Biofeedback

Surface Electromyography (sEMG)

In assessing and treating swallowing disorders, biofeedback tools are important in providing SLPs a method to effectively guide patients in relearning how to swallow. While palpation and visual inspection are often used, they are unable to determine the intrinsic muscle activities involved in chewing and swallowing (Benfield et al., 2019; Crary & Groher, 2010; Crary et al., 2004). Surface electromyography (sEMG) allows for a visual of muscle movement, as electrodes are applied to the skin and muscle movement is captured, processed, and transmitted into a signal for viewing. This is noninvasive and has a low level of discomfort (Crary et al., 2004). sEMG is beneficial for treatment efforts, as it allows clinicians and patients to view intrinsic muscle movement through objective feedback (Crary et al., 2004).  This can help determine treatment effectiveness as well as increase patient effort during treatment sessions (Crary et al, 2004). 

Vitalstim Plus

Vitalstim is an electrotherapy and sEMG biofeedback system that allows patients and clinicians to collect objective data on muscle activity on a computer or tablet during a live swallow (Liang et al., 2021). VitalStim Plus also offers options for stimulation during the swallow. Vitalstim Plus sEMG allows clinicians to guide patients through swallowing exercises and compensatory strategies. Use of biofeedback can encourage patient participation, resulting in increased effort and duration of swallowing attempts. For example, a clinician can set a number of trials (0-90) using the device to challenge patients. Additionally, sEMG allows for objective data collection and evaluation of swallowing function (Liang et al., 2021).   

Options for therapy efforts using Vitalstim Plus:

• sEMG 

• Electrical muscle stimulation 

Important considerations: As mentioned on our home page, cognitive abilities are important in considering biofeedback in conjunction with treatment efforts (e.g. compensatory strategies, rehabilitation exercises, etc.). The patient needs to have the ability to follow directions, interpret visual information, and use it to make physiological changes during the swallowing process (Crary et al., 2004). Due to the necessity of adequate cognitive abilities, the primary setting to use biofeedback in therapy attempts to improve functional swallow is outpatient. 

Data collection: VitalStim allows clinicians to quantify treatment progression with objective data. This data is collected on the device. Patient data can be saved to a SD card, allowing the information to be retrieved at any time. Furthermore, the device can provide treatment summaries in sEMG mode, demonstrating outcomes for therapy sessions.

Here is a link to Performance Health's website with additional information about VitalStim Plus: www.performancehealth.com/vitalstim-plus  

References

Benfield, J. K., Everton, L. F., Bath, P. M., & England, T. J. (2019). Does therapy with biofeedback improve swallowing in adults
with dysphagia? A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 100(3), 551–
561. https://doi.org/10.1016/j.apmr.2018.04.031

Crary, M.A., & Groher, M.E. (2010). Dysphagia: Clinical management in adults and children,
Mosby Elsevier, Maryland Heights, MO. 

Crary, M. A., Carnaby (Mann), G. D., Groher, M. E., & Helseth, E. (2004). Functional benefits of dysphagia therapy using
adjunctive SEMG BIOFEEDBACK. Dysphagia, 19(3). https://doi.org/10.1007/s00455-004-0003-8.

Liang, Y., Lin, J., Wang, H., Li, S., Chen, F., Chen, L., & Li, L. (2021). Evaluating the Efficacy of VitalStim Electrical Stimulation Combined with Swallowing Function Training for Treating Dysphagia following an Acute Stroke. Clinics (Sao Paulo, Brazil), 76, e3069. https://doi.org/10.6061/clinics/2021/e3069