[Dysphagia] vital stim & mentally retarded population

[kfarabaugh at comcast.net (kfarabaugh at comcast.net)]

This is the best posting I have seen in a while and I am so excited to see this information, these questions, posted in this manner!
Diddo HURRAH!!!

-------------- Original message -------------- 
From: Barbara Sonies <bsonies at comcast.net> 

> Hurrah!!!!!! 
> 
> 
> On 9/7/07 1:56 PM, "Suzanne Morris" wrote: 
> 
> > I am not trained in VitalStim and thus, do not consider using it in 
> > my practice. I have had extensive experience with individuals who 
> > have severe and profound developmental disabilities. Many of these 
> > individuals who have severe swallowing problems also have substantial 
> > problems with muscle tone and movement coordination throughout their 
> > body. The swallowing issues, in my experience, are rarely an issue 
> > of the oral-pharyngeal mechanism independent of what is going on in 
> > the rest of the body. The mouth and pharynx are very much 
> > influenced by head and trunk position, postural tone and reflexive 
> > movements. You may be able to stimulate specific muscles in the neck 
> > that influence the physiological swallow, but this is going to be in 
> > strong competition with the shifts in tone and movement that occur on 
> > a daily basis with reflexes that respond to the vestibular input of 
> > gravity and the proprioceptive stimulation of muscles in the neck. 
> > 
> > From time to time I view videotapes of children who are receiving 
> > VitalStim. Their parents will be participating in an intensive 
> > workshop that I teach or I will be seeing the kids themselves for 
> > assessment and treatment at a later time. I just reviewed one of 
> > these recordings yesterday which shows a VitalStim session. It was 
> > very similar to others I have viewed in the past. In this instance 
> > the client was a young pre-teen boy who had been in a near-drowning 
> > accident as a toddler. He shows stiff extension throughout his body 
> > and strong hyperextension of his head/neck in all positions. While 
> > sitting in his wheelchair his trunk is pulling down toward the left 
> > side and there is increased tension and shoulder girdle elevation on 
> > the right side. His ribcage is stiff and shows slight movement 
> > predominantly in the upper thoracic and clavicular areas. His jaw is 
> > open widely in a thrust position and there is limited jaw movement. 
> > There is minimal movement of the facial muscles at rest or with 
> > emotion. The electrodes for the VItalStim are on his neck and I 
> > assume that stimulation is occurring throughout the session. In the 
> > filmed treatment session the therapist stimulates his mouth with a 
> > cotton swab with taste and then with small spoonfuls of pudding. 
> > The stimulation of the mouth itself elicits greater lip/cheek 
> > movement and some purse-string closure of the lips; slight downward 
> > pressure of the spoon on the tongue stimulates a very weak and 
> > inconsistent backward-forward suckle motion of the tongue. There is 
> > intermittent coughing up of mucus and food, usually occurring after 
> > the 3rd or 4th spoonful of pudding. This suggests to me that a 
> > swallow is not being triggered (despite the therapists comments that 
> > he has swallowed). I think that food i simply falling over the back 
> > of the tongue and disappearing into the valleculae and pyriform 
> > sinuses until they fill up and trigger the cough. What concerned 
> > me the most about this session is that his head was in severe 
> > hyperextension the whole time and at times went into greater 
> > extension with the oral stimulation. The therapist was working on 
> > lip closure and swallowing but with a wide-open jaw. We know that 
> > neck hyperextension can increase extensor tone in the jaw and reduce 
> > oral coordination. Mechanically it is extremely difficult to get a 
> > good and efficient swallow with the head pushing back into extension. 
> > 
> > So my question is a common-sense one. Why do we choose to use a 
> > specialized piece of equipment (VitalStim) to stimulate specific 
> > muscles in the neck for swallowing (even assuming that this does 
> > work) when the underlying foundation for the swallow really isn't 
> > there? This therapist and family have continued with VitalStim 
> > because the child's MBS has shown some "improvement over time" (I 
> > haven't seen copies of the MBS reports so I don't know the 
> > specifics). But even if there is some improvement in this artificial 
> > setting, how does this relate to his life and to how we choose to 
> > spend our time and money to improve swallowing function? 
> > 
> > I have worked with numerous children whose physical involvement and 
> > cognitive impairment was similar to that seen in this boy. The focus 
> > of treatment has been on working in an integrated way with postural 
> > tone and movement to reduce tone and the constant stimulation of 
> > reflexive movements. A major focus has been to reduce the extension 
> > patterns in the body and neck and help the child learn how to get a 
> > "soft body" or "soft neck" just with a verbal or touch reminder. This 
> > is combined with oral stimulation of the suckle to elicit a stronger 
> > and more sustained suckle-swallow movement pattern. I have found 
> > that this has been highly effective, and children have learned more 
> > functional swallowing skills (especially for handling their own 
> > secretions and reducing the amount of drooling or need for constant 
> > suctioning to clear the airway) without any electrical stimulation of 
> > the swallowing muscles. 
> > 
> > Suzanne 
> > __________________________________ 
> > Suzanne Evans Morris, Ph.D. 
> > Speech-Language Pathologist 
> > New Visions 
> > 1124 Roberts Mountain Rd. 
> > Faber, VA 22938 
> > (434) 361-2285 ext. 5 
> > www.new-vis.com 
> > 
> > 
> > On Sep 7, 2007, at 11:36 AM, Michele.Graziadei at dhs.state.nj.us wrote: 
> > 
> >> Does anyone have any information regarding Vital Stimulation 
> >> Therapy with the severe and profound developmentally disabled 
> >> population (MR)? I presently am employed at a residental facility 
> >> for the MR population -mainly severe & profound whom are not able 
> >> to follow directions. Thanks!!!!! 
> > 
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> 
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