) is a candidate, according to proponents, and it helps just about everyone improve (~98% is the oft-quoted number). The “contraindications” are laughable.
Now, none of these criticisms are reasons to completely discount the modality as a potential asset to dysphagia therapy, but they do indicate the need for critical thinking and honesty with patients. I’m sure I’ll be blogging quite a bit about VitalStim, since it’s such a hot topic currently, and also because the debate over it relates to a number of underlying issues in swallowing disorders and speech pathology in general.
My take on VitalStim? I think it has potential. I think it certainly deserves further study. I think there is probably something to at least some of the anecdotal reports (besides spontaneous recovery). However, I also think that, at least in some cases, there is a placebo effect, both for the patient who expects it to cause drastic improvements, as well as for the clinician who expects to see remarkable change. That said, if I were in a position to do so, I would likely become "certified" and offer it as an option to some of my patients on an experimental basis, with patients informed that it was still unproven, and I would keep careful records of all those on whom I trialed it -- more or less my own clinical trials.
With that said, I do not like how it has been marketed. At all. It seems to me that it was rushed to market with only one (very poorly done) study to back its use. Much of its support comes in the form of anecdotes. The general message from its proponents seems to be, "Everybody start using it now! Better evidence of efficacy will come along later." I think a lot of statements made about it are misleading or poorly informed. Just about everybody (with dysphagia) is a candidate, according to proponents, and it helps just about everyone improve (~98% is the oft-quoted number). The “contraindications” are laughable.
Now, none of these criticisms are reasons to completely discount the modality as a potential asset to dysphagia therapy, but they do indicate the need for critical thinking and honesty with patients. I’m sure I’ll be blogging quite a bit about VitalStim, since it’s such a hot topic currently, and also because the debate over it relates to a number of underlying issues in swallowing disorders and speech pathology in general.
posted by Speechy at 8:04 PM
5 Comments:
I hate it when a doctor would ask how we know something works, like VitalStim or DPNS, and there's really nothing to say besides something vague about the tools in our toolbox.
I like your take on it!
Yeah, I'm not a big fan of "vague" when it comes to explaining. I would much rather say flat out that we DON'T know for sure that a certain technique works, or which populations might benefit, but that it has a good theoretical basis (although this is questionable in VitalStim and NOT true for DPNS) and that it is being performed on an experimental basis. Honesty is the best policy when it comes to evidence-based practice (or lack thereof), I think.
i know this is an old blog but i just found it. i use vitalstim a lot and have found it to increase swallow function in about 95% of my patients.
the ones that didn't improve included - undiagnosed ALS, (diagnosed after extensive treatment with regression noted), 2-3 year post CVA, and a 2 year old with a degenerative disease (done on trial basis only).
the ones that improved included - cva patients with SEVERE - PROFOUND dysphagia, HANC (1 year post radiation/remission), generalized weakness.
It may not get them back to 100% but it's better than nothing.
I agree with you. I feel like this turning out to be the new "fad". We as SLPs need to strive to present and practice evidence based therapy. With minimal evidence in its favor, I am not comfortable recommending it. My employer has offered to pay for me to get certified, but have opted against it due to the paucity of evidence. I feel like its being used and almost abused in the SNF settings. I would love to see some credible research in its favor soon.
Another Speechy!
I work with peds and I frequently get asked what I think about it. I am with you- it may be useful, but we don't know how the little ones feel because they can't tell us- not to mention the difference in anatomy wreaking havoc on placements! I hear some horror stories and it is becoming way too commonly used as a 'catch-all' for kids with dysphagia.
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