SWALLOWING
- Difficulty Swallowing & Swallowing Disorders
- Why Can’t I Swallow?
- NeuroMuscular Electrial Stimulation (NMES)
- Interdisciplinary Approach
- Advanced certifications and training
FEES
(Flexible Endoscopic Evaluation of Swallowing)
We are proud to be one of the few providers that has this functional exam of the swallow with use of flexible endoscopy, more commonly referred to as FEES (Flexible Endoscopic Evaluation of Swallow). This allows us to bring invaluable diagnostic measures regarding the function of your swallow. It requires no anesthesia. The small wire on the end of the scope gets passed through your nose to the back of your throat where we can visualize the areas within and surrounding your voice box.
Difficulty Swallowing & Swallowing Disorders
Cobalt Therapy offers extensive support to those experiencing a range of swallowing difficulties. We are often a doctor’s invaluable resource for helping to narrow down what may be underlying their patients’ swallowing disorders. The medical term for a swallowing disorder is dysphagia, which presents as difficulty in swallowing food or liquids safely.
When we swallow a drink for example, it should go down the esophagus (food pipe) into your stomach. If the swallow is impaired, it may result in the drink getting displaced into the trachea (airway) which may then lead to coughing. If not expelled by coughing, the liquid may enter the lungs. This increases chances of acquiring aspiration pneumonia.
Why Can’t I Swallow?
Figuring out the source of one’s swallowing difficulties is a challenging task to say the least if there was not an acute event (such as a stroke or surgical injury). So many factors can impact how we swallow from our colon all the way up to the brain. No doctor’s order is necessary to be evaluated by us for your swallowing difficulties. But we will need a doctor that is willing to sign your plan of care once established before we can begin treatment. Often our evaluations can identify more accurately what type of testing you will need for better diagnosis of what is truly causing your swallowing disorder. There are more than 25 different tests to date that are part of diagnosing a swallowing disorder. Getting the right ones done will not only be cost effective, but will save you a lot of time and frustration! We often serve as a coordinator between doctors for helping you resolve your swallowing difficulties.
Click here to learn more about Why Can’t I Swallow?
Neuromuscular Electrical Stimulation (NMES)
People also refer to NMES therapy as VitalStim or E-Stim, which is short for electrical stimulation. NMES therapy involves a device that delivers an electrical current through electrodes that are placed over the identified areas of weakness. The current sends a signal to the nerves which help increase muscle contractions when swallowing. With this technology, the patient can not only improve accuracy of muscle contraction but help re-educate the muscles for swallowing purposes.
We are especially excited about the Ampcare Effective Swallowing Protocol (ESP™). ESP uses a neuro re-eduation method for optimal treatment results. We’ve seen great results so far with this program!
Click here to learn about Ampcare’s Effective Swallowing Protocol
Interdisciplinary Approach
Swallowing disorders can involve multiple phases of the swallow, including the oral, pharyngeal, and esophageal systems. When concerns extend beyond the oropharyngeal phase, an interdisciplinary approach is essential for accurate diagnosis and effective management.
At Cobalt Therapy, we specialize in evaluating and treating oropharyngeal dysphagia. Through advanced diagnostics such as FEES, we are able to identify patterns that may suggest esophageal involvement and guide appropriate next steps in care.
While we do not treat esophageal disorders directly, we play an important role in:
- Identifying clinical signs that warrant further medical evaluation
- Collaborating with physicians and specialists (such as Gastroenterology and ENT)
- Supporting patients with safe swallowing strategies and symptom management
- Reinforcing medical and nutritional recommendations as part of the overall care plan
In many cases, additional medical testing (such as imaging or esophageal studies) may be recommended by your physician to further evaluate the underlying cause.
Our goal is to ensure each patient receives comprehensive, coordinated care, addressing all aspects of swallowing function through the appropriate medical and therapeutic channels.
Advanced Certifications and Training
At Cobalt Therapy, our clinicians are committed to ongoing education and advanced training to provide the highest level of care for adults with voice, swallowing, and cognitive-communication disorders.
Our team is trained in a variety of evidence-based programs and specialized techniques, allowing us to tailor treatment to each patient’s specific diagnosis, medical complexity, and goals.
Advanced areas of training include:
- FEES (Flexible Endoscopic Evaluation of Swallowing)
- Neuromuscular Electrical Stimulation (NMES) for dysphagia and facial paresis
- Ampcare Effective Swallowing Protocol (ESP)
- McNeill Dysphagia Therapy Program (MDTP)
This level of specialized training allows us to adapt treatment approaches across a wide range of conditions—from medically complex patients to those requiring more traditional or compensatory strategies—ensuring safe, effective, and individualized care.
DON’S SUCCESS STORY
What: Parkinson’s Disease
Why: Referred to Cobalt Therapy for his voice
Then what happened?
Don’s voice was getting softer. He initially came to us in November of 2020 to improve his speech. During the assessment, it became apparent that his voice wasn’t the only problem. Don was having significant swallowing problems causing him to choke often when he ate or drank.
We made the recommendation for an instrumental study. Don already had one done the previous year. This updated study revealed that his swallow was declining compared to the results of the previous year. His once “mild” swallowing problem was now “moderate”. This study also confirmed our suspicion that his esophagus (food pipe) was contributing to his difficulties.
The referring doctor did not believe there were contributing structural problems and that his difficulties were purely neurological. We had to work around this doctor and get second opinions from the recommended specialists, which were an ENT (Ear, Nose, Throat) doctor and GI (Gastroenterologist).
Fortunately, Don followed our recommendations to see these specialists. It required a lot of waiting and testing. We decided we would start therapy for his swallow once he was cleared by these doctors.
On April 19, 2021 we began his swallow therapy. We were pretty certain due to Don’s medical history and his instrumental studies that we were dealing with an overactive UES (Upper Esophageal Sphincter) which had caused further problems in his esophagus. We were also dealing with the progressive nature of Parkinson’s Disease and its impact on his swallowing muscles.
The GI doctor would be performing a procedure to both confirm and surgically deal with the suspected abnormalities in his esophagus. Until then, we needed to get his muscles stronger to better allow that UES to open up the way it should. We also needed to strengthen other weakened areas from his Parkinson’s Disease. We used a combination of e-stim and exercises. After 2 months we were subjectively seeing progress with his swallow. He went from coughing after every sip of a drink, to coughing in 1 out of 15 sips. His strength was also evident in his ability to perform exercises that he was too weak to do in the beginning.
Then came the procedure. On July 14, 2021 the GI discovered that Don had not one, but two pockets in his esophagus, a Schatzki’s ring and a hiatal hernia. Parkinson’s Disease by itself can cause a swallow to decline if not maintained through exercises. However, with these additional structural problems Don’s swallow was going to experience an even more rapid decline had he not gotten the help he needed from a team of specialists.
BILL’S SUCCESS STORY
What: Emery-Dreifuss Muscular Dystrophy (EDMD)
Why: Initially referred to Cobalt Therapy for his swallowing difficulties
Then what happened? Bill was having trouble swallowing his food and drinks safely. When he came to us, his swallow study showed severe impairments. His doctor insisted it was time for Bill to stop eating or drinking by mouth and to get his nutrition only through his g-tube.
Fortunately, Bill and his wife decided to look for a more pro-active option to get Bill to swallow safely again by seeking speech therapy services. We did e-stim treatment (also known as NMES) 3-4 days a week for almost 3 months. The e-stim was used in conjunction with exercises for the identified weak areas from his swallow study. By the end of the first month, we were already noticing subjective improvements, such as being able to swallow puree without coughing by the teaspoon. We decided to schedule a repeat swallow study. The earliest appointment we could get was not available for another month and a half. We continued with the exercises and e-stim treatment and over the next month noticed even more progress with his ability to tolerate thin liquids. By the time Bill went to his swallow study the progress was so significant that the recommendation was to start eating again. The swallow study showed he was safe to stary a puree diet with thin liquids when taking small sips and using his strategies.
Over a year later, Bill has progressed to being able to tolerate mechanical soft foods and thin liquids by cup. Him and his wife understand the importance of his exercise maintenance program as well as strategies for eating safer. They’ve been coached and educated to better understand when to consult with their doctor and Speech Therapist if they notice particular changes. Most importantly, they’ve been trained to manage Bill’s dysphagia in a way that allows him to understand his risks while keeping him as safe as possible and enjoying his preferred quality of life.
