There were several interesting findings from Dr. Ludlow's study looking at the effect of applying NMES to the anterior portion of the neck, including the improvement in swallowing from sensory stim alone that Dr. Day mentioned. Another outcome that is often not mentioned is the unexpected finding that the patients who had greatest hyoid depression had the greatest improvement in swallowing. I would be interested to see future research looking into the cause behind this counter-intuitive finding. While these findings could possibly suggest a positive effect from using NMES during tx, as the authors point out, this is not a treatment study but an effect study. Therefore, conclusions should not be made, either positive or negative, about the impact these findings may have on treatment.
Instead, we should make conclusions about treatment based on treatment studies. One study worth noting is Carnaby-Mann GD, Crary MA. Examining the evidence on neuromuscular electrical stimulation for swallowing: a meta-analysis. Arch Otolaryngol Head Neck Surg. June 2007; 133 (6): 564-571.
With regards to the question "where is research on chronic dysphagia (1 year post)?"asked in an earlier posting , look for Dr. Carnaby-Mann and Dr. Crary's study "Adjunctive neuromuscular electrical stimulation for treatment refractory dysphagia: A phase I case series report" which will be published in the Annals of Otology, Rhinology & Laryngology soon. The patients in this study were an average of 5 years post onset.
With regards to any research, rather than focusing on the source of funding, I believe it is more productive to critically read the entire study, look at the research methodology, and then make decisions about if the the findings are applicable to what we do in treatment. Again, we should agree to disagree on what conclusions we will each make.
The debate about using NMES in swallowing tx has been good for our profession in that it has challenged us to look at the research behind what we do as clinicians. The caliber of research that we are requesting about VitalStim (randomized controls, studies that account for the possibility of spontaneous recovery) should be sought for all our therapies.
Jen Carter, M.Ed., CCC-SLP
Clinical Specialist, VitalStim Therapy
