[Dysphagia] swallow apraxia

[s_langer at juno.com (S. Langer)]

Hi all

What are the signs and symptoms of swallow apraxia?  How can it be differentially diagnosed from difficulty initiating/triggering swallow for some other reason?

Pt. in question is about 80 yo, s/p CVA with global aphasia and severe oral/verbal apraxia. Pt. also has significant OM weakness and dysphagia.

Upon admission, when taking cup sips thin liquid, pt. triggered swallow only ~1/3 of the time; increased to ~50% of the time with nectar-thick.  This is gradually improving; at this point, swallow generally triggered after every swallow, but often delayed.

MBS performed this AM to R/O silent aspiration.  Pt. p/w lengthy oral prep, decreased A-P transport/lengthy OTT, decreased BOT retraction, prem. loss of bolus to valleculae with all trials, and spillover to pyriforms with thin.  Swallow delay with solids, increased with increased cohesion (min for finely ground...to mod-severe for soft solid), but not with liquids.

Questions:

1.  Does this sound like swallow apraxia to you? (why/why not?)

2. What are s/s swallow apraxia?  How can it be differentially diagnosed?

3.  What are some tx. techniques/strategies appropriate for this dx?

Would appreciate any thoughts/comments ppl could offer.

Thanks
Sharon Langer MA CCC-SLP

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