Patient Information: Male, Age 83
Diagnosis: Dysphagia | COPD | CHF | Aspiration Pneumonia
History: Over a two month period of time, this gentleman had multiple hospitalizations due to recurrent episodes of aspiration pneumonia (a complication of inhaling food, drink, or saliva into the lungs) and significant weight loss. The aspiration pneumonia was a result of his dysphagia (difficulty swallowing) and compromised respiratory system. He was put on a modified diet with thickened liquids, with a goal to deter aspiration. He received home health speech therapy with no improvement, and self-reports non-compliance with diet modification, especially thickened liquids. Following his most recent hospitalization, he was admitted to a skilled nursing facility and referred to speech therapy for rehabilitation.
•Swallow Assessment: Clinical evaluation revealed mild swallow delay, hoarse vocal quality, decreased coordination of the swallow, and intermittent throat clear/cough with intake of thin liquids. A modified barium swallow study (MBSS) showed silent and/or audible aspiration (liquid entering the airway) with decreased movement and coordination of the tongue base and throat muscles.
•Diet Modifications: Pureed solids with nectar thick liquids.
•Functional Oral Intake Score: Level 5; total oral diet with multiple consistencies but requiring special preparation or compensations.
•Modality/Equipment: OMNIsEMG™, Omnistim® FX2 Portable Patterned Electrical Neuromuscular Stimulation (PENS).
•Frequency: 4-5x per week.
•Protocol Specifics: Upper extremity biphasic PENS head and neck protocol to improve neuromuscular coordination of swallow function. Typical swallow, effortful swallows, and Mendelsohn manuevers performed using sEMG biofeedback visualizations (kangaroo, diver, and bow and arrow) to improve effort, quality, and coordination of swallow musculature. By the end of therapy, his Mendelsohn Manuever progessed from a 3.97 to a 7.36 second hold, indicating increased swallow effort and improved airway protection.
•Duration: Four weeks.
•Other Therapy Services Provided: Resistive oral pharyngeal strengthening exercises, VitalStim® therapy
2-3x per week, and compensatory techniques including positioning maneuvers.
•Swallow Assessment: No clinical signs/symptoms of aspiration. MBSS confirmed no aspiration with thin liquids due to tongue and pharyngeal muscle movement within normal function.
•Diet Recommendations: Regular diet and thin liquids.
•Functional Oral Intake Scale: Level 7; total oral diet with no restrictions.
This man is very impressed with the Synchrony technology and is surprised his swallowing problems were able to be resolved. He reports he enjoyed assisting the therapist in “assessing” his swallows by interpreting the trace display once he became more familiar with it. His speech language pathologist notes the man cried when she told him he can now eat a regular diet and drink thin liquids without difficulty. The gentleman is very proud of his work as well as the work of the therapist, and expressed that he feels the treatment he received will help prevent him from further hospitalizations related to aspiration pneumonia!