Rosa was admitted for rehabilitation after a stroke in an area of the brainstem that can cause severe swallowing problems, known as dysphagia. This stroke also caused one of Rosa’s vocal folds to be paralyzed, further complicating safe swallowing. She was on a very restricted diet that consisted of pureed solids and liquids the consistency of honey. Rosa was committed to trying anything that might help her eat regular food again, so her speech language pathologist started a vigorous exercise program coupled with VitalStim® Therapy.
Strategies such as small bites and sips, slow rate and turning her head to the left when swallowing enabled Rosa to expand her diet. Vitalstim® Therapy was utilized both with and without eating to improve her strength. Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) as needed allowed Rosa to progress quickly in a short period of time.
Rosa’s strength improved so much that she was able to leave HHH eating and drinking whatever she wanted, with no need to turn her head while eating anymore. She was ready to go out to eat with her family!
Content
27.68 -> Therapist - Okay Rosa so I brought the VitalStim
30.7 -> with me for us to do as we've been doing.
32.71 -> I just kind of wanted to review again
34.42 -> the recommendations for the VitalStim and why we
38.08 -> might use it, or why we are using it.
39.97 -> Because of the stroke that left side,
44.02 -> all the muscles on the left side are
46.03 -> just not working as well, so they have a
48.16 -> really hard time kind of raising up and
49.87 -> going forward which is what our muscles
51.4 -> do when we swallow successfully. So using
54.7 -> the electrical stimulation specifically
57.04 -> the VitalStim, helps give you kind of
59.95 -> jumpstart to your muscles. What it makes
61.809 -> your muscles do, is tighten and give them
65.65 -> an extra boost for 50 seconds and then
68.95 -> it lets you down. You always feel that up and
70.69 -> down right let you down for 10 seconds
73.09 -> with the idea being that we don't want
74.5 -> to do anything for you know minutes on end.
77.89 -> We want to have a break and so if
80.05 -> you think about weight training you know
81.369 -> nobody ever lifts the weight up and just
83.17 -> stays up there indefinitely,
84.79 -> nor do they do this either. It's a
87.49 -> very concentrated movement that they
89.229 -> tackle and then they stop and change
92.2 -> that movement. So VitalStim is kind of
94.42 -> geared along towards that thing, and
96.31 -> certainly have seen a fair amount of
98.47 -> success in the last 19 years. You had
101.95 -> told me before that you felt that it was
103.69 -> making a positive difference like you
105.009 -> could feel that it was so maybe just
107.11 -> explain like when I put the VitalStim
108.819 -> on, how does it feel ? Patient - I feel tingly first and then
113.74 -> you feel like they're pulling the vocal cord,
117.429 -> and then let it go.
119.679 -> In an interval time. Therapist - And is it easier
123.88 -> or harder to swallow when you have it on?
125.17 -> Patient - Easier.
127.72 -> Therapist - It feels a little easier. Okay
130.03 -> alright give me a swallow please. Just keep
132.4 -> your head level though, chin down a little bit, good.
135.4 -> Alright,
135.97 -> definitely a lot stronger than when we met
138.099 -> which is the whole idea right.
172.2 -> Therapist - alright I'm gonna turn you on, you tell
174.06 -> me when you feel the tingling, ok. Patient - now its tingling.
176.129 -> Therapist - but now we want the
177.06 -> pulling and grabbing so you tell me when
179.25 -> you feel it's really lifting and grabbing. Let's
181.44 -> go through a couple of our swallowing
184.41 -> exercises, your Dysphagia exercises.
186.54 -> Let's do the tongue blade one with the Ga Ga
188.819 -> Patient - go first.
190.62 -> Therapist - why don't we try the straw one to as
191.88 -> well too. We're going to skip the other
193.98 -> ones that would really require a lot of
195.63 -> the vocal cord involvement but the
196.95 -> straw is a better one.
198.51 -> So the same analogy again right as
201.299 -> weight training, two seconds is a good
203.25 -> time to do it because you don't want to
204.599 -> do it forever or your fatigue the muscle
206.19 -> needlessly but you also don't want to do
208.799 -> it just for half a second because then
210.329 -> you didn't work out the muscle. Patient - you feel more pulling.
216.09 -> Therapist - you do right?
216.84 -> Therapist - Rosa, the idea behind doing the VitalStim
221.94 -> while you're eating again is to give
223.65 -> those muscles a little extra jump while
225.269 -> you're actually swallowing food.Think we
228.569 -> kind of review the importance of
230.61 -> turning to the left.
232.11 -> You're so good about doing it, but
234.209 -> remembering you saw from the picture on
235.95 -> the fees that what it does, it just
237.66 -> closes off more of the weak side, so if
240.42 -> you were to turn to the right side when
241.98 -> you're swallowing what would probably
243.15 -> happen?
244.17 -> Patient - Its going to the airway. Therapist cause it would be
