Neuromuscular electrical stimulation (NMES) is a therapeutic modality that uses electrical impulses to contract muscles. While VitalStim® is a type of NMES used to treat dysphagia.
How is NMES used in the rehab world? What’s the recent evidence? And how can you learn more about NMES for adult speech therapy?
In this post, we explore these questions to help you make informed choices in your dysphagia practice.
For our bestselling patient handouts and worksheets, check out the Adult Speech Therapy Starter Pack!
More Popular Articles
What Is Neuromuscular Electrical Stimulation?
Neuromuscular electrical stimulation is a modality that’s been used in the rehab therapy world for decades.
During NMES, electrodes are placed on the skin over the target muscle groups. These send electrical impulses to the nerves which in turn cause the target muscles to contract.
The electrodes are connected to a controller unit where the therapist can adjust the parameters of the electrical impulses sent to the patient.
NMES in PT and OT
Our physical therapy and occupational therapy colleagues use NMES to improve functional movement, range of motion, and muscle atrophy for their patients with spinal cord injuries, strokes, and TBIs.
Beyond this more traditional rehab, NMES has been shown to improve impaired muscle function after surgery and in patients with chronic diseases including heart failure and COPD, amongst other diagnoses (Manske et al, 2007).
OTs and PTs sometimes use the term ‘Functional NMES’ to emphasize that their treatment uses NMES during functional activity, such as grasping or walking.
NMES for Adult Speech Therapy
NMES is most commonly used in adult speech therapy to treat dysphagia. The electrodes are placed on the patient’s neck to stimulate the muscles used for swallowing.
On top of an extensive understanding of swallowing anatomy, assessment, and treatment, the therapist must be skilled in how to use the NMES device.
There’s been a lot of research on NMES for dysphagia–with historically mixed results. ASHA, for example, concludes that the benefits of NMES remain unclear.
In a 2019 literature review of randomized controlled trials, 10 out of the 11 studies found that NMES improved the swallowing function of patients with dysphagia post-stroke in all outcome measures, compared to control groups (Alamer et al, 2019).
While a 2022 randomized controlled trial studying dysphagia related to Parkinson’s disease found that adding surface electrical stimulation to traditional dysphagia treatment did not significantly improve outcomes (Baijens et al, 2022).
What’s a therapist to make of this?
While you’ll have come to your own conclusions, much of the research recommends the need for consistent standards for NMES treatment.
Differences in study design and how therapists use NMES play a major role in the results.
For example, another 2022 literature review found that while all of the included studies showed positive outcomes for oropharyngeal dysphagia treated with sensory-NMES, the study designs and procedures varied a lot, muddying the waters (Speyer et al. 2022).
VitalStim® for Adult Speech Therapy
While there are several NMES devices for dysphagia, VitalStim® is the best known. They also have a certification program that’s approved for ASHA CEUs.
Visit their website for details on the certification.
Below, SLP mentor Alisha Kleindel, MS, CCC-SLP shares her experience using VitalStim® (NMES) to treat dysphagia.
What patients are good candidates for VitalStim®?
I feel that good candidates for VitalStim® are those that are very motivated to improve their dysphagia, are able to follow consistent commands, and have relatively intact cognition. It is also most appropriate for patients with more acute dysphagia; however, there is research supporting use in patients with more chronic dysphagia.
Patients who aren’t appropriate for VitalStim® include severely demented patients, those with significant reflux, active cancer (particularly of the head/mouth/throat area), or an active infection in the neck. There’s also limited support for patients with ALS or Bell’s Palsy. Always check with a doctor if a patient has a pacemaker, deep brain stimulator, or experiences seizures as well.
In your clinical experience, what are the pros and cons of using VitalStim®?
I have found VitalStim® to be a very effective treatment for certain patients with dysphagia. Although it doesn’t work for all dysphagia patients, I have had some amazing results (shown in repeat MBS) with some patients who weren’t having much improvement with traditional swallowing exercises.
A con is that VitalStim® takes time. The recommended amount is at least 10 sessions, but I’ve had patients who needed 3 months of VitalStim® treatment to reach their full swallowing potential.
It’s also expensive. Not only the unit itself but the electrodes, which are for 1-person use only.
What did you learn in the Vitalstim® certification process?
In my certification process, I first took an extensive anatomy course that covered all of the muscles and cranial nerves involved in dysphagia.
After that, I took a weekend-long course that reviewed anatomy and then taught about muscle training, NMES in the treatment of dysphagia, and the effectiveness of NMES with various neurogenic disorders.
I was also taught specific placement of electrodes based on the results of modified barium swallow studies and the impairments noted, as well as hands-on practice placing electrodes on other course participants.
I also learned how to progress treatment and about diets, exercises, and various case studies.
Any suggestions for SLPs considering whether or not be become certified in Vitalstim®?
I recommend it! I feel that VitalStim® is an excellent tool to have in your ‘toolbox’ of dysphagia therapy modalities. There’s substantial research supporting it, and I’ve personally had great success. While it doesn’t work for all dysphagia patients, it’s been excellent to have in my back pocket when treating certain patients with dysphagia.
More Resources
References
- Alamer, A., Melese, H., & Nigussie, F. (2020). Effectiveness of Neuromuscular Electrical Stimulation on Post-Stroke Dysphagia: A Systematic Review of Randomized Controlled Trials. Clinical interventions in aging, 15, 1521–1531. https://doi.org/10.2147/CIA.S262596
- American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). Retrieved Jul, 14, 2023, from www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/
- Assoratgoon, I., Shiraishi, N., Tagaino, R., Ogawa, T., & Sasaki, K. (2023). Sensory neuromuscular electrical stimulation for dysphagia rehabilitation: A literature review. Journal of Oral Rehabilitation, 50(2), 157-164. https://doi.org/10.1111/joor.13391
- Baijens, L., Speyer, R., Pilz, W., Lima Passos, V., van der Kruis, J., Haarmans, S., & Rombouts, C. (2022). The effect of surface electrical stimulation as adjunct to traditional dysphagia treatment in Parkinson patients. Dysphagia, 26(4), 482. https://link.gale.com/apps/doc/A741364487/AONE?u=anon~bff188dd&sid=googleScholar&xid=19f06066
- Manske, R. C., & Reiman, M. P. (2007). Muscle Weakness. Physical Rehabilitation, 64-86. https://doi.org/10.1016/B978-072160361-2.50008-9
- Sharpe, G., Macerollo, A., Fabbri, M., & Tripoliti, E. (2020). Non-pharmacological Treatment Challenges in Early Parkinson’s Disease for Axial and Cognitive Symptoms: A Mini Review. Frontiers in Neurology, 11, 576569. https://doi.org/10.3389/fneur.2020.576569
- Speyer, R., Sutt, A. L., Bergström, L., Hamdy, S., Heijnen, B. J., Remijn, L., Wilkes-Gillan, S., & Cordier, R. (2022). Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials-Part I: Pharyngeal and Neuromuscular Electrical Stimulation. Journal of clinical medicine, 11(3), 776. https://doi.org/10.3390/jcm11030776
- Wang, Y., Xu, L., Wang, L., Jiang, M., & Zhao, L. (2023). Effects of transcutaneous neuromuscular electrical stimulation on post-stroke dysphagia: A systematic review and meta-analysis. Frontiers in Neurology, 14, 1163045. https://doi.org/10.3389/fneur.2023.1163045
- ScienceDirect. (n.d.) Neuromuscular Electrical Stimulation. https://www.sciencedirect.com/topics/medicine-and-dentistry/neuromuscular-electrical-stimulation