[Dysphagia] RE: E-stim for dysphagia

[eripley at yahoo.com (Irene Campbell-Taylor)]

paul evitts <evitts_paul@hotmail.com> wrote:
I a Without seeing the VFSS, it's difficult to determine from a bedside what adequate laryngeal elevation 

I must disagree on two points. When taught properly and adequately praticed it is easy to identify adequate movement of the hyoid - it is not laryngeal elevation that needs to be measured. It's the anterior movement of the hyoid that opens the UES, inadequate movement being possibly the most common swallowing impairment.

 what better way to quantify the efficacy of the treatment than to be able to measure hyoid movement based on the VFSS or to verify decreased aspiration/penetration

I believe the writer was referring to the use of VFSS for electrode placement. VFSS. according to Groher, Logemann, Shaker, Kahrilas. et al is not used to identify the presence or absence of aspiration. The best measure is the one that should be the outcome measure/goal of all intervention. i.e improved nutrition and hydration which is the primary reason for intervention in the first place and the only way to measure effectiveness of treatment. Aspiration of oropharyngeal contents is not necessarily harmful and the constant confusion of pneumonitis with pneumonia confounds every investigation.

.  Finally, although vital stim may not directly affect the "muscles of the pharynx" (I'm not sure where this quote came from)

>From the VitalStim advertising.

, it does directly affect the pharyngeal area itself - increased laryngeal (hyoid) elevation results in decreased pharyngeal residue and increased protection of the airway (both, I assume, the primary purpose of vital stim).

Again, the primary protection of the airway is not laryngeal/hyoid movement but anterior arytenoid movement against the base of the epiglottis with contraction of the lateral and oblique arytenoid muscles. I refer you to work by Kahrilas, Logemann, Shaker, Rademaker and others mainly in the American Journal of Physiology. I would hope that the primary purpose of VitalStim was to increase the probability of the bolus's entering the esophagus - a subtle but important difference taking away, as Groher, Logemann, Martin-harris and others have urged, the "misguided emphasis on aspiration."





Dr I Campbell-Taylor
Clinical Neuroscientist
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