Jan Speirs, MS, CCC-SLP

Supervisor, Speech Audiology, Scripps Center for Voice and Swallowing

 

That moment in 2003 when I tried the VitalStim® Therapy on myself was the moment I was more excited about swallowing therapy than I have been in 18 years.

I put the VitalStim® Therapy electrodes on my own throat. I felt my muscles activate and contract. I felt myself wanting to swallow.

As far back as 1995, I had read an abstract about VitalStim Therapy by Marcy Freed and how she was getting people who were severe aspirators eating by the time they left the hospital, five to seven days later. Over the years I had kept in touch with her and knew she was continuing to get remarkable results with VitalStim Therapy and dysphagia.

But that moment in 2003 when I tried VitalStim Therapy on myself at a demonstration in Chattanooga was the moment I was more excited about swallowing therapy than I had been in my 18 years of work in the field.

Because my supervisor, Johan Otter, was a physical therapist who had broad experience using electrical stimulation to treat other muscle disorders, he had no qualms about letting me buy two VitalStim Therapy units right off the bat. Later, we bought additional units.

The first thing I did was bring in patients who had failed conventional therapy. Some of them had been suffering from dysphagia for a very long time, as much as a year or more. And, since typically spontaneous recovery occurs between onset and one year, there had been little or no hope they would spontaneously recover their ability to swallow.

One of those patients, for example, was a man who had had a stroke and had a PEG tube. We had given him inpatient and outpatient therapy, including biofeedback. But we had never gotten him to the point where it was safe for him to eat at home. We had to discharge him from swallowing therapy still on his gastrostomy tube.

After I had gotten my VitalStim Therapy training, I called him back in and after four visits, I could tell that his swallow was markedly better. We did a Modified Barium Swallow and after that pulled his tube because his swallowing was restored.

When we analyzed the data from our first 13 VitalStim Therapy patients, we saw that 77% of them had been able to improve their swallowing, often significantly. Since then we have worked with approximately 75 more patients and the results have been consistent with those we first experienced. We have gotten a lot of people off their tubes.

Something else impressed me about VitalStim Therapy.

When you use conventional methods to help patients swallow again, they never refer to any physical sensations that might be accompanying the therapy. They don't say to me, "I feel food going the wrong way or I feel like I still have something in my throat."

But when I use a VitalStim Therapy device, I get more feedback from the patients about what is going on in their throats. If someone is a silent aspirator, even I, though I am a trained therapist, can't monitor their swallowing as we are working together.

Now patients are telling me that they are more aware of what is going on in their throats. They can tell me whether food is going down the wrong way, whether they feel food sticking. That improved sensation means that they are safer than they once were because they can alter their behavior and clear the food that is sticking, or cough if they think it has gone down the wrong way.

I have never been involved in a therapy that is so patient-driven. Word has really gotten out on the internet and patient listservs, those automated e-mailing lists that keep people informed about developments in a field in which they are interested, and patients are demanding that doctors prescribe this for them. We are even getting referrals from outside, from health maintenance organizations such as Kaiser-Permanente, which is almost unheard of.

On the other hand, patients may come to us thinking we have the "magic bullet" for them. However, when we get their Modified Barium Swallow results I tell them exactly what we can and cannot do for them. I also let them know what other treatments they may need, like dilatation.

But it is really satisfying to see people swallow again who have not even been able to swallow, not even their own saliva. When they finally do, there are a lot of tears and they look as if a cloud has been lifted. Just the other day I was working with a patient who got an audible contraction, which he had not had for a year-and-a-half. His eyes lit up. He looked at me and smiled. He knew he got his swallow back. This was a man who just a week earlier had no contraction of the pharyngeal muscle during his Modified Barium Swallow.

After VitalStim Therapy, patients can return to life.