[Dysphagia] vital stim & mentally retarded population

[bsonies at comcast.net (Barbara Sonies)]

Hurrah!!!!!!


On 9/7/07 1:56 PM, "Suzanne Morris" <sem at new-vis.com> wrote:

> I am not trained in VitalStim and thus, do not consider using it in
> my practice.   I have had extensive experience with individuals who
> have severe and profound developmental disabilities.  Many of these
> individuals who have severe swallowing problems also have substantial
> problems with muscle tone and movement coordination throughout their
> body.   The swallowing issues, in my experience, are rarely an issue
> of the oral-pharyngeal mechanism independent of what is going on in
> the rest of the body.   The mouth and pharynx are very much
> influenced by head and trunk position, postural tone and reflexive
> movements.  You may be able to stimulate specific muscles in the neck
> that influence the physiological swallow, but this is going to be in
> strong competition with the shifts in tone and movement that occur on
> a daily basis with reflexes that respond to the vestibular input of
> gravity and the proprioceptive stimulation of muscles in the neck.
> 
>  From time to time I view videotapes of children who are receiving
> VitalStim.   Their parents will be participating in an intensive
> workshop that I teach or I will be seeing the kids themselves for
> assessment and treatment at a later time.   I just reviewed one of
> these recordings yesterday which shows a VitalStim session.  It was
> very similar to others I have viewed in the past.  In this instance
> the client was a young pre-teen boy who had been in a near-drowning
> accident as a toddler.   He shows stiff extension throughout his body
> and strong hyperextension of his head/neck in all positions. While
> sitting in his wheelchair his trunk is pulling down toward the left
> side and there is increased tension and shoulder girdle elevation on
> the right side.  His ribcage is stiff and shows slight movement
> predominantly in the upper thoracic and clavicular areas.  His jaw is
> open widely in a thrust position and there is limited jaw movement.
> There is minimal movement of the facial muscles at rest or with
> emotion.  The electrodes for the VItalStim are on his neck and I
> assume that stimulation is occurring throughout the session. In the
> filmed treatment session the therapist stimulates his mouth with a
> cotton swab with taste and then with small spoonfuls of pudding.
> The stimulation of the mouth itself elicits greater lip/cheek
> movement and some purse-string closure of the lips; slight downward
> pressure of the spoon on the tongue stimulates a very weak and
> inconsistent backward-forward suckle motion of the tongue.  There is
> intermittent coughing up of mucus and food, usually occurring after
> the 3rd or 4th spoonful of pudding.   This suggests to me that a
> swallow is not being triggered (despite the therapists comments that
> he has swallowed).  I think that food i simply falling over the back
> of the tongue and disappearing into the valleculae and pyriform
> sinuses until they fill up and trigger the cough.    What concerned
> me the most about this session is that his head was in severe
> hyperextension the whole time and at times went into greater
> extension with the oral stimulation.  The therapist was working on
> lip closure and swallowing but with a wide-open jaw.   We know that
> neck hyperextension can increase extensor tone in the jaw and reduce
> oral coordination.  Mechanically it is extremely difficult to get a
> good and efficient swallow with the head pushing back into extension.
> 
> So my question is a common-sense one.  Why do we choose to use a
> specialized piece of equipment (VitalStim) to stimulate specific
> muscles in the neck for swallowing (even assuming that this does
> work) when the underlying foundation for the swallow really isn't
> there?   This therapist and family have continued with VitalStim
> because the child's MBS has shown some "improvement over time" (I
> haven't seen copies of the MBS reports so I don't know the
> specifics).  But even if there is some improvement in this artificial
> setting, how does this relate to his life and to how we choose to
> spend our time and money to improve swallowing function?
> 
> I have worked with numerous children whose physical involvement and
> cognitive impairment was similar to that seen in this boy.  The focus
> of treatment has been on working in an integrated way with postural
> tone and movement to reduce tone and the constant stimulation of
> reflexive movements.   A major focus has been to reduce the extension
> patterns in the body and neck and help the child learn how to get a
> "soft body" or "soft neck" just with a verbal or touch reminder. This
> is combined with oral stimulation of the suckle to elicit a stronger
> and more sustained suckle-swallow movement pattern.  I have found
> that this has been highly effective, and children have learned more
> functional swallowing skills (especially for handling their own
> secretions and reducing the amount of drooling or need for constant
> suctioning to clear the airway) without any electrical stimulation of
> the swallowing muscles.
> 
> Suzanne
> __________________________________
> Suzanne Evans Morris, Ph.D.
> Speech-Language Pathologist
> New Visions
> 1124 Roberts Mountain Rd.
> Faber, VA 22938
> (434) 361-2285 ext. 5
> www.new-vis.com
> 
> 
> On Sep 7, 2007, at 11:36 AM, Michele.Graziadei at dhs.state.nj.us wrote:
> 
>>  Does anyone have any information regarding Vital Stimulation
>> Therapy with the severe and profound developmentally disabled
>> population (MR)?  I presently am employed at a residental facility
>> for the MR population -mainly severe & profound whom are not able
>> to follow directions. Thanks!!!!!
> 
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