Contraindications

Contraindication (noun): something (as a symptom or condition) that makes a particular treatment or procedure inadvisable

From Wikipedia: In medicine, a contraindication is a condition or factor that increases the risk involved in using a particular drug, carrying out a medical procedure or engaging in a particular activity.

VitalStim has a list of oft-repeated contraindications for their their therapy:

The contraindications for VitalStim Therapy are specific to patients suffering from dysphagia. Caution should be used with patients who have cardiac demand pacemakers. Its use is contraindicated with patients who are severely demented and exhibit non-stop verbalization. Constant verbalization could result in aspiration during trials of oral intake. VitalStim Therapy is also contraindicated in patients with significant reflux due to use of a feeding tube. Such patients are prone to repeated cases of aspiration pneumonia, and the VitalStim Therapy device has not been studied in this population. Use of the VitalStim Therapy device is contraindicated in patients with dysphagia due to drug toxicity. Patients suffering from drug toxicity could aspirate during trials of oral intake.

Quite an odd assortment of “contraindications,” if you ask me. Let’s look at them individually:

Its use is contraindicated with patients who are severely demented and exhibit non-stop verbalization. Constant verbalization could result in aspiration during trials of oral intake.
You think??! How about, “VitalStim would not be effective since the primary cause of aspiration in these patients is most likely decreased oral control due to nonstop verbalization, which VitalStim cannot fix”!

VitalStim Therapy is also contraindicated in patients with significant reflux due to use of a feeding tube. Such patients are prone to repeated cases of aspiration pneumonia, and the VitalStim Therapy device has not been studied in this population.
Only due to a feeding tube? What about severe reflux, period? And, yes, these patients are prone to repeated pneumonia/pneumonitis due to the reflux, but that is because of aspirating acidic gastric secretions. And the device “hasn’t been studied in this population”? Well, neither has it in many of the rest of the populations it’s claimed to work for.

Use of the VitalStim Therapy device is contraindicated in patients with dysphagia due to drug toxicity. Patients suffering from drug toxicity could aspirate during trials of oral intake.
Couldn’t most patients who are VitalStim candidates aspirate? I mean, that’s usually a large part of why they’re getting the therapy, right? Why separate out “due to drug toxicity”? And do they mean “due to a drug side effect” or actual toxicity (e.g., digitalis toxicity)?

So everybody else is guaranteed not to aspirate during po trials?

The word contraindication means that there will likely be negative effects if a particular treatment is used. For instance, nitroglycerin is contraindicated in patients with low blood pressure as it will drop blood pressure even further, potentially causing severe hypotension (with all its accompanying adverse effects). None of these “contraindicated” things listed above are really contraindications to VitalStim therapy itself -- they are more “who is a good candidate?” The only two that are even halfway decent are the pacer precaution and the contraindication to passing current through an area of active neoplasm (not listed in the blurb above, but found elsewhere in the VitalStim literature). Those two make sense. The others appear to have been cobbled together to give the impression of a responsible company -- see, it’s not for everyone, there *are* contraindications. Really, a clinician with even a marginal amount of critical thinking should be able to determine that those patients listed above may require alternate approaches besides “swallowing therapy.” Nothing about these diagnoses suggests that e-stim would be particularly appropriate or effective in decreasing aspiration for these patients.