April 13, 2004 Feature

Verdict Still Out on Electrical Stimulation

More Research Needed on "E-Stim" Techniques

Electrical stimulation for the treatment of dysphagia continues to be controversial. A headline in the March 16 issue of The ASHA Leader, "Electrical Stimulation Aids Dysphagia," suggested the technique is more efficacious than research suggests (see correction on page 2 of the printed ASHA Leader).  The article in that issue by Ianessa Humbert and Christy Ludlow featured ongoing research at the National Institutes of Health comparing intramuscular electrical stimulation with surface electrical stimulation to determine benefit in reducing aspiration for those with delayed or reduced laryngeal elevation, and/or reduced upper esophageal opening.

Some argue that the evidence to support the majority of current medical and clinical practice across all professions is weak or lacking. Others contend that advances in clinical practice would be nonexistent if we withheld novel or new treatment procedures until every bit of evidence was available to support their usefulness. However, it is irresponsible for us as a profession to embrace and utilize electrical stimulation at this time as currently there is no peer-reviewed efficacy data demonstrating its value for oropharyngeal dysphagia.

Clinicians must demand answers to many unanswered questions before considering the use of this non-supported technique in their clinical practice. These questions include: What muscles are being stimulated?  Does stimulation activate neural fibers and neural circuits? If so, is there the potential of neural deactivation as a result of stimulation? Where should electrodes be placed? What stimulation intensity should be applied? What is the optimum dose-the number of repetitions per session and day and for how long? What patients or populations benefit? Are the effects immediate or long-term?

"At this time, there is no published evidence in peer-reviewed journals indicating that electrical stimulation improves swallowing when spontaneous recovery is taken into account," said Jeri Logemann, professor of speech-language pathology at Northwestern University and a noted expert in dysphagia.

"There is anecdotal evidence that electrical stimulation to the external neck can sometimes worsen swallow. Clearly, we need a great deal more research before clinicians use electrical stimulation broadly for dysphagia therapy."

To further guide clinicians and our profession, it is critical that we wait for evidence regarding the efficacy of e-stim from Humbert and Ludlow and others who are engaged in ongoing research. If we prematurely embrace this promising procedure, the risks to our patients and profession are far-reaching and costly. Risks include slowing progress by delaying use of or reduced use of supported techniques, potential health risks, false hope, not being reimbursed for our services, and loss of credibility. 

The value of the speech-language pathology profession and our specialty practice will be assured only if members advocate for evidence-based principles and engage in its practice on a daily basis. Only by careful and critical evaluation of new procedures or techniques (such as electrical stimulation) will we be able to demonstrate the value of our services and our profession.

Paula Sullivan, is a speech-language pathologist and coordinator of Special Interest Division 13, Swallowing and Swallowing Disorders. Reach her at paula.sullivan@med.va.gov.

cite as: Sullivan, P. (2004, April 13). Verdict Still Out on Electrical Stimulation : More Research Needed on "E-Stim" Techniques. The ASHA Leader.

  

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