The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

ELECTRICAL STIMULATION FOR TREATMENT OF DYSPHAGIA IN CHILDREN FAILING CONVENTIONAL THERAPY

Robert L. Chatburn RRT FAARC, Marcy Freed, MSP University Hospitals of Cleveland, OH

INTRODUCTION: Severe dysphagia (swallow disorder) leads to medical complications such as aspiration pneumonia, bronchospasm, dehydration, malnutrition, and asphyxia. These can cause death or increased health care costs from prolonged length of stay, readmission's, increased respiratory support, tracheotomies, and percutaneous enterostomal gastric (PEG) tube placement for feeding. There is a high failure rate with conventional treatments. We describe a new treatment using electrical stimulation (ES) to help retrain swallow muscles. The purpose of this study was to determine the degree of improvement in swallow function using this technique in children who failed conventional treatment.

Methods:
A convenience sample was selected from referrals to our hospital for dysphagia treatment. All patients had failed previous conventional treatment, which included thermal stimulation to the oropharynx and a variety of standard interventions. The initial swallowing disorder was assessed by a modified barium swallow (MBS) procedure using various consistencies of food. Invasive dilation of the esophagus was performed if indicated. A swallow score was assigned by a speech pathologist based on the MBS results (0 = could not swallow saliva; 6 = normal swallow for all foods). Failure to swallow was confirmed by a radiologist blinded to the treatment protocol. ES was administered by a speech therapist using a modified battery powered electrical stimulator (Rehabilicare Inc.). Neuromuscular electrical stimulation consisted of a rectangular AC current waveform, frequency = 80 Hz, pulse width = 300 microseconds. Current intensity was set to the patient's tolerance level. ES duration was one hour per treatment. MBS and swallow scoring were repeated when the patient showed signs of clinical improvement. The change in swallow score was evaluated with a Wilcoxon signed rank test. Informed consent was obtained.

Results:
Thirty children were treated; median age was 3 years (range 0.5 -18); 57% females. Diagnoses: 40% neuromuscular, 30% cerebral palsy, 30% CHARGE syndrome. Swallow scores improved significantly after treatment (p < 0.0001). Normal swallow function was achieved by 73% of patients. The median number of treatments was 11 (range 3- 16). The median duration of treatment was 14 days (range 3-42). Data below are mean ± SD.
CONCLUSION: Treatment of dysphagia with electrical stimulation and esophageal dilation (as needed) results in significant improvement in swallow function. This treatment appears to offer better results than conventional therapy. (See Original for Figure)

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