Kerstin Müller is an experienced speech therapist and works with the vocaSTIM®-Master in her daily practice. In the interview, she reveals what she uses the device for, what experiences she has had with electrotherapy in speech therapy and what her patients say about it.
PM: Please introduce yourself briefly and describe your field of activity. In which area do you mainly work?
KM: My name is Kerstin Müller. I have a practice in Bonn. My focus is on speech therapy with a focus on neurology and ENT. I mainly treat patients with swallowing disorders, facial paresis and recurrent paresis.
I was a little sceptical at first about treating peripheral facial paresis, but I have achieved positive effects without synkinesia by carefully using the vocaSTIM®. This enabled me to restore up to 95% of facial motor function within 35 hours. Electrotherapy can therefore also be used as a treatment option in this area, but should not be used as a standard method.
However, in the case of central facial paresis, such as occurs after strokes or haemorrhages, the use of vocaSTIM® is highly recommended, as spontaneous healing is unlikely. I had a patient in whom the involuntary movement of the face worked well, but she could not consciously control it. Through a combination of manual techniques of Brondotherapy and the vocaSTIM®, I was able to stimulate the obicularis oculi so that she was able to close her eyes slowly and consciously, at least for a short time, which was not possible before. Dr Juan Brondo himself was impressed with the progress made. We also stimulated the soft palate and tongue with the vocaSTIM® to increase sensitivity and improve function.
The device is also very suitable for treating recurrent paresis. I used to treat these with conventional voice therapy, which was more strenuous for the patients. Some colleagues have even specifically referred patients to me because of the vocaSTIM®, where positive effects were observed within 10-20 hours. With the voice field meter from lingWAVES, I can objectively measure whether the voice has improved. Through the vocaSTIM® I was able to notice an increase in the voice field, which would not have been possible with conventional speech therapy in such a short time. The patients also confirm these results. Although the therapy can seem monotonous and exhausting after some time, the patients appreciate the possibility to practise independently after they have been instructed.
I have also successfully used the vocaSTIM® with hyperfunctional voice disorders to relax the voice. In addition, I have been able to achieve tissue relaxation in patients after laryngeal surgery where cancer was no longer present, in order to improve the oesophageal voice. In patients with dysarthric voice, the device can help the voice sound more relaxed and softer. It is very gratifying to see when a sound can be held longer and sounds clearer. This has great value for patients, especially with dysarthria. I also like to use it in dysphagia therapy to stimulate the swallowing reflex. The vocaSTIM® allows for dual channel use so I can stimulate the hyoid and larynx. This is an effective motor sequence for the patients. They can decide for themselves when they want to swallow, or I can adjust the device settings so that the pulses dictate the frequency of swallowing.
I have a patient with a very small head where I cannot apply the electrodes in two channels. In such cases, it is sufficient to stimulate the floor of the mouth with the vocaSTIM®. The patient can then give the impulse and swallow by herself, which would not be possible without vocaSTIM®.
I am very satisfied with the vocaSTIM® because it offers me many possibilities in speech therapy. There are only a few devices worldwide that are approved for the head and neck area, but the vocaSTIM® opens up many application possibilities for me. The prerequisite is, of course, an understanding of the effect of electricity and no fear of it. Our body consists of fluid and electricity, through the nerve conduction velocity. It is nice to be able to use these rehabilitation possibilities. The device is very versatile and I wouldn’t want to miss it. I would like to treat more patients with it. I am very enthusiastic about it.
PM: How long have you been working with the vocaSTIM®?
KM: Not for too long. Since 2016, but I have known electrotherapy since 2001. At the speech therapy school we had a lecturer, a doctor, who knew Professor Doktor Pahn because they had studied together. That’s why we had an electrotherapy device in the phoniatrics department of the school of speech therapy. That was my first contact with electrotherapy.
PM: What is the opinion of your staff in the practice about the vocaSTIM®? Do they like working with it?
KM: At the beginning there was a lot of respect, but this diminished after my instruction. Two colleagues use the device regularly, especially for the treatment of recurrent paresis. One colleague has even used it for central facial paresis. After training and knowledge about electrotherapy, they no longer had any concerns. When the opportunity is there, they like to use the device.
PM: You have already given some information about patients’ reactions to the device. On average, how do patients respond to it? What feedback do you get from them?
KM: Patients react very positively and want to use the device as often as possible. Currently, I have a patient who has even chosen a rehabilitation clinic based on it. However, the problem is that there is a waiting period of half a year because this clinic has a large contingent. Not every rehabilitation clinic has vocaSTIM®. Patients are explicitly looking for vocaSTIM® and electrotherapy, especially patients with facial paralysis are specifically looking for facial therapy.
PM: For which indications is the device most frequently used?
KM: The device is most often used to treat recurrent paresis. I find it particularly good that the patient or the therapist can give the impulse to the muscle themselves. In addition, I also use vocaSTIM® with patients with multiple muscular dystrophy or atrophy to maintain a certain level of muscle tone. Patients report that their speech is clearer when they come home. However, for patients with muscular dystrophy or atrophy, I have to be careful not to give too much stimulus so as not to exhaust the muscle. Here it is important to find a balance and have expertise in speech therapy. Treatment with the device is more comfortable for the patient than manual work. They can do their exercises at home. In my therapy I combine both. We try to slow down the muscle deterioration a bit through electrotherapy.
PM: To what extent does working with vocaSTIM® offer advantages in therapy compared to classical speech therapy?
KM: With vocaSTIM® I make much faster progress. The patients make progress so that I can continue my classical therapy. I already have a basis at the beginning that works again. That takes much longer in classical therapy. I used to have my 20 hours and then the therapy was over. Nowadays I can treat longer. The first 10 hours with vocaSTIM® have already helped me so much that I was able to make progress that I could not achieve in classical therapy.
One patient reports that she had the feeling that her ary cartilages were stuck together and a kind of spasticity appeared. After using vocaSTIM® she has a much softer voice with better resonance. She also says that she gets better air and her voice is more pleasant and no longer scratchy. It is really impressive what you can see. I did a voice field measurement where you could clearly see a significant change since starting to work with vocaSTIM®. One patient who completed 20 hours of therapy said, “I am thrilled, I have my voice back, it is resilient and I am myself again”.
As I mentioned before, I love this device, vocaSTIM®. It is extremely versatile. I would love to have more patients in the outpatient clinic to try it out on.
PM: Thank you very much for taking the time for this interview.