FAQ's for Patients and Caregivers


What is NMES and how does it work?

NMES stand for Neuromuscular Electrical Stimulation. NMES uses a handheld device to transmit tiny pulses through small cloth pads placed on the surface of the skin to stimulate the nerves to tell the muscles to move. The tiny pulses are painless and can activate weak or paralyzed muscles. This muscle activation combined with specific targeted tasks can cause an improvement in swallowing, voicing and facial movement. The Biber Protocol® is a customized NMES protocol for dysphagia, dysphonia and facial droop/paralysis.


Can I learn this technique for myself or a loved one?

Absolutely! Teresa will personally customize your NMES protocol and walk you through the step by step process to perform your treatments at home. Follow-up sessions will assure your confidence and there is a lifetime commitment to your needs. You can contact Teresa directly with questions or concerns for as long as you need to. 

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Will insurance pay for this?

Teresa is a private provider and does not accept insurance plans. 

FAQ's for Clinicians


Do I need a certification to do NMES?

The only certification that ASHA will recognize is their board certifications/specialities and the Certificate of Clinical Competence. A certificate from an ASHA CEU course is simply a piece of paper that proves you attended that course, calling it a certification is not consistent with the rigorous standards of ASHA and other organizations. The focus of a well designed course is on establishing competency in the technique of NMES which is consistent with the Principle of Ethics I, Rule A which insists that clinicians provide all services "competently," while Principle of Ethics III, Rule A admonishes against misrepresenting one's competence. Principle of Ethics II, Rule A provides specific guidelines by stating that an individual's level of education, training, and experience must be considered in determining the scope of their competence. For additional information and clarification please review the following articles:





Do I need a doctor’s prescription for NMES?

Not usually, but check with your employer as some organizations may require it. In a typical outpatient or acute care setting setting you simply need a prescription or doctor’s order for swallowing therapy. Your plan of treatment, which is signed by the doctor, includes NMES as part of your plan.


Can I bill separately for NMES?

No. We usually bill for dysphagia therapy 92526 regardless of what type of intervention we provide. Speech therapy billing for additional modalities is not consistent with standard best practice.

FAQ's for Clinicians


Can I use NMES with a pacemaker?

Yes but it is recommend that you go through the pacemaker interference protocol. Click below for the pacemaker protocol. 

However, NEVER use NMES with a defibrillator. 

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Can I use NMES with a cancer patient?

Yes. There is no scientific evidence for any risk when using NMES on a cancer patient. Indeed there is evidence that electrical stimulation can help shrink tumors and enhance radiation therapy. Please click below for more information. 

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What's the difference between VitalStim and The Biber Protocol®

There are a multitude of differences including electrode placement, parameters used, treatment time, method of delivery, treatment philosophy etc. The Biber Protocol® is true NMES and can be externally validated by dozens of electrotherapy sources. Although VitalStim uses electrical stimulation, it does not meet the criteria for an NMES protocol and therefore it should not be referred to as NMES. 

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