Experimental Treatment

Question 1

ASHA National Center for Evidence Based Practice in Communication Disorder

Clark et al 2009

FOR NMES

Answer 1

1) Systematic review of 14 articles
2) 10/14 were exploratory (experimental) research
3) many had flawed metholodolgy

• billed for the study and dropped ppl who didn’t pay
• populations varies, methods varied, studies were just very different and couldn’t be compared to each other

Question 2

ASHA National Center for Evidence Based Practice in Communication Disorder

Since 2009 - chen et al 2015

FOR NMES

Answer 2

• 8 published studies reviewed

- found insufficient evidence for NMES over traditional therapy techniques

Question 3

So, should we use NMES?

Answer 3

OVERALL, the jury is still out.

Issues with research include:

1) Which populations?
2) Electrode placement?
3) Unit parameters?
4) Duration?
5) Other procedures?

ASHA: (does not take a position on any types of treatments) DOES SAY:

• “scant evidence to support it”
• “conflicting” , “mixed evidence”
• could have negative consequences

Question 4

ASHA:

What to ask when evaluating any treatment or program?

Answer 4

1) What are the stated uses of the procedure, product, or program?
2) To which pt pop does it apply?
3) Are outcomes clearly stated?
4) Are there publications about this procedure, product, or program?
5) Is there peer-reviewed research that supports or contradicts the stated outcomes or benefits?
6) What is the professional background of the developers of the procedure/product/program? (bias?)
7) Are there similar procedures, products, or programs currently available? How do they compare in performance and cost?
8) Is it within your personal scope of practice?

etc.

Just bc it is FDA approved doesn’t mean its the best.

Question 5

How does e-stim rank in answering ASHA’s questions?

Answer 5

People say they have a success rate of about 50%

Only about half the research supports it

Needs more studies with normal healthy swallowers before using it on dysphagia. And, the research we do have on normal swallowers says it makes swallowing worse.

etc.

Question 6

Botox

Answer 6

Lasts about 6 months

Problems: CP remains open which can lead to backflow, air getting into esophagus

Question 7

Dr. C’s research with myfacial release included:

Answer 7

11 facial release points

Question 8

Frazier water protocol

Answer 8

1) Thickened water with meals
2) Free access to water between meals
3) Water has a neutral pH
4) Better than dehydration
5) Not enough evidence (Karagiannis&Karagiannis, 2014)

Rational: aspiration of water is little risk to the pt, this will increase pt compliance with swallowing precautions during meal times,

Question 9

VitalStim Electrods Placements

Answer 9

Suprahyoids (channel 1)
Thyrohyoids (channel 2)

Designed for increased hyolaryngeal excursion

What you will feel:
1)
2) vibration
3) muscles grabbing

59 seconds on 1 second off

Question 10

Ampcare Placement:

Answer 10

Uses postural device to keep your head neutral

1 channel on the suprahyoids

5 seconds on, 3 seconds off