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Electrical Therapy Helps Inventor Swallow

Robert Rines, PhD, has never been deterred by the critics. The 86-year-old inventor spent three decades gathering evidence to prove the existence of the Loch Ness Monster, enduring sharp criticism from fellow scientists.

BOSTON - Robert Rines, PhD, has never been deterred by the critics. The 86-year-old inventor spent three decades gathering evidence to prove the existence of the Loch Ness Monster, enduring sharp criticism from fellow scientists.

Five years ago, he made his most significant finding. He discovered that Loch Ness, which today is a fresh water lake in the Scottish Highlands, was once filled with sea water, and it could have sustained a creature like "Nessie."

But as he was preparing for his next trip to Scotland, Rines suffered a stroke in March 2007 that left him unable to swallow. He was told that he would be feeding tube reliant. That's when this inventor decided to take a chance on a relatively new inventionā€¦ neuromuscular electrical stimulation.

Although FDA approved in 2002, few well-respected randomized controlled trials had been done to determine the therapy's effectiveness in swallowing disorders. But Rines was eager to try it. Cynthia Wise Wagner was the only speech pathologist in an acute care hospital in Boston offering this treatment immediately after Rines' stroke.

Rines was initially unable to contract the muscles in the middle of his throat, Wagner said. Since neuromuscular electrical stimulation has been successfully used in physical therapy for years to jump start muscles after surgery or injury, Wagner hoped the therapy would create contractions in Rines' pharynx.

"Once we establish a functional swallow, it's like going to the gym," Wagner said. "This therapy provides the resistance. It's like the swallowing muscles are weight training."

Two electrodes are placed on the muscles of the throat and two additional electrodes are placed under the base of the tongue. The patient then eats a meal to engage the swallowing muscles while Wagner performs swallowing therapy, increasing the electrical current to provide the necessary resistance. Her goal for Rines was for him to eat more food with fewer swallows. Wagner also enlisted the helps of Ram Chuttani, MD, the Chief of Endoscopy, who performed two dilations or stretching procedures of the muscle between Rines' throat and esophagus.

After meeting with Wagner three to four times a week for eight weeks, Rines went from being unable to swallow his own saliva to eating lobster, a dish he shared with Wagner during an emotional surprise 85th birthday party for him last August.

"It's no fun being fed through a hole in your stomach," Rines said. "I'm grateful that Cynthia and BIDMC took a chance on me."

Wagner and Rines also credit Rines' wife, Joanne Hayes-Rines, for her tireless support from driving her husband to therapy to cooking modified meals to helping Wagner chart the number of swallows he took during treatments. When the couple found out Wagner's therapy had lost its funding before trials could be finished, they decided to donate the money needed to not only reinstate, but also expand the program.

The C.W. Wagner Swallowing Therapy Program now operates four days a week and is staffed with a rehabilitation aide and administrative support.

"Cynthia had a vision and we had the resources to help," Hayes-Rines said. "We knew she was going against conventional wisdom by implementing this technology, but we also knew that without this therapy, Bob would not be able to go on this expedition."

Rines departs for Scotland in late August to finish up where his research left off five years ago. He hopes the five degree water of Loch Ness has preserved the skeletal remains of Nessie. It's another adventure made possible by placing his faith in a fellow pioneer.

"I know some people stick to the rules," Rines said. "But this is real life and I really don't care about the rules."

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and consistently ranks among the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.harvard.edu.