[Dysphagia] bilaterial 7th palsy

[wwasmith at comcast.net (wwasmith@comcast.net)]

Hello all,

 This is not entirely a dysphagia problem, but an interesting one.  I have a patient, early 70's who sustained a fall down the stairs and got her head caught in the bannister, not found for a number of hours.  She's doing quite well at our rehab, has central cord syndrome (they're calling it "tetraplegia"), but is ambulating a bit.  In addition to weak arms, (legs a bit weak too), she has bilateral 7th nerve palsy, which look central in origin to me (she can't wrinkle her forehead) and NOT A BIT of movement.  I can't imagine how the 7th nerve problems might relate to her spinal cord injury, perhaps an infection/additional consequence from her hospital stay?  It's kind of academic at this point.

At any rate, she has a trach, but no pulmonary disease other than some hard to get rid of infiltrates (has been on antibiotics).  The trach is plugged most of the time during the day.  Fairly good phonation.  Good 02 sats (95-95 range). Has a PEG.  In terms of eating by mouth, she's starting to take some thin lix, water via spoon, and servings of pudding and soft foods.  Food collecting a bit in the anterior sulcus in front of her gums, but she can retrieve with her tongue with some effort.  No aspiration/penetration on her MBS.    Somehow she's not even drooling, except when taking fluids (we're encouraging her to lean forward and drool a bit, rather than backwards to propel the bolus).   Appetite's limited, eating is a chore and not hungry probably due to PEG, but I suspect her appetite will improve as she progresses.

This lady is actually the second patient I've had in a couple of years with bilateral 7th nerve palsy.   ( The last one was scary, he would drink with a straw by inhaling then do a quick glottic closure to swallow.   ) My question is this: Any treatment ideas ??  Anyone having luck with estim for these patients, either unilateral or bilateral?  We don't have any special software, but do have some regular FEE/estim units where I work.  (I have a date with our outpatient OT to try some  of this).   I'm  also thinking sort of passive range/facial massage to at least provide some stretch in the opposite direction from gravity.  Thanks for any ideas you can offer.  

Wendy