History of DPNS Dysphagia Treatment
During the period 1991-1993, Deep Pharyngeal Neuromuscular Stimulation (DPNS) dysphagia treatment was developed at Mease Hospital, (later to become Morton-Plant-Mease hospital system) in Countryside, Florida. DPNS dysphagia treatment was developed as a result of poor patient compliance with “traditional” dysphagia compensatory techniques. Patient results with “traditional” compensatory techniques were found to be largely ineffective due to the patient’s inability, or unwillingness to habituate these techniques into their lifestyle. Too often, the dysphagic patient became prone to chronic weight loss, habitual use of nutritional supplements, episodic dehydration, high risk behaviors which would result in aspiration pneumonia(s), and, in some cases, physical deterioration and/or death.
DPNS dysphagia treatment represents an organic understanding of the swallow mechanism. Rather than observing the swallow from a “symptom” point of view, i.e., valleculae pooling, pyriform sinus pooling, etc., DPNS dysphagia treatment evaluates the swallow mechanism from an etiological basis. Evaluative analysis concentrates on the four parameters of organic dysfunction:
1. Sensory pathway deficits which impair motor action/function
2. Specifically identified muscle deficits generating swallow dysfunction
3. Autonomic salivation function/dysfunction
4. Reflex deficits of strength, and incoordination
This etiological evaluation of the swallow mechanism allows the clinician to develop accurate and targeted treatment plans to “restore” the swallow mechanism’s individual functional components. for recovery of the total swallow mechanism.
DPNS dysphagia treatment techniques are developed from physical therapy and medical research which is published and in textbooks. DPNS is an applied therapy of the “bedrock” research of physical therapist Signe Brunnstrom (Stanford University 1947-1961). Her upper and lower body rehabilitation programs, which utilize “reflex stimulation”, have been published in text form in 1970, 1979, and 1983 by F.A. Davis Co. She is well respected in the field of physical therapy, occupational therapy, and rehabilitation medicine. She is studied in every PT and OT academic curriculum. In 1986, the American Physical Therapy Association established the Signe Brunnstom Award for Excellence in Clinical Teaching, which is granted yearly. Her reflex stimulation based rehabilitation programs are a culminating achievement built upon the great body of peer reviewed, published research in the area of reflex stimulation, which dates back to the early 1900’s.
DPNS dysphagia treatment techniques were developed utilizing reflex stimulation through the thermal (cold) modality, first used in treatment by Margaret Rood, PT in the 1950s. The clinician practices direct, targeted reflex triggering to generate muscle group contraction. Utilizing the inherent reflex system with the muscle groups of the swallow, the therapist is now able to increase muscle strength, endurance, ROM, and, as a result, function. The DPNS treatment is a systematized therapeutic method for oral and pharyngeal dysphagia which utilizes eleven specific stimulation techniques. DPNS study results (1991-1993) indicated a high efficacy rate (83%) of swallow function improvement in the patient populations of CVA (all types inclusive of brainstem), Parkinson’s disease (mild - moderate stages), TBI, Dementia (into stage 6), and aspiration pneumonia.
The Speech Team has been training clinical practitioners in the use of DPNS dysphagia treatment techniques since the first workshop in 1993. Over 8,000 speech-language pathologists worldwide have been trained. National and International Certification databases are maintained for patient referrals to DPNS certified clinicians.
Ms. Stefanakos began her International Training Tours in 2000, and has trained yearly in England, Ireland, Finland, Sweden, and China. She has trained speech-language pathologists from many countries in Europe and Asia in these international workshops. In 2004, she established the non-profit educational Finnish DPNS Association, endowing it yearly for educational clinician scholarships.
Ms. Stefanakos and her colleagues have an ongoing development program for clincian-relevant tools. She has obtained a national/international patent for developing the labial goniometer. She is senior author of two therapeutic texts entitled Auditory Rehabilitation, and Auditory Memory for Language.