Baptist Health Brain & Spine Care is the first in Florida to implement this type of targeted pharyngeal neurostimulation therapy for post-stroke dysphagia

Pharyngeal Electrical Stimulation (PES), a therapeutic intervention designed to facilitate the recovery of deglutition in post-stroke patients, has been introduced into clinical practice at Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital. This implementation follows successful pilot protocols conducted earlier this year by Baptist Health Miami Neuroscience Institute. Baptist Health Brain & Spine Care is the first in Florida to implement this type of targeted pharyngeal neurostimulation therapy for post-stroke dysphagia, which differs from traditional swallowing rehabilitation by directly stimulating the neural pathways that control swallowing rather than relying solely on exercise-based therapy.

This modality utilizes neurostimulation to target the neural pathways governing swallowing function. By activating sensory nerves within the pharynx, PES is intended to induce neuroplastic changes and cortical reorganization, potentially accelerating the return to oral intake and mitigating complications associated with prolonged dysphagia.

How PES Works: Exploring the Science Behind Swallowing Recovery

The PES system functions through a temporary catheter inserted into the pharynx. Electrical stimulation is delivered directly to the pharyngeal sensory nerve fibers. This peripheral stimulation aims to increase excitability in the motor cortex regions responsible for swallowing, thereby facilitating central nervous system recovery and re-establishing functional control of deglutition.

The protocol typically involves:

• Duration: Short daily therapeutic sessions administered over a defined period (typically 3 days)
• Monitoring: Close supervision by a multidisciplinary team, including speech-language pathologists and physiatrists, to assess tolerance and functional progress 

Pilot Experience: Highlights from Early Implementation and Patient Progress

Initial implementation at Miami Neuroscience Institute involved a cohort of stroke patients within the Neuro ICU. These patients were managed by an interdisciplinary team comprising stroke neurology, critical care nursing, speech-language pathology, and physical medicine and rehabilitation (PM&R) specialists.

Clinical observations from this pilot phase indicate positive functional outcomes. “Our initial patients demonstrated significant improvement in swallowing mechanics and achieved dietary advancement more rapidly than anticipated,” states Lina Hurtado, M.D., PM&R physician at Miami Neuroscience Institute. The integration of PES offers an adjunctive therapeutic option to address the complex pathophysiology of post-stroke dysphagia.

Consistency Through Collaboration: Teamwork in PES Integration

At Marcus Neuroscience Institute, where PES use is currently centered on Neuro ICU patients, protocols are being developed for deployment across Progressive Care and Neuro-Telemetry units. 

The adoption of PES therapy represents a strategic alignment with Baptist Health’s commitment to evidence-based innovation. Marcalee Sipski Alexander, M.D., physiatrist at Marcus Neuroscience Institute and medical director of the Cornell Institute for Rehabilitation Medicine, emphasizes that restoring deglutition is critical for patient independence and quality of life.

Collaboration between Marcus Neuroscience Institute and Miami Neuroscience Institute was initiated during the exploratory phase to ensure standardized clinical protocols. “The objective is to ensure consistent, evidence-informed care delivery across the organization,” Dr. Alexander notes. This alignment facilitates shared clinical learnings and optimizes patient management strategies.

Indications and Advantages of PES for Stroke Recovery

PES therapy is indicated for patients exhibiting neurogenic dysphagia following a cerebrovascular accident. The primary clinical objectives include:

• Functional Recovery: Accelerated restoration of the swallowing reflex and coordination
• Oral Intake: Expedited resumption of oral nutrition and hydration
• Complication Reduction: Potential decrease in aspiration risk and reduced dependence on enteral feeding (PEG/NG tubes) in appropriate candidates
• Length of Stay: Potential for reduced ICU and hospital length of stay through earlier dietary advancement

Physicians are encouraged to consult with the speech-language pathology team or PM&R specialists to identify suitable candidates for this intervention. Further data regarding patient outcomes and case studies will be disseminated as the clinical volume increases.