[Dysphagia] traumatic fall and tongue mobility

[smhjr at surfbest.net (smhjr@surfbest.net)]

He sounds a lot like posterior fossa craniotomy patients I have seen.
Good tongue tip movement but bad base of tongue, poor or no UES
function and sometimes a weak voice/cough. To stimulate the swallow I
have used tiny sips of very cold water with the patient attempting a
hard swallow. Would also consider surface EMG.

OM exercises have no research efficacy to back them up. I only use
them when a patient can do them indepedently to make them feel like
they are working towards their goal of being able to eat again. I
stand by the statement "The best exercise for swallowing is
swallowing".

PS - Had a construction worker once who fell off the second story of
a building into a pile of sand (on his back). He tripped on a
concrete block and when he fell the block followed him. The block
landed on his face. Major trauma to the face, large hematoma in
pharynx but no brain damage. Sand absorbed most of his fall and the
brick's impact.

Sara M Hoffman, MS, CCC-SLP

---- Original Message ----
From: naomislp@aol.com
To: dysphagia@b9.com
Subject: RE: [Dysphagia] traumatic fall and tongue mobility
Date: Tue, 08 Mar 2005 12:01:40 -0500

>Hello all,
>Recently saw a young patient s/p 3-story fall, currently on trach
>collar and s/p PEG placement. There were multiple fractures but no
>documented head trauma or fractures around skull or face. Oral motor
>function is intact except for what seems to be isolated but
>significantly impaired lingual mobility and strength.  This has
>resolved slightly, with better range of motion at tongue tip and
>front but poorer movement mid-back and likely poorest movement at
>base, given poor swallow function and gross aspiration on single
>trial puree during bedside eval.  He was initially aphonic (despite
>cuff deflation, trach occlusion) but vocal function is gradually
>improving.
>What could be causing the isolated impairment of tongue function - is
>this cranial nerve damage? Would that also explain initially poor
>laryngeal function (or is that more likely due to period of
>intubation prior to trach and/or presence of trach currently?)
>He seems to be responding to traditional OM exs - any other
>suggestions?
>Thanks in advance,
>Naomi
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