What is the treatment protocol for VitalStim (Vital Stim) therapy for patients with swallowing disorders?

VitalStim Therapy Protocol for Swallowing Disorders

Neuromuscular electrical stimulation (NMES) using VitalStim should be applied together with behavioral swallowing treatment, as this combination is superior to behavioral swallowing treatment alone, particularly in post-stroke dysphagia. 1

Initial Assessment Requirements

Before initiating VitalStim therapy:

• A clinical swallowing examination or preferably an instrumental swallowing evaluation (VFSS or FEES) must be performed 1, 2
• This assessment should identify specific swallowing abnormalities to target with therapy
• Reassessment should be conducted after treatment completion to evaluate effectiveness 1

VitalStim Protocol Components

Equipment Setup

• VitalStim stimulator device
• Surface electrodes placed on cervical swallowing muscles
• Proper skin preparation to minimize adverse effects 3

Treatment Parameters

• Session frequency: 3 times per week 3
• Session duration: 1 hour per session 4
• Treatment course: Typically 5-6 weeks 3
• Electrode placement: On neck targeting specific swallowing muscles based on individual deficits

Combined Approach

VitalStim therapy should be combined with traditional swallowing exercises for optimal results:

1. Shaker Head Lift Exercise (Grade A recommendation)

   • Isometric component: Three head lifts held for 60 seconds with 60-second rest periods
   • Isokinetic component: 30 consecutive head lifts without holding
   • Targets suprahyoid muscles and upper esophageal sphincter opening 1

2. Chin-down Maneuver (Grade B recommendation)

   • Recommended for patients with premature spillage and predeglutitive aspiration
   • Patient brings chin to chest during swallow 1

3. Expiratory Muscle Strength Training

   • Particularly beneficial for patients with Parkinson's disease
   • Improves swallowing function in dysphagia of various etiologies 1, 2

Patient Selection Considerations

VitalStim therapy shows varying effectiveness based on dysphagia severity:

• Most effective: Patients with mild to moderate dysphagia 5
• Less effective: Patients with severe dysphagia (those dependent on feeding tubes may not gain independence) 5
• Best candidates: Patients with dysphagia of neurological origin, particularly post-stroke 3, 4

Expected Outcomes

• Improvement in swallowing function measured by Functional Oral Intake Scale 3
• Potential improvement in voice quality (observed in 30% of patients) 3
• Improved hyoid movement when combined with effortful swallowing 1
• Enhanced feeding status in patients with dysphagia after stroke or traumatic brain injury 1, 6

Safety Considerations

• Low incidence of adverse effects (approximately 1.3% of electrode placements) 3
• Proper skin preparation and electrode placement minimize risks 3
• Contraindications include patients with implanted electrical devices (pacemakers)
• Not recommended as standalone therapy for severe dysphagia 5

Monitoring and Follow-up

• Regular reassessment of swallowing function using instrumental assessment
• Monitoring for signs of aspiration pneumonia, malnutrition, and dehydration 2
• Adjustment of therapy based on patient progress

Common Pitfalls to Avoid

1. Using VitalStim as a standalone therapy rather than in combination with behavioral techniques
2. Expecting dramatic improvement in patients with severe dysphagia
3. Failing to conduct proper pre- and post-treatment assessments
4. Not individualizing electrode placement based on specific swallowing deficits
5. Setting unrealistic expectations for patients with longstanding dysphagia

While VitalStim therapy shows promise, particularly when combined with traditional swallowing therapy, clinicians should be aware that the most severely affected patients may not achieve complete independence from feeding tubes 5.