為國內外 語言治療師 用於治療吞嚥障礙的一種方法
不過在使用上仍有一些需要留意的部分
並不是所有 有吞嚥障礙的個案 都適合使用
關於 vitalstim 運用在吞嚥治療須留意的問題
在2008年 由具VitalStim認證的教師編寫了:
Safety Issues regarding the use ofVitalStim Therapy (free
download)
Created by VitalStim
Therapy Instructors Last updated: September 14, 2008
以下為整理文章內容所提及到的臨床個案之類型
* Pacemakers and
Implantable Cardioverter Defibrillators (ICD)
(心臟節律器,植入性心律除顫器)
Guidelines
對於有裝心臟節律器的個案
美國心臟協會不建議使用 VitalStim Therapy
因為 VitalStim 的電流可能會影響心臟節律器的功能, 使用風險大
Recommendation
The likelihood of the occurrence of interference between the
VitalStim Therapy
device and the pacemaker is small. The clinician should proceed
with caution when
using VitalStim Therapy in patients who have an implanted ICD
and/or pacemaker.
Monitor the patient for any signs of possible interference,
including syncope,
dizziness, palpitations, slow or fast heart rate, or, in the case
of an ICD,
inappropriate defibrillation. It is prudent to inform the
physician and patient about
possible interference. Discontinue treatment if
interference occurs and refer the
patient back to the
physician for possible reprogramming of the pacemaker.
(若有使用的必要, 則建議需要隨時監控患者是否有任何干擾的情況,
如:昏厥,頭暈.心悸, 心率過快或是過慢. 若出現干擾的情形,甚至需要重新再由心臟科醫師調整其心臟節律器)
*VitalStim和pacemakers
& ICD是有可能會出現干擾.
* Deep Brain Stimulators (DBS) (腦深層電刺激)
一種用於治療巴金森氏病的手術方法:
DBS手術包括了植入一個細長的電極導線（electrode），至腦中的丘腦下核（subthalamus nucleus，STN）或是蒼白球內核（globus pallidus internal
segment，GPi），此一導線經皮下和植入於胸前的脈衝產生器（pulse generator）相連（此一裝置，類似於心律調節器）。不同於燒灼手術，DBS不會破壞腦部組織，它是一種可逆式的反應，藉著產生電流來控制調節腦內不正常的活動訊息，而達到運動症狀的控制。目前DBS已成為治療巴金森氏病最有效的手術方式，但它也是非常複雜及精細的一種手術。此外，在達到它的效果之前，病人必須經過一段調適期及有耐心的等待。
Guidelines
No guidance is currently available from the FDA or from the DBS
manufacturers and the
professional literature is non-existent on the topic. (目前未有相關的文獻探討此主題)
Recommendation
The likelihood of the occurrence of interference between the
VitalStim Therapy device
and the DBS is small. The clinician should proceed with caution
when using VitalStim
Therapy in patients with an implanted DBS system, even though the
DBS extension wire
(running subcutaneously and posterior to the sternocleidomastoid
muscle) is theoretically
outside the stimulation field of the VitalStim electrodes. It is
prudent to inform the
physician and patient about possible interference. Discontinue
treatment if interference
occurs.
*VitalStim和DBS是有可能會出現干擾.
* Vagal Nerve
Stimulators(迷走神經刺激器)
一種治療頑固行癲癇的方式,迷走神經刺激器的作用機制不同於抗癲癇藥物，所以當藥物無法控制時, 有些病人仍然可以從迷走神經刺激器治療中獲得益處。
Guidelines
No guidance is currently available from the FDA or from the VNS
manufacturer and the
professional literature is non-existent on the topic. (目前未有相關的文獻探討此主題)
Recommendation
The likelihood of the occurrence of interference between the
VitalStim Therapy device
and the VNS system is small. The clinician should proceed with
caution when using
VitalStim Therapy in adult patients with an implanted VNS system,
even though the VNS
electrodes and lead wire are theoretically outside the stimulation
field of the VitalStim
electrodes. It is prudent to inform the physician and patient
about possible interference.
Discontinue treatment if interference occurs.
*VitalStim和VNS是有可能會出現干擾.
*Tracheostomy (氣切)
Guidelines
No specific guidance is issued by either the FDA or the
manufacturer on the use of
NMES in patients with a tracheostomy tube. The general guideline
applicable to
electrotherapy is to not allow the current to flow through
indwelling metal. Electrodes
will therefore have to be placed superior to the tracheostomy tube
in the case of a metal
tube. Because of the anatomical location of the tracheostomy below
the cricoid cartilage
this should not be a
problem with VitalStim Therapy.
(一般來說電療的電流是不能通過金屬物,而VitalStim電極的位置高於氣切管,就解剖位置來說氣切管低於環狀軟骨,應該在使用上不會有問題.)
Recommendation
The therapist should initiate therapy using the VitalStim device
when the patient is stable
enough to engage in active treatment. In some cases, only two
electrodes may be used
when the neck does not offer enough available space because of the
presence of the
tracheostomy tube. Electrodes should be placed according to
general electrode placement
guidelines and should
not be placed on either side of (“bracketing”) the tracheostomy.
(對於有氣切的病人使用VitalStim時,通常因為頸部空間不足,可只使用2個電極.
且應該依據使用指南來放置電極的位置.且須注意不能將電極放在氣切兩側(包圍住).)
*Implanted Metal (植入金屬)
Guidelines
The accepted rule of thumb when using electrotherapy is to apply
the electrodes in such a
manner so that the current will not flow through the implanted
metal. Metal has a high
conductivity to current causing it to flow through the metal
rather than through the
tissues. This may cause high current density at the point of entry
and possible tissue
irritation. As long as electrodes are placed correctly so as to
avoid this situation, there is
no reason to withhold
electrotherapy from patients.
(一般來說只要電流不通過金屬,則使用電療是可以被接受的. 因金屬具有高導電性, 所以會影響電流通過金屬而不是組織.導致有高強度的電流刺激組織)
Recommendation
VitalStim Therapy can safely be used in patients with metal
implants in patients with
carotid stents, cervical
hardware or titanium mandible. The likelihood of current to flow
through the implanted metal is very low when applying VitalStim
Therapy according to
recommended electrode
placement guidelines.
(VitalStim可以安全的使用在有頸動脈支架,頸椎支架,鈦下頷骨等病人,電流通過這些植入之金屬的可能性很低)
*Cochlear Implants (電子耳)
Guidelines
Some therapists using VitalStim Therapy in this population have
reported patients
noticing “sounds” during treatment, especially when using
electrode placements on the
face, which would be indicative of the subcutaneous receiver
picking up some
electromagnetic interference from the VitalStim application.
Temporarily turning the
cochlear implant off
resolves this issue
(曾有治療師反應使用VitalStim在CI的個案時,個案表示有聽到些”聲音”,尤其是將貼電極貼在臉部時.這表示VitalStim產生干擾.)
Recommendation
The likelihood of the occurrence of interference between the
VitalStim Therapy device
and the cochlear implant system is small. The
clinician should encourage the patient to
turn the implant off for the duration of the VitalStim Therapy treatment if any
interference is reported
by the patient.
(建議在使用VitalStim時,應將CI關閉,避免引起干擾)
*Pregnancy (懷孕)
Guidelines
Authors of electrotherapy textbooks have varied positions on the
safety of using
electrotherapy during pregnancy. Most authors consider it a
precaution as long as the
application of the current is not over the pelvic, lumbar or
abdominal anatomy.
(目前相關的教科書對於電療是否能用在孕婦身上仍有不同的立場,多數的作者認為這是一種預防,電流不應該通過骨盆腔,腰部或腹部,在懷孕的前三個月與低電流量是否會造成影響是未知的,目前沒有報告指出電流會影響早期懷孕階段,但此議題仍受高度的關注.有些則擔憂會影響子宮收縮而早產.)
Recommendation
The likelihood of the use of VitalStim Therapy inadvertently
interfering with fetal
development is extremely small. VitalStim Therapy can safely be
used on pregnant
patients
(VitalStim 可安全的使用在孕婦)
*Reflux (胃酸逆流)
Guidelines
Patients with reflux are managed by their physician with
medication and lifestyle changes
(diet).(藥物治療及改變飲食習慣)
Recommendation
Dysphagic patients with reflux may be treated with VitalStim
Therapy for their muscle
dysfunction causing
dysphagia provided the underlying reflux disease is addressed.
(VitalStim 可安全的使用在有胃食道逆流的吞嚥障礙者)
*Seizures, Epilepsy.(癲癇)
Guidelines
Authors on the subject of electrotherapy have varied positions on
the safety of using
electrotherapy in patients with epilepsy. (對於電療使用在癲癇患者有不同的論點)
The following statements reflect the opinions of these authors
It is recommended that ES not be applied on the craniofacial or
cervical region
of patients with a history of CVAs or seizures due to concern that
the applied
electrical current may alter conduction in the CNS.
(認為ES不應使用在有CVA或seizures的顱面或頸部區域)
The use of electrotherapy is a precaution with CVA, TIA and/or
epilepsy and
other seizure disorders. The authors suggest appropriate patient
monitoring
when applying stimulation to the head or upper cervical spine
regions (until
more definitive information is available regarding the effects of
stimulation).
(認為ES運用在有CVA或seizures的個案時,應適時的監控個案的情況)
The use of TENS may be contraindicated in patients with seizure
activity. The
authors describe a case report in which seizures and absences
increased during
the period of TENS use. This increased seizure activity lasted for
2 days after
cessation of TENS. (P.S.TENS: Transcutaneous electrical nerve stimulation)
(曾有一個案報告表示使用癲癇患者在使用TENS時,癲癇狀況增加)
Recommendation
The likelihood of the use of VitalStim Therapy exacerbating
seizure activity is small. The
clinician should proceed with caution when using VitalStim Therapy
in patients with
epilepsy and seizure activity. It is
prudent to inform the patient about possible
exacerbation of symptoms. Ensure knowledge of the
patient's prior history of seizure
activity. Monitor compliance with the medication schedule.
Discontinue treatment if
exacerbation of symptoms occurs and refer patient back to the
referring physician.
(VitalStim應謹慎小心地使用在有癲癇的個案,應讓個案知道是有可能會增加癲癇的症狀,也須明確知道個案之前癲癇發展的情形.監控個案的用藥情形,如果癲癇狀況加重則應停止治療並回轉介醫生)
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