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Implications of Research: Ruth Crawford
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Implications of Research: Ruth Crawford

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  • 1. The Implications of Thermal Tactile Stimulation Research Ruth Crawford CD 514
  • 2. Pro or Con? The Debate Rages On
    • The use of thermal tactile stimulation therapy has undergone much debate. While the method remains popular with many therapists, several studies have indicated that it is less effective than other treatment methods.
    • Nonetheless, this is not simply a black and white issue since studies have also demonstrated that thermal tactile stimulation provides unquestionably significant treatment results in certain situations.
  • 3. Effective Treatments
    • Thermal Tactile Stimulation has been effectively used with a variety of clients with a variety of needs. Logemann (1998) contends that this method is most useful for improving delayed or absent triggering of pharyngeal swallow.
    • The method has also proven effective in dysphagia treatment plans for patient’s with cerebral palsy, closed head trauma, dementia and dysautonomia and stroke.
  • 4. Research Proponents Rosenbek J, Williford W, Schiltz A, Robbins J, Sowell T, Deutsch S et al. (1998). Comparing treatment intensities of tactile thermal application. Dysphagia, 13, 1-9.
    • The results from this study indicated that the thermal tactile stimulation was highly effectively for heightening sensory input.
    • The study also revealed that significant results were achieved when the optimal dosage (which is 5 times/day) was applied alone or with meals
  • 5. Additional Research Support Rosenbek J, Roecker E, Wood J, & Robbins J (1996). Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia, 11, 225-233.
    • This study examined the use of thermal tactile stimulation on 23 patients with multiple CVA and dysphagia.
    • The study revealed that the use of this method resulted in a significantly shorter duration of stage transition and a significantly shorter total swallow duration after a stroke.
  • 6. Information on thermal tactile stimulation is presented in this update on current treatment and practice patterns for dysphagia
    • Suiter, D M., Easterling, C. S. (2007).Topics in Geriatric Rehabilitation. Dysphagia in Older Adults, Part I. 23(3):197-210.
    • Abstract: More than 12% of the population of the United States is older than 65 years. Factors related to normal aging and a higher incidence of central nervous system diseases such as stroke, parkinsonism, and dementia in older adults increase the need for speech-language pathologists to responsibly seek and employ evidence-based treatment to rehabilitate dysphagia and allow patients to resume their quality of life. This article discusses the evidence that supports treatment techniques used in dysphagia rehabilitation.
    • http://pt.wkhealth.com/pt/re/tgr/abstract.00013614-200707000-00003.htm;jsessionid=LK5NGhwX1qsRd4qRTdfdJ9rl57D1VS1YTG1dNhcxfwZ9QKjCRTCt!774718804!181195629!8091!-1
  • 7. The Opposition’s Position
    • According to James, Coyle University of Pittsburgh, thermal stimulation or thermal-tactile application has been widely investigated and “has largely been dismissed as it has been shown to produce only momentary and non-durable reductions in stage transition duration (pharyngeal delay time)”.
    • Coyle cites the following studies to support his contention: Hamdy et al., 2003; Miyaoka et al., 2006; Rosenbek et al., 1998; Rosenbek, Robbins, Fishback, & Levine, 1991; Rosenbek, Roecker, Wood, & Robbins, 1996.
  • 8. Thermal Tactile Simulation (TS) Verses Electrical Stimulation (ES)
    • Freed, M. L., Freed, L., Chatburn, R. L., & Christian, M. (2001). Electrical stimulation for swallowing disorders caused by stroke. Respiratory Care, 46 , 466-474.
    • In this study patients in both groups improved significantly from their pretreatment swallow function. However, the ES group improved significantly more than those using TS.
    • A second finding revealed a need for external support. Forty-one of the 43 severe ES patients and only 15 of the 29 severe TS patients achieved a significantly higher swallow function post treatment.
  • 9. In Comparison to Vital Stim The New England Rehab Hospital and the Maine Medical Center’s Joint Research Study on Dysphagia Therapy conducted a clinical trial of nearly 900 patients comparing the use of thermal tactile stimulation with VitalStim Therapy® Depending upon the severity level, VitalStim Therapy® was proven to be two to three times as effective as traditional thermal-tactile stimulation. http://www.nerhp.org/technology_vitalstim_therapy.asp
  • 10. Professional Deliberations
    • Experts are currently engaged in multidisciplinary discussions that exemplify the manner in which they effectively utilize thermal tactile stimulation as a treatment method.
    • As professional discussions and symposiums continue, the effectiveness of thermal tactile stimulation therapy will be more clearly understood.
    • http://www.speechpathology.com/askexpert/display_question.asp?question_id =177
  • 11. Directions For Further Research http://www.eurekalert.org/pub_releases/2007-08/jorr-j rv080107.php Public release date: 1-Aug-2007 Journal of Rehabilitation Research volume 44, issue 3
    • “Further studies of swallowing patterns in non-disabled patients should ideally be developed in terms of thermal tactile stimulation in different sizes and viscosity to determine the optimal intervention and treatment strategies.”
  • 12. Future Focus For Research
    • Recently, thermal tactile stimulation therapy has received new attention due to current questions about the role of sensory input on neuromuscular plasticity in adults with neurological diseases and stroke. Since sensory input therapy is being implemented in novel ways, thermal tactile stimulation research may head into new directions as well.
    • Miyaoka, Y., Haishima, K., Takagi, M., Haishima, H., Asari, J., & Yamada, Y. (2006). Influences of thermal and gustatory characteristics on sensory and motor aspects of swallowing. Dysphagia, 21, 1-11.
  • 13. Summation
    • Although researchers continue to debate the effectiveness of this method in comparison to other therapies, thermal tactile stimulation has proven implications for use alone or in conjunction with other dysphagia therapies.
    • Future research endeavors will provide valuable information concerning the range of treatment possibilities for this method.
  • 14. References
    • Coyle, J. ( 2002 ). Critical Appraisal of a Treatment Publication: Electrical Stimulation for the Treatment of Dysphagia, 11, 4. http://www.asha.org/about/membership-certification/divs/Coyle_e-stim02.htm
    • Hamdy, S., Jilani, S., Price, V., Parker, C., Hall, N., & Power, M. (2003). Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury. Neurogastroenterology & Motility, 15, 69-77.
    • Longmann, J. A. (1998). Evaluation and Treatment of Swallowing Disorders. ( 2. ed ) Austin, Texas. Pro Ed.
    • Miyaoka, Y., Haishima, K., Takagi, M., Haishima, H., Asari, J., & Yamada, Y. (2006). Influences of thermal and gustatory characteristics on sensory and motor aspects of swallowing. Dysphagia, 21, 1-11.
  • 15. References Cont.
    • Rosenbek, J. C., Robbins, J. A., Fishback, B., & Levine, R. L. (1991). Effects of thermal application on dysphagia after stroke. Journal of Speech and Hearing Research, 34, 1257-1268. Rosenbek, J. C., Robbins, J. A., Willford, W. O., Kirk, G., Schiltz, A., Sowell, T. W. et al. (1998). Comparing treatment intensities of tactile-thermal application. Dysphagia., 13, 1-9.
    • Rosenbek, J. C., Roecker, E. B., Wood, J. L., & Robbins, J. A. (1996). Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia, 11, 225-233.
    • Sciortino, K., Liss, J. M., Case, J. L., Gerritsen, K. G., & Katz, R. C. (2003). Effects of mechanical, cold, gustatory, and combined stimulation to the human anterior faucial pillars. Dysphagia, 18, 16-26.