Patient FAQ


What is neuromuscular electrical stimulation (NMES)?

NMES uses a device that sends electrical pulses through electrodes placed on the skin to the nerves. The pulses are modified and manipulated to excite the nerves. This input causes muscles to contract.

What is The Guardian Way?

The Guardian Way is a fundamentally different approach for the treatment of dysphagia. The Guardian way utilizes neuromuscular electrical stimulation (NMES) and surface electromyography (sEMG) to promote improved strength, timing, and reeducation of muscles used for swallowing. The protocol used is specifically designed for use with the small muscles involved in swallowing.

Is The Guardian Way painful?

No, the skilled use of NMES dictates that the parameters are adjusted to maintain patient comfort while still achieving the desired muscle contraction. True NMES should never burn, sting, grab or be uncomfortable in any way, shape, or form.

Can I receive The Guardian Way treatment if I have a pacemaker?

Yes, but it is recommended that you go through the pacemaker interference protocol. Your treating speech-language pathologist would discuss the treatment with your cardiologist and receive approval. Please note that NMES is not to be used with a defibrillator.

How long is each treatment session?

The average treatment time for NMES is 30 minutes. This may need to be reduced based on your fatigue. Your speech-language pathologist will work with you throughout the session and will be combining NMES with other treatment interventions.

Are there any contraindications?

The use of NMES on a patient with a defibrillator is contraindicated. There are a few precautions to consider:

  • Patient’s ability to respond to painful stimuli – Although we can set the parameters very low for infants and other patients unable to verbalize and likely avoid any discomfort you should only proceed if you have some reliable indication of pain such as a grimace, withdrawal response, watery eyes, refusal etc.
  • Pacemaker – see interference protocol
  • Radiation fibrosis – NMES alone will have little effect on tissue that is fibrotic, but if combined with manual therapy may have a very positive outcome.
  • Seizure disorders – although there is no evidence that NMES will contribute to seizures it is recommended that you double check with the neurologist
  • Post surgical changes or implants –Any metal implants located in proximity to electrode placement should not cause adverse effects however the patient may experience some sensation in the area. If so, the patient will decide to continue or terminate treatment. Any patient with any other implanted electronic devices such as cochlear implants, vagal nerve stimulation, deep brain stimulation, etc. may not be a candidate and the implanting surgeon should be contacted to discuss possible interference issues. If there is extensive surgical reconstruction and implants to replace structures, you should consider what is being stimulated and why.