Patient Information: Female, Age 80
Diagnosis: Dysphagia / Parathyroid Adenoma / Subdural Hemorrhage
History: This woman was hospitalized and diagnosed with a subdural hematoma after falling down a flight of stairs at her home. She underwent a surgical procedure (a craniotomy) to relieve the pressure on her brain. While hospitalized she was diagnosed with cancer in her throat (parathyroid adenoma) and underwent a second surgery to remove the mass. Due to the disruption of her swallow caused by surgery, a feeding tube was placed to ensure proper nutrition. After six weeks in the hospital, this woman transferred to a skilled nursing facility for rehabilitation.
- Swallow Assessment: A video fluoroscopic swallow study revealed delayed swallow initiation, weakness of the oral musculature, and absence of a cough reflex. Penetration of the airway was noted with all food and liquid consistencies and aspiration (liquid entering the lungs) was noted with thin liquids.
- National Outcomes Measurement System (NOMS): Level 1; unable to swallow anything safely by mouth.
- Diet: All nutrition and hydration delivered through the feeding tube.
- Cognition Assessment: Moderate cognitive impairment indicated via a Mini Mental State Examination (MMSE) score of 10/30; dementia indicated via a Saint Louis University Mental Status (SLUMS) score of 12.
- Modality/Equipment: OMNIsEMG™, Omnistim® FX2 Portable Patterned Electrical Neuromuscular Stimulation (PENS).
- Frequency: 3-5x per week.
- Protocol Specifics: Upper extremity biphasic PENS to face and posterior neck musculature to improve oral-pharyngeal neuromuscular coordination. Progressive resistive oral motor exercises using OMNIsEMG™ line graph and kangaroo visualizations with work/rest cycles to improve strength and timing of muscle contractions.
- Duration: Seven weeks.
- Other Therapy Services Provided: Resistive tongue exercises, cognitive skills development, and patient education on safe swallow strategies.
- Swallow Assessment: A video fluoroscopic swallow study revealed a normalized swallow with no penetration or aspiration noted with any consistency of food or liquids.
- National Outcomes Measurement System (NOMS): Level 7; swallowing is safe and efficient for all consistencies. Compensatory strategies are effectively used when needed.
- Diet: Regular consistency with thin liquids; feeding tube removed.
- Cognition Assessment: Cognitive skill significantly improved, as indicated via a Mini Mental State Examination (MMSE) score of 27/30; mild neurocognitive deficit indicated via a Saint Louis University Mental Status (SLUMS) score of 24.
This woman is thrilled that she is able to eat a regular diet and enjoy thin liquids again. Her improvement with swallowing not only enabled the removal of the feeding tube, but significantly improved her quality of life, allowing her to share meals with family and friends.
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