[Dysphagia] Cricopharyngeal Diet

[ldcrabtr at pmt.org (Leslie D. Crabtree)]

I took the vitalstim course in July, 2003, and they didn't present anything 
about a "cricopharyngeal diet".  I looked in the coursebook to make sure I 
didn't just forget about it, but I couldn't find any reference to it.  If 
I'm missing it, I appologize, but I don't see anything.  They definitely 
discussed cricopharyngeal dysfunction, alot.  However in my practice, I have 
not, to date, found 1 patient who I would say had cricopharyngeal 
dysfunction as the causal factor for their dysphagia.  I have had patients 
referred to me for swallow therapy by a GI doc AFTER they had performed a 
dilitation, but I have not recommended assessment looking specifically at CP 
dysfunction as the cause of dysphagia.  Unfortunately, as more therapists 
have been certified in vitalstim, I'm getting more reports which mention 
possible cricopharyngal dysfunction.  I actually get quite annoyed with 
other therapists who have taken the course and  immediately feel CP 
dysfunction is the primary problem with the majority of their dysphagia 
patients.  It's exactly the same thing that happened when DPNS was taught. 
I would even get home health orders asking specifically for DPNS, because 
the hospital clinician recommended it.  .  The more I talk about this, the 
more annoyed I get.  WHY do some clinicians take a course, and then think 
the information that was just presented to them is the perfect thing for 
EVERY patient?  Yes, I took the vitalstim course.  Yes, it is making a 
significant difference in the lives of my patients with dysphagia, 
especially those who have been long-term NPO.  Is it the answer for all of 
my dysphagia patients?  No.  However, it is a powerful tool when used 
appropriately in conjunction with all the tools we have to date.  And for 
the record, I think I'm one of the very few SLP's in my state who doesn't 
use DPNS.

To get back on track after my step up onto the soapbox--I don't recall 
anything about a cricopharyngeal diet in the earlier vitalstim courses. 
Maybe this is something that was added in the last 2 years.

Leslie Crabtree



----- Original Message ----- 
From: "Irene Campbell-Taylor" <eripley@yahoo.com>
To: <dysphagia@b9.com>
Sent: Wednesday, September 14, 2005 1:58 PM
Subject: [Dysphagia] Cricopharyngeal Diet


>
>
> We've come to learn that it stems from vitalstim education and the 
> identification of and significance of cricopharyngeal dysfunction in 
> dysphagia.
>
> *** Well. well. Another example of the almost complete misunderstanding of 
> swallowing physiology evidenced by the promoters of VitalStim. Many.many 
> communications with them have led me to accept that I am banging my head 
> against that proverbial brick wall. It is NOT a cricopharyngeal 
> dysfunction (unless so demonstrated by manometry and in very specific 
> cases) but failure of opening of the UES due to failure of anterior 
> movement of the hyoid - the most common aspect of oropharyngeal dysphagia. 
> The "diet" part refers to the multiple studies that have shown that the 
> larger and heavier the bolus, the easier the passage through the UES - 
> See, Kahrilas, Logemann, Dent, Cook, Ravich, Shaker etc. etc. (Which, as a 
> by the way - has always called into question the inexplicable tendency to 
> recommend tiny boluses for dysphagic patients. I'l never  understand that 
> one.)
>
> Tiny crackers may be of a better consistency when mixed with saliva but 
> not by much.
>
> The "diet" part is very simple - larger, heavier boluses are easier to 
> swallow than tiny, light ones as passage through the UES depends on the 
> traction of the hyoid combined with the weight and velocity of the bolus - 
> on which there is a plethora of research.
>
>
>
>
> Dr I Campbell-Taylor
> Clinical Neuroscientist
> Exclusive Distributor:
> www.interactivetherapy.com
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