[Dysphagia] VitalStim applied to anterior neck

[yorickw at att.net (Yorick)]

The article by Grant, et al.
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A
bstract&list_uids=15646768) talks about mechanical shear forces produced by
a massager that is driven by electricity, not a device emitting electrical
stimulation. The text following the excerpt that is quoted clarifies: "A
38-year-old woman with no significant stroke risk factors had sudden onset
of severe dysarthria and left hemiparesis several days after receiving an
approximately 20-minute neck massage with a handheld electric massager. The
moving elements consisted of two approximately 2-cm-diameter spheres that
percuss the skin with low amplitude and high frequency." Electrotherapy
devices (ENS, ES, NMES, FES) are definitely not such devices. 

In the case of the VitalStim application (since this post is about
VitalStim), an electrical current is emitted at a precise location, of
limited amplitude and producing a submaximal motor stimulation of the target
musculature. When applied as instructed, this stimulation will produce
absolutely no shear forces on the ICA. I do, however agree that instruction
is essential prior to applying electrical stimulation to the anterior
portion of the neck so as to ensure safety and accurate technique; such
instruction can adequately be obtained during a well designed and well
taught continuing education seminar.

Yorick Wijting, PT




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Message: 3
Date: Thu, 3 Feb 2005 05:14:52 -0800 (PST)
From: Irene Campbell-Taylor <eripley@yahoo.com>
Subject: [Dysphagia] VitalStim

Today, on Mescape, the following was posted:

Carotid Dissection Associated With a Handheld Electric Massager 

Arthur C. Grant, MD, PHD; Norman Wang, MD




The extracranial internal carotid artery (ICA) is susceptible to injury and
dissection from external shear forces applied to the neck. Traumatic ICA
dissection usually occurs in the setting of a sudden, high amplitude force
causing significant distortion of surrounding soft tissues. Weaker,
repetitive forces applied for longer intervals may also pose a risk for ICA
dissection.

 
A search of the Web shows that ENS devices fall into the general category of
electric massagers. Great care is required to avoid, absolutely, any
stimulation of the carotids, not easy to do without detailed anatomical
knowledge and lengthy practice. The external carotid is relatively easy to
locate but this does not necessarily, in all individuals, provide
information as to the location of the internal carotid.  Occupational
Therapists and Physical therapist who regularly use these and similar
devices, usually do gross anatomy as part of their training and are well
practised in locating various points on the human form. Without this, or
other significant medical training, I would be very cautious about the use
of external stimulation of the neck.
Irene.


Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com

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End of Dysphagia Digest, Vol 15, Issue 3
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