[Dysphagia] VitalStim use in the NICU

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

Mary 
Thanks for the update on the status of the research being done, I hope there is some structured, well documented research that proves something.
In the meantime, I am sorry, but my questions regarding what you are stimulating, what it is you are trying to facititate (how did you determine that the specific muscles being stimulated were the "weak" muscles responsible for a "weak swallow", and where you place those electrodes given the size of the neonates laryngeal area continues to remain unanswered.
I think that there are many concerns that prevent many of us from jumping on this bandwagon when there are so many other variables clouding the effectiveness of VS.
Hope all had a great weekend.
Kate

-------------- Original message -------------- 
From: "Mary Warburton" <maryew at bjc.org> 

> Kate & Irene, 
> Thank you for your very appropriate concern about using VitalStim on this 
> fragile population. 
> In the past 4 years, our SLPs with combined experience of 25 years, have used 
> VitalStim in the NICU on 6 patients. These patients have been at term or very 
> close ( youngest was 37 weeks). The process for selecting candidates is very 
> careful, based on many factors, but primarily it has been used to improve a 
> weak or ineffective, but present, swallow in very stable patients. We have 
> experienced no complications or significant changes in vital signs during our 
> sessions. Vital Stim does not happen in isolation, but during traditional 
> therapy. The child is also receiving physical and occupational therapy, during 
> their admission. They are also growing and maturing. So, of course, I cannot 
> say improvement is all due to VS, but it has been presenting as a successful 
> adjunctive therapeutic modality in our very few patients. 
> We have used this modality only after consultation with the patient's 
> neonatologist and providing the parents with informed consent. 
> We have also been in consultation with Orange County Children's Hospital, which 
> is currently aggregating data from their pilot study on 18 patients in the NICU. 
> There is a real possibility that we will be participating in a multi-center 
> study in the future. We will also be able to present case studies, with some 
> longer term outcomes, in the future. 
> I was just putting feelers out on some speculation I heard, but that has proved 
> fruitless. 
> Thanks, 
> Mary 
> 
> Mary Warburton, M.A., CCC-SLP 
> Lead Speech-Language Pathologist 
> Therapy Services 
> St. Louis Children's Hospital 
> One Children's Place 
> St. Louis, MO 63110 
> 
> >>> 9/27/2007 9:23 PM >>> 
> Mary 
> Can you explain to me why you would use VS on NICU babes? 
> What is the source of the dysphagia that you feel you are treating at this age 
> and why is VS being used or why do you all feel it is the source of the 
> improvement? 
> Are there no vital changes (HR, RR, O2sat) at all occuring when you are doing 
> this to these babes and what muscles exactly in these tiny no-neck creatures are 
> being targeted effectively? 
> I am sorry if this is sounding blunt but I am having a very difficult time 
> understanding what the VS is presumed to be doing for infants whose main issues 
> are premature development, poor resp regulation, poor resp and swallow 
> coordination, etc. 
> I am hoping that this treatment being used is based on some research I have yet 
> to read, please advise? 
> Sincerely 
> Kate 
> 
> -------------- Original message -------------- 
> From: "Mary Warburton" 
> 
> > We have used VitalStim on patients in our NICU from ages 37-47 weeks EGA, with 
> > excellent results. 
> > Lately, there has been rumblings about concerns with possible brainstem 
> > stimulation from these surface electrodes. 
> > The SLPs and neurologists I have talked to about this have discounted it. 
> > What's the buzz in the community and IF it is of such great concern, what is 
> > being done? 
> > 
> > 
> > 
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