• 8/2/2005
  • Newark, NJ
  • Vicki Hyman
  • The Star Ledger (www.nj.com)

Robert O’Brien was staring at the mirror when he saw it — a small crease forming in the corner of his mouth — on the side of his face that had collapsed three months before.

O’Brien, a retired Montclair police officer who now is security director at Ramapo College, had developed Ramsay Hunt Syndrome, a neurological complication of shingles that paralyzed the right side of his face. He drooled, slurred his speech, had difficulty moving food around in his mouth and had to tape his drooping eye shut at night.

Some patients recover spontaneously; O’Brien was told there was nothing that could be done to help him.

His wife, Jane, had studied speech therapy in college and knew that it could maximize his recovery, so she contacted a speech language pathologist at Mountainside Hospital in Montclair. Janet Kalina-Suarez had just been trained on VitalStim, a new device that uses electrical currents to stimulate inactive or atrophied muscles in the neck to facilitate swallowing.

Therapists using VitalStim have reported promising results with stroke patients, those with neurological disorders such as ALS, Parkinson’s Disease and multiple sclerosis, and those who had been treated for mouth or throat cancer. The device reportedly helped people when traditional treatment and therapy had failed; it even helped patients who had trouble swallowing their own saliva.

As Jane O’Brien described her husband’s symptoms over the phone, Kalina-Suarez thought he could benefit from the therapy, as well.

It took three months to convince O’Brien’s insurance carrier, but after the first hour-long session, he spotted the crease in his formerly slack skin. After six sessions, he was able to put in his contact lenses again. He could drink from a soda bottle without the liquid pouring down his chin. After a few months, he had regained 95 percent of his facial movement.

Only the slight sag of his right eye tells the tale. His face, weather-beaten from years of competitive and recreational skiing, is gratefully lined. His reddish-silver mustache no longer droops to one side. He speaks clearly and with a sensitivity that might not instantly be associated with a lawman: “You can’t imagine what it’s like not to be able to smile.”

About 15 million Americans suffer from dysphagia, or difficulty swallowing, including about 75 percent of all stroke survivors. Others, like O’Brien, suffer from a neurological condition. O’Brien’s symptoms were concentrated in his mouth, rather than his throat, so it did not affect his diet, but other dysphagia sufferers are either on a feeding tube or a diet of thickened liquids or puréed foods.

Although electrical stimulation has been used in physical therapy for years, doctors had long warned against using it in the throat area, worried it might affect the carotid sinus, which could lead to a drop in blood pressure. They also were concerned about vocal cord spasms.

But an Ohio speech therapist named Marcy Freed thought electrical stimulation could help jump-start the swallowing reflex in some of her patients. With repeated therapy, the muscles might be retrained to work properly.

She created the forerunner of the VitalStim by adapting a device used for other muscles and minimizing the electrical output. Working with a physician, she used electrical stimulation on more than 800 patients with swallowing problems, most of whom showed significant recovery.

The Food and Drug Administration approved the device for treating dysphagia in 2001, and Freed licensed it to the Chattanooga Group, a medical and physical therapy equipment manufacturer. Since it started marketing VitalStim in 2003, the company has trained 4,000 therapists nationwide, who have in turn treated about 30,000 patients.

The treatment has not caused any of the problems originally feared by doctors, but there are about 25 different trials underway to determine exactly how well the therapy works under different conditions and with a variety of protocols, says Yorick Wijting, the director of new product development and clinical education for the Chattanooga Group.

Though the FDA has cleared VitalStim for swallowing disorders, it has been tested for other conditions, including facial paralysis. Wijting says the company plans to petition the FDA for approval for other uses, including voice disorders. The company is also working on special electrodes to reach muscles in the throat or mouth that currently are out of reach.

The hand-held device, slightly larger than an iPod, anchors two sets of lead wires that the therapist attaches to the patient’s throat or, in O’Brien’s case, face. The electrical impulses start low and get continuously stronger. Patients with problems swallowing eat or drink during the treatment; O’Brien and Kalina-Suarez simply chat during his sessions.

O’Brien likened the feeling to sticking a finger in a light socket. John Dec, another patient who suffered a stroke in 2003, jokes that the twice-weekly visits are “one time too much.”

Dec, a retired check printer from Clifton, first went to Kalina-Suarez in August 2004, after spending nearly a year recovering from the stroke that paralyzed his left side. But he still had problems swallowing. His throat muscles were weakened and the food would overflow into his airway, causing him to cough up his meal and scaring “the liver out of me,” says his wife, Cornelia.

Now Dec is able to tackle a hoagie once again, although it usually takes him more than an hour to eat it.

“It’s a miracle really,” Cornelia Dec says.

Kalina-Suarez says she and a fellow Mountainside therapist have used VitalStim on about 15 patients, almost all with very good results.

“Before, we’re doing exercises and we’re giving strategies, but we couldn’t really kind of fix the problem,” she says. They would have to depend on the patient to tell them whether they felt any improvement. Now, she says, “it’s exciting to really see a result, and it’s like a drastic result.”