[DYSPHAGIA] Trach and MBS

[vstefans@care.ach.uams.edu (Vikki A. Stefans)]

A fair number of patients use finger occlusion to increase voicing quickly
and temporarily.  It should not take a lot of pressure and if it further
limits larnyngeal elevation (more than just having the trach in in the
first place) maybe they are pressing too hard.

I thought one reason to do VFSS with a trach was to assess this sort of
thing; i.e. how much does the loss of laryngeal elevation affect the
swallow in any given individual?- not to mention the underlying condition
necessitating the trach affectign the swallow as well.  I'm not sure I
would conisder a VFSS a bad idea for someone just because they had a
trach...

(PS I tried it and can swallow OK, and it actually seems too uncomfortable
to press hard enough to really limit excursion.  Maybe I am just too
sensitive?)


Vikki Stefans, pediatric physiatrist (rehab doc for kids), e-mail junkie, 
working Mom of Sarah T. and Michael C., and wife of Henry "My Travel Agent", 
Arkansas Children's Hospital/ U of A for Medical Sciences, Little Rock, aka
vstefans@care.ach.uams.edu ...and EVERY mom is a working mom! (OK, dads too.) 


On Sun, 4 Mar 2001, I Campbell-Taylor wrote:

> I often receive videos for analysis and comment. Recently I saw one
> that begs a question that I sincerely hope someone will answer.  The
> patient had a trach in place but was able to tolerate long periods
> with it corked and, shortly after this MBS was done, the trach was
> removed. This is a side issue and we'll leave, for the moment, the
> wisdom of performing MBS or VFSS of any kind with a trach in place.
> There were only two lateral shots. No AP. In the first, there was some
> laryngeal elevation but NO hyoid movement - as expected in a lateral
> medullary stroke, which this patient had. The UES therefore, could not
> open and aspiration resulted. The next thing is what I need some input
> about. For some reason, the clinician then had the patient occlude the
> stoma with his finger. This, of course, had the result of eliminating
> whatever laryngeal elevation he had which, coupled with the absence of
> hyoid movement made aspiration absolutely inevitable. Can anyone tell
> me why anyone would occlude the stoma with the finger in a case like
> this? For what reason? And, try it yourself. Put your finger at the
> usual location of a stoma and apply some moderate pressure. Then try
> to swallow.

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