[Dysphagia] vital stim

[yorickw at att.net (yorickw@att.net)]

Hi Nancy,

I'm sorry to hear that your dept is not seeing the results you expected. 
It is difficult to say why some patients experience better results than 
others without knowing the exact clinical details but the case you 
reference (brainstem CVA) is a difficult one since one is dealing with a 
lower motor neuron lesion (not always affecting all swallowing muscles but 
can be very extensive). The muscles innervated by these neurons are now 
denervated and the current emitted by the VitalStim device will not be 
able to elicit any contraction in them. In such absence of response (as 
you describe) it is obviously not indicated to continue with any modality, 
including VitalStim. From the many comments I receive, the patients who 
respond the quickest are the cortical stroke patients and also the 
deconditioned patients. Brainstem stroke are much harder, as are advanced 
stages of a variety of progressive neuromuscular diseases. I can put you 
in touch with a number of clinicians who are getting good results if you 
want. Just e-mail me if you do: yorickw@att.net.

Yorick Wijting, PT

----- Original Message ----- 
From: "Behrndt Nancy R" <Nancy.Behrndt@lonestarhealth.com>
To: <dysphagia@b9.com>
Cc: "Harmon Brenda" <Brenda.Harmon@lonestarhealth.com>
Sent: Tuesday, March 08, 2005 1:31 PM
Subject: [Dysphagia] vital stim


> I am about to opena can of worms I think.  We have been using Vital Stim
for
> several months.  I have invested time and money into training staff.
> Everywhere we turn we are hearing these wonderful success stories.  What
we
> are not seeing is the wonderful success stories in our own department. 
On
> caseload right now we have a  sub cortical (Brainstem) CVA.  We 
initiated
> vital stim therapy, two weeks into daily tx sessions MBS shows minimal
> improvement, some swallow initiation only with use of electrodes during
the
> VFSS.  Similar stories with other patients.  Marcy Freed was kind enough
to
> come and inservice our department regarding vital stim and reviewed some
of
> our tapes.  Of course, most of her recommendations were for patients to
have
> dilitation.  However, with our case above, he does not even show a 
swallow
> response spontaneously.  So long story short, are any of you getting 
good
> response with vital stim, and if yes, what types of cases are the most
> successful.  We are starting to think we are cursed and/or completely
doing
> it wrong.
>
> Nancy R Behrndt MS-CCC/SLP
> Director of Therapy Services
> Denton Regional Medical Center
> (940) 384-3975