For an estimated one in five people over age 50, as well as children and younger adults with certain medical or genetic conditions, swallowing is a body function not taken for granted.
For them it can be painful and tedious and causes uncontrollable coughing, hoarseness and even pneumonia when food meant to go down the esophagus goes into the trachea instead. It can even lead to weight loss if the affected person begins limiting eating in order to avoid symptoms of the condition, called dysphagia (dis-FAY-juh).
But treatment can help people with swallowing problems.
Dysphagia, or difficulty swallowing, most often occurs in the elderly as the muscles in the body weaken over time. Some of the most common medical conditions coinciding with or leading to dysphagia include stroke, traumatic head or spinal cord injury, brain tumors, cerebral palsy, muscular dystrophy and Alzheimer's disease.
Individuals who have undergone radiation treatment in the head, chest or neck are also prone to the condition. Burn patients, particularly if they have inhalation burns, may develop dysphagia.
According to the American Speech-Language-Hearing Association (ASHA), 30 percent of individuals with multiple sclerosis and up to 40 percent of people with Parkinson's disease have dysphagia.
I remember when my late father, who had MS and later developed Parkinson's, began having more and more difficulty eating meat. In his last few years, the nursing home where he resided began pureeing his food. If you've not eaten or even seen a pureed sugar cookie, count yourself fortunate.
My dad really only had difficulty eating meat, but, at that time, the rule, at least at that facility, was if the doctor ordered one food to be pureed, they all had to be ground up into pudding-like consistency.
Food was one thing he enjoyed, and he hated that everything was the same consistency and pretty much looked the same, with slight variations of color between such foods as peas and peaches. I remember thinking I hoped I would never be subjected to such a diet.
Swallowing difficulties affect as many as 75 percent of nursing home residents. Kari Mason, a speech-language pathologist at Summit City Nursing and Rehabilitation, 2940 N. Clinton St., works daily with residents who have swallowing problems.
The facility, owned by Indianapolis-based American Senior Communities, has a special unit for people with dementia, and dysphagia is a common issue. This population presents multiple treatment challenges due to not understanding the problem, inability to follow instructions, behavioral issues and loss of desire for food.
But Mason, who has worked in the speech pathology field for more than 10 years, has seen good success with VitalStim for many with dementia as well as other conditions. VitalStim uses a low-level electrical current to stimulate the nerves and muscles involved in the swallowing process.
For decades, transcutaneous electrical stimulation, or e-stim, has been used to treat muscle and spinal cord injuries, chronic pain, to reduce spasticity and for many other conditions.
VitalStim was cleared by the FDA in 2002 and is the only such e-stim dysphagia treatment approved to date. It is used in adjunct with traditional therapies that involve specific kinds of exercise of the throat, voice and tongue. Sometimes individuals also need liquids thickened and, as with my dad, foods pureed.
With VitalStim, small electrodes are placed externally at identified problem-areas of the throat or face. The patient first undergoes a swallow study X-ray to pinpoint the problem. Swallowing involves use of multiple nerves and muscles in the lips, tongue, mouth, throat and esophagus. Dysphagia may be result from an issue in the mouth rather than the throat, for example, so pinpointing the problem is important.
“The current is very small but targeted,” Mason says, noting, “It is actually strengthening the muscle.” The goal is to help the patient achieve and maintain as normal a swallowing function as possible.
Not every patient can tolerate the “prickly or biting” sensations produced by the electrical current, as Mason describes the feeling of the current, and some people with severe dementia may not be able to cooperate. The prickly sensations usually lessen, she says, as the current reaches deeper muscle tissue.
VitalStim should not be used in patients with active cancer or those with pacemakers or implanted defibrillators. Still, Mason says of the residents at Summit City Nursing and Rehab, “It's rare that I would have a patient that wouldn't benefit from it.” When working in a different setting, she has used VitalStim successfully with children.
Parkview Regional Medical Center uses VitalStim for acute-care patients and in the inpatient rehab unit, confirms spokesman John Perlich. Mason says many local neurologists are proponents of the treatment for dysphagia.
While a growing body of evidence points to the efficacy of the treatment, and only very minor side effects have been reported, not everyone concurs. At the Rehabilitation Hospital of Fort Wayne, for example, VitalStim is not used, says speech-language pathologist Jackie Kolb. The hospital is part of Lutheran Health Network. Throat, mouth, tongue and voice exercises are preferable.
E-stim is “a time-consuming process. You want to make sure what you're doing is a good outcome for as long as possible,” Kolb says. The goal for most patients at the rehab hospital is to help them learn the exercises so they can do them on their own when they go home.
Kolb points to concerns ASHA members have raised on e-stim for dysphagia. ASHA has numerous studies on its website that reveal positive outcomes. In December, however, the site published a white paper, written by member Ianessa A. Humbert, arguing against use of the e-stim treatment.
Key concerns are that some past research lacks scientific validity, that VitalStim has failed to define which clinical conditions causing dysphagia will benefit most from the treatment and that speech-language clinicians do not have adequate training in physiological treatments for dysphagia.
Data will continue to unfold, and that's a good thing. I, for one, do not want to be eating pureed cookies at 90!
