[Dysphagia] e stim

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

LSterling@aol.com wrote:
In a message dated 6/3/2004 12:54:33 PM Central Standard Time, 
pasekoffde@upmc.edu writes:

> Is there a set of criteria for patient eligibility for Vital Stim?

At our MDA ALS Clinic today, a patient brought us a flyer from a local SLP at 
a national rehab facility (which shall remain nameless but the company logo 
was all over this flyer) offering services for Vital Stim and extolling the 
benefit of Vital Stim on ALS, MS, and Parkinson's patients...as well as H/N 
Cancer, CVA. 

E-stim is contraindicated in patients with a degenerative neurological 
disease. What function is no longer there cannot be regained no matter how much a 
muscle is stimulated. 

I don't think that's quite true. I believe that it can be helpful, for a time ,in patients with PD, PSP etc although there does occur a point at which all interventions are pointless. It is a clinical and ethical judgment as to when intervention is no longer useful


To speak specifically of the ALS population, as I follow 300 patients, use of 
e-stim can exacerbate the condition.

I would tend to agree for ALS. This is a very difficult disease to treat in any fashion and it would seem logical that external muscle contraction might well be contraindicated.

 I guarantee you there 
is no efficacy data...in fact not even anecdotal evidence...that e-stim is 
beneficial for this population. 

True - but then there is very little evidence of any kind of efficacy overall. That's not to say that studies are not on the way, but for ALS patients, I would have to remain in the doubting corner on neurophysiological bases.

Irene.

Laurie Sterling, M.S., CCC-SLP
Team Speech-Language Pathologist
The Vicki Appel MDA/ALS Clinic
Baylor College of Medicine/The Methodist Hospital
Houston, TX

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Dr I Campbell-Taylor
Clinical Neuroscientist
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