Role of modified Barium Swallow Pre and Post VitalStim therapy In the rehabilitation of the swallowing mechanism

Abstract

Aim: Of our study is to evaluate the efficacy of transcutaneous electrical stimulation (Vitalstim therapy) to treat patients with dysphagia and to determine the impact of the modified barium swallow study (MBSS) on patient management. Material and methods: From June 2014 to April 2016, seventy three patients with dysphagia were included. All the patients underwent pre vitalstim-therapy evaluation by speech-language pathologists, including clinical evaluation of swallowing and modified barium swallow study (MBSS). In MBSS we evaluate the following, delay in oropharyngeal swallowing phase, closure of epiglottis, laryngeal elevation, passage of contrast behind the epiglottis that denoting penetration, presence of aspiration and presence residual barium after swallowing. After VitalStim therapy, all patients underwent MBSS assessments and also underwent a follow up survey months (range, 1 to 6 months) after their therapy to assess whether the improvement was worthwhile and sustained. Results: In our study our 73 patients showing radiological findings denoting neurological swallowing disorders, 65 patients (89%) showing delay in oropharyngeal swallowing phase, weak laryngeal elevation found in 58 patients (79%) , 68 patients (93%) showing aspiration and 70 cases (96%) showing penetration and incomplete closure of the epiglottis. Presence of residual barium after swallowing within the vallecula was seen in 68 patients (93%). 52 of the 73 patients (71%) showing complete improvement at first follow up study after VitalStim therapy. 21 of the 73 patients (29%) showing some improvement and need another therapy sessions and in the next follow up study 15 cases showing complete improvement. However, 7 cases of the 21 patients having severe dysphagia before therapy, only 2 of 7 showed any improvement, and these patients still required a feeding tube for adequate nutrition, however, the 5 of 7 showing complete improvement after another session of therapy. Conclusion: We conclude that the modified barium swallow is valuable in the rehabilitation of patient with swallowing disorders helps speech pathologist to identify and modify swallowing abnormalities as well as management program. We also conclude that VitalStim therapy is effective and safe in the treatment of patients suffering with the swallowing difficulties.