Modified Mondays: A Stimulating Swallow



Modifed Monday: A stimulating swallow with bonus cough content!


Full disclosure/background: I am not VitalStim certified, but the treating SLP (who directed this) was certified. 

I have a great video from years ago that has always stuck with me. The treating SLP was using VitalStim with this patient, and asked to apply the electrodes and stim with the patient during the MBS study. I agreed, we’ve done it before (and it’s recommended in the VitalStim training). The first swallow is a teaspoon of thin barium, with NO stimulation-the electrodes are in place, but not activated. The patient has a small amount of aspiration, and coughs in response.


The second swallow is another teaspoon of thin barium, this time with the stimulation that the SLP had been using in therapy activated. The patient aspirates again, just a small amount again…. but this time with no cough. We did repeat this a few more times, with the same results. This is not necessarily a comment on the VitalStim, but it is important to consider the cough response. Cough response is not an adequate indicator of aspiration (and lack of cough is not an adequate indicator of lack of aspiration), and can be inconsistent, even with the same patient, with the same consistency.


This video is interesting… because it could lead a clinician to think that the VitalStim application was “improving” the swallow clinically, since the patient didn’t cough. It’s important to consider, and be aware of how often “signs and symptoms” can be misleading. Check the links below for more information: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475497/


https://pubmed.ncbi.nlm.nih.gov/29845700/

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