|
[Date Prev][Date Next]
[Chronological]
[Thread]
[Top]
[Dysphagia] Re: Yorick Wijting response
----- Original Message -----
From: <dysphagia-request@b9.com>
To: <dysphagia@b9.com>
Sent: Saturday, March 08, 2003 8:25 AM
Subject: Dysphagia digest, Vol 1 #490 - 3 msgs
> Send Dysphagia mailing list submissions to
> dysphagia@b9.com
>
> To subscribe or unsubscribe via the World Wide Web, visit
> http://www.b9.com/mailman/listinfo/dysphagia
> or, via email, send a message with subject or body 'help' to
> dysphagia-request@b9.com
>
Well said and incorporates the global principles that make dysphagia therapy
work. You are a perfect example of why interdisciplinary treatment works.
The language is not the important venue. The concepts and the
implementation are why we succeed. Wish I had you on my team. Thanks for
the input. Patti
> You can reach the person managing the list at
> dysphagia-admin@b9.com
>
> When replying, please edit your Subject line so it is more specific
> than "Re: Contents of Dysphagia digest..."
>
>
> Today's Topics:
>
> 1. RE: "learned non-use" and dysphagia (Yorick Wijting)
> 2. RE: "learned non-use" and dysphagia (Yorick Wijting)
> 3. turn off feeding??? (Ron McClanahan)
>
> --__--__--
>
> Message: 1
> From: "Yorick Wijting" <yorickw@worldnet.att.net>
> To: <dysphagia@b9.com>
> Date: Fri, 7 Mar 2003 23:46:36 -0500
> Subject: [Dysphagia] RE: "learned non-use" and dysphagia
>
> Hi Michael,
>
> I'm new to this mailing list and your message caught my interest. Even
> though I do not work on dysphagia with patients (I'm a PT - :-) ), I
> frequently see and deal with the problem of learned non-use. Through an
> accidental turn of events, I have also recently started studying the
> physiological mechanisms underlying the pathology involved in the
> various presentations of dysphagia. It has really been interesting!
>
> Regarding your comment, I am convinced that learned non-use plays a
> major role in the development and maintenance of the problem. Without
> direct practical experience in your area of expertise, I can only
> comment on the general principles involved. As those principles hold
> true in other parts of the body, I feel they probably have some
> significance in dysphagia as well.
>
> As you know, learned non-use is the term given to the phenomenon of
> acquired motor deficit through the lack of functional, volitional
> recruitment of the extremity or muscle group. Simplistically said, "If
> you don't use it, you'll lose it." There is lots of research describing
> this phenomenon quite eloquently, most of it generated in the context of
> constraint induced therapy (CIT). Basically the thought goes that as a
> result of the stroke, the one side of the body goes through a phase of
> non-use as a result of the insult. During this time the body starts
> relying on the healthy side to perform the functions otherwise performed
> by the involved side. This causes a certain amount of cortical
> reorganization, creating a super-dominant 'healthy' side and a dormant
> 'involved' side.
>
> To remedy this situation, characteristics of this treatment approach
> (CIT) include 1) to provide LOTS of stimulation to the impaired side of
> the body, 2) to reduce stimulation to and recruitment of the healthy
> side of the body, and 3) to maximize functional recruitment of the
> impaired side/extremity/muscle group. In the typical CIT group, the
> patient will therefore 1) do lots of repetitive activities with the
> involved side, 2) wear a mitt or some other restraint to minimize input
> to the healthy side, and 3) increase functional activities of the
> involved side as much as possible.
>
> How does this relate to dysphagia? In the context of CIT, compensatory
> strategies for missing motor patterns can really be counter-productive
> as they teach the brain to use motor recruitment patterns that are not
> natural nor normal, thereby inhibiting the motor patterns which we are
> trying to rehabilitate. Translate this to your patient and you are faced
> with a dilemma, as you already suspect: turn his head and he performs a
> safer swallow, which may be essential at first, but at the same time you
> teach him to rely on his stronger side thereby compounding the problem.
>
> In my opinion you should try incorporate the 3 principles above: 1)
> numerous repetitive activities (at least 1 hour at a time) recruiting
> the weakened side in ways that he can manage (exercise, etc), 2)
> restrain the stronger side somehow (how to achieve that? I'll leave that
> up to the swallowing experts - maybe turn the head the opposite way???),
> and 3) increase functional activities - more and more swallowing, using
> any and all tools at your disposal: modalities, exercise, biofeedback,
> positive reinforcement, etc.
>
> Forgive me in case this response uses incorrect speech terms or
> principles. I think that you're onto something though. Pursue it and let
> all know what happens!
>
> Cheers, Yorick
>
> PS: I'll post references re. CIT and other if you want
>
> Message: 1
> From: "michael biel" <soobaaaa9@hotmail.com>
> To: dysphagia@b9.com
> Date: Thu, 06 Mar 2003 22:48:53 +0000
> Subject: [Dysphagia] "learned non-use" and dysphagia.
>
>
> Hi, I was wondering if anyone on this list had any thoughts about how
> the
> concept of learned non-use might play out when dealing with management
> of
> dysphagia. For example, I recently had a pt with a unilateral
> pharyngeal
> weakness. His swallow was much more efficient with his head turned
> toward
> the weak side. I saw him about 1 month post-cva. If I recommend that
> he
> assume this posture am I negatively affecting his recovery by making him
>
> rely on the intact inside?
>
> Thanks
> Mike
>
>
>
> --__--__--
>
> Message: 2
> From: "Yorick Wijting" <yorickw@worldnet.att.net>
> To: <dysphagia@b9.com>
> Date: Fri, 7 Mar 2003 23:49:47 -0500
> Subject: [Dysphagia] RE: "learned non-use" and dysphagia
>
> Hi Michael,
>
> I'm new to this mailing list and your message caught my interest. Even
> though I do not work on dysphagia with patients (I'm a PT - :-) ), I
> frequently see and deal with the problem of learned non-use. Through an
> accidental turn of events, I have also recently started studying the
> physiological mechanisms underlying the pathology involved in the
> various presentations of dysphagia. It has really been interesting!
>
> Regarding your comment, I am convinced that learned non-use plays a
> major role in the development and maintenance of the problem. Without
> direct practical experience in your area of expertise, I can only
> comment on the general principles involved. As those principles hold
> true in other parts of the body, I feel they probably have some
> significance in dysphagia as well.
>
> As you know, learned non-use is the term given to the phenomenon of
> acquired motor deficit through the lack of functional, volitional
> recruitment of the extremity or muscle group. Simplistically said, "If
> you don't use it, you'll lose it." There is lots of research describing
> this phenomenon quite eloquently, most of it generated in the context of
> constraint induced therapy (CIT). Basically the thought goes that as a
> result of the stroke, the one side of the body goes through a phase of
> non-use as a result of the insult. During this time the body starts
> relying on the healthy side to perform the functions otherwise performed
> by the involved side. This causes a certain amount of cortical
> reorganization, creating a super-dominant 'healthy' side and a dormant
> 'involved' side.
>
> To remedy this situation, characteristics of this treatment approach
> (CIT) include 1) to provide LOTS of stimulation to the impaired side of
> the body, 2) to reduce stimulation to and recruitment of the healthy
> side of the body, and 3) to maximize functional recruitment of the
> impaired side/extremity/muscle group. In the typical CIT group, the
> patient will therefore 1) do lots of repetitive activities with the
> involved side, 2) wear a mitt or some other restraint to minimize input
> to the healthy side, and 3) increase functional activities of the
> involved side as much as possible.
>
> How does this relate to dysphagia? In the context of CIT, compensatory
> strategies for missing motor patterns can really be counter-productive
> as they teach the brain to use motor recruitment patterns that are not
> natural nor normal, thereby inhibiting the motor patterns which we are
> trying to rehabilitate. Translate this to your patient and you are faced
> with a dilemma, as you already suspect: turn his head and he performs a
> safer swallow, which may be essential at first, but at the same time you
> teach him to rely on his stronger side thereby compounding the problem.
>
> In my opinion you should try incorporate the 3 principles above: 1)
> numerous repetitive activities (at least 1 hour at a time) recruiting
> the weakened side in ways that he can manage (exercise, etc), 2)
> restrain the stronger side somehow (how to achieve that? I'll leave that
> up to the swallowing experts - maybe turn the head the opposite way???),
> and 3) increase functional activities - more and more swallowing, using
> any and all tools at your disposal: modalities, exercise, biofeedback,
> positive reinforcement, etc.
>
> Forgive me in case this response uses incorrect speech terms or
> principles. I think that you're onto something though. Pursue it and let
> all know what happens!
>
> Cheers, Yorick
>
> PS: I'll post references re. CIT and other if you want
>
> Message: 1
> From: "michael biel" <soobaaaa9@hotmail.com>
> To: dysphagia@b9.com
> Date: Thu, 06 Mar 2003 22:48:53 +0000
> Subject: [Dysphagia] "learned non-use" and dysphagia.
>
>
> Hi, I was wondering if anyone on this list had any thoughts about how
> the
> concept of learned non-use might play out when dealing with management
> of
> dysphagia. For example, I recently had a pt with a unilateral
> pharyngeal
> weakness. His swallow was much more efficient with his head turned
> toward
> the weak side. I saw him about 1 month post-cva. If I recommend that
> he
> assume this posture am I negatively affecting his recovery by making him
>
> rely on the intact inside?
>
> Thanks
> Mike
>
>
>
> --__--__--
>
> Message: 3
> From: "Ron McClanahan" <rmcclana@kvmo.net>
> To: "dyspha" <dysphagia@medonline.com>
> Date: Sat, 8 Mar 2003 05:52:29 -0600
> Subject: [Dysphagia] turn off feeding???
>
> This is a multi-part message in MIME format.
>
> ------=_NextPart_000_000B_01C2E536.E7738EE0
> Content-Type: text/plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: quoted-printable
>
> I was wondering if one should turn off the feeding during oral feeding =
> of a patient...I have always requested this especially since one patient =
> regurgitated .... would like to know if there is a physiologically-sound =
> reason or just a coincidence...usually I request turning off the machine =
> 1 hr prior and post to oral feeding....thank you....spkez
> ------=_NextPart_000_000B_01C2E536.E7738EE0
> Content-Type: text/html;
> charset="iso-8859-1"
> Content-Transfer-Encoding: quoted-printable
>
> <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
> <HTML><HEAD>
> <META http-equiv=3DContent-Type content=3D"text/html; =
> charset=3Diso-8859-1">
> <META content=3D"MSHTML 6.00.2800.1106" name=3DGENERATOR>
> <STYLE></STYLE>
> </HEAD>
> <BODY bgColor=3D#ffffff>
> <DIV><FONT face=3DArial size=3D2>I was wondering if one should turn off =
> the feeding=20
> during oral feeding of a patient...I have always requested this =
> especially since=20
> one patient regurgitated .... would like to know if there is a=20
> physiologically-sound reason or just a coincidence...usually I request =
> turning=20
> off the machine 1 hr prior and post to oral feeding....thank=20
> you....spkez</FONT></DIV></BODY></HTML>
>
> ------=_NextPart_000_000B_01C2E536.E7738EE0--
>
>
>
> --__--__--
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://www.b9.com/mailman/listinfo/dysphagia
>
>
> End of Dysphagia Digest
|
|