A treatment that's easy to swallow
GLENYS Watkins had resigned herself to being fed liquid meals through a tube up her nose after a fall down the stairs caused a brain injury that meant she could not swallow food and drink.
Yet the retired teacher from Dyserth in Wales can now enjoy chocolate and her favourite dish, spaghetti bolognese, following a revolutionary treatment.
She is one of the first people in the UK to be treated with VitalStim therapy. A technique called neuromuscular electrical stimulation helps to activate the jaw and throat, while a therapist encourages the patient to swallow. It can be effective in six to 20 one-hour sessions.
Glenys, 64, who was in a coma for a week following the fall, recovered almost completely in just two weeks.
“Once more I can experience the pleasure of food and enjoy meals,” she says. “You have no idea how wonderful that is after the horrible experience of being fed artificially.”
Difficulty swallowing is known as dysphagia. Weak tongue or cheek muscles make it hard to move food around in the mouth for chewing. Food pieces that are too large for swallowing may enter the throat and block the passage of air.
Any condition that weakens or damages the muscles and nerves used for swallowing may be the cause. Head injury or stroke may affect the co-ordination of the swallowing muscles or limit sensation in the mouth and throat. Conditions of the nervous system, such as cerebral palsy or Parkinson’s disease, can also be to blame. An infection can also cause a narrowing of the oesophagus.
Physiotherapists recommend exercises to strengthen throat muscles but this is rarely enough. Most patients end up relying on a tube inserted into their nose or stomach to deliver liquid nutrition.
VITALSTIM therapy could change all that. The device consists of a generator and two electrode pads placed on the throat. A current is passed through the pads into the muscles of the cheeks and throat, causing them to contract. As this occurs, the patient does swallowing exercises under supervision by a therapist.
In one trial at the University of Kansas the therapy, which is non-invasive and pain-free, enabled 85 per cent of patients to stop feeding through a stomach tube as they relearned to swallow and eat normally.
“The muscles are re-educated and swallowing function improves,” explains speech and language therapist Sumathi Sinnappan, the UK’s first trained provider of the therapy, who treated Glenys at Rowley Hall Hospital in Stafford. “It also has a neurological effect, reinforcing nerve signals sent between the swallowing muscles and brain.”
Sumathi believes it could help up to 1.6 million people in the UK and save the NHS millions. Glenys began therapy in August 2007.
“I had 17 treatments,” says Glenys, who spent 11-and- a-half months being fed through a tube in her nose.
“After three sessions I could chew slowly. My sense of smell became sharper and my voice strengthened as my swallowing muscles became more toned.Psychologically it had a huge effect.”
Sumathi agrees. “When you are tube fed, you are no longer independent. This has a huge effect on people’s state of mind.”
S o far it is offered only by two NHS trusts in Belfast but Sumathi is campaigning for it to become recognised as standard treatment as it is in the US.
“Compared to life-long tube feeding the cost of this is very little,” she says. “In many cases it could save on nursing home care, which many tube-fed people come to need.”
Bob Rafal, professor of clinical neuroscience and neuropsychology at Bangor University, who treated Glenys after her accident, says her degree of recovery has been remarkable.
“Published research suggests this is a promising treatment and my experience with this patient reinforces that view,” he says. “I would want VitalStim therapy to be considered as a treatment for patients with problems in swallowing due to a neurological difficulty where other treatments had failed.”
