[Dysphagia] RE: Dysphagia Digest, Vol 26, Issue 16

[DAmelio.Melissa at TorontoRehab.on.ca (D'Amelio, Melissa)]

Hi all, 
I need some input. 

Male patient, 81 years old. Dx: Aortic dissection (Bentall's procedure), L
CVA post-surgery, R vocal fold paralysis. No hx of GERD, diabetes,
respiratory compromise. PMHx: A-fib. Currently, NPO and receiving feeds/meds
through G-J tube. OME indicated no tongue protrusion, limited ability to
protrude, lateralize, elevate and depress tongue, xerostomia, severe thrush
(hard and soft palate deterioration) - resolving today with treatment,
hoarse, inaudible voice, dysarthric speech (indicating poor airway closure).


I have not formally assessed for aphasia, but auditory comprehension and
expression appears WNL. Patient is using an alpha-numeric board to
communicate. I am using gauze wrapped around a tongue depressor soaked in
cool water for oral care and relief. Patient is also chewing on gauze to
stimulate saliva production. No coughing, wet voice quality when swallowing
saliva. I am currently providing intensive therapy 2-3x/day:
1) tongue exercises, 2) Shaker, 3) ??? Effortful swallow (concerned about
heart condition, so have not taught this one yet). I have seen some
improvement in tongue strength, ROM, & coordination. Planning to trial water
sips next week providing oral infection is clear.

Any input or references on other exercises, oral care/relief, plan for
resuming PO intake - trialing water etc? 

In acute care, SLP trialed ice chips and apple sauce without success. Any
ideas for this gentleman???

Thanks, 
Melissa D'Amelio, MHSc, SLP(C), Reg. CASLPO
Toronto Rehabilitation Institute

-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On Behalf
Of dysphagia-request@b9.com
Sent: Friday, January 13, 2006 2:01 PM
To: dysphagia@b9.com
Subject: Dysphagia Digest, Vol 26, Issue 16

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Today's Topics:

   1. Re: Dysphagia Digest, Vol 26, Issue 13 (S. Langer)
   2. FW: [Dysphagia] Cited reference
      (Bassani, Heidi D Ms WRAMC-Wash DC)
   3. Re: Cited reference (Namp304@aol.com)


----------------------------------------------------------------------

Message: 1
Date: Fri, 13 Jan 2006 04:57:37 GMT
From: "S. Langer" <s_langer@juno.com>
Subject: [Dysphagia] Re: Dysphagia Digest, Vol 26, Issue 13
To: dysphagia@b9.com
Cc: dysphagia@b9.com
Message-ID: <20060112.205743.1718.16027@webmail25.lax.untd.com>
Content-Type: text/plain

Hi all
Speaking of the effect of hot liquids on swallow, I have a pt. who reports
signif. coughing with HOT thin liquids only (long-standing h/o.)  At the
moment, she's s/p CVA but states this is not a new problem and that she's
had this her whole life.  What do you think the mechanism behind this might
be?
Thanks
Sharon


------------------------------

Message: 2
Date: Fri, 13 Jan 2006 09:47:44 -0500
From: "Bassani, Heidi D Ms WRAMC-Wash DC"
	<Heidi.Bassani@amedd.army.mil>
Subject: FW: [Dysphagia] Cited reference
To: <dysphagia@b9.com>
Message-ID:
	
<F37AE22BB1CCF84494FFD44DAD3E8187015B6C06@AMEDMLNARMC133.amed.ds.army.mil>
	
Content-Type: text/plain;	charset="us-ascii"

 
 Oops, forwarding this b/c I must have not clicked "Reply to all". 
-----Original Message-----
From: Kutner, Alina [mailto:Ali.Kutner@healthsouth.com] 
Sent: Friday, January 13, 2006 8:33 AM
To: Bassani, Heidi D Ms WRAMC-Wash DC
Subject: RE: [Dysphagia] Cited reference

I totally agree - we have been trying to stop the pass/fail language for
years!

-----Original Message-----
From: Bassani, Heidi D Ms WRAMC-Wash DC
[mailto:Heidi.Bassani@amedd.army.mil]
Sent: Friday, January 13, 2006 8:24 AM
To: Kutner, Alina
Subject: RE: [Dysphagia] Cited reference


You are absolutely right. This gets to the heart of the idea (one of my
biggest pet peeves) that VFSS's are pass/fail exams.  Every time I heard
"Did he pass his modified?" a little part of me dies.  Unfortunately,
some SLP's perpetuate this by simply saying yes or no and this is why we
need to educate not only ourselves, but colleagues outside of our field
as to what a VFSS does.  People do not ask "Did he pass his MRI?"  We
need to let our doctors, nurses, etc. know that VFSS determine if
aspiration is present, how much material is aspirated, on what
consistencies, WHY is it being aspirated, do compensatory
strategies/maneuvers improve the aspiration, etc, etc.  It's not
Pass/fail.


-----Original Message-----
From: Kutner, Alina [mailto:Ali.Kutner@healthsouth.com]
Sent: Thursday, January 12, 2006 3:46 PM
To: Clarke-Goertz, Kim (PAPHR); dysphagia@b9.com
Subject: RE: [Dysphagia] Cited reference

I feel most SLP's utilize the VFSS to do exactly that - identify
abnormalities of swallowing physiology so we may make an appropriate
plan.  If we all had the "misguided tendancy" to simply ID aspiration,
we would have one line reports:
yes	no	(check one)


-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of Clarke-Goertz, Kim (PAPHR)
Sent: Thursday, January 12, 2006 2:58 PM
To: 'dysphagia@b9.com'
Subject: FW: [Dysphagia] Cited reference


The link is:
http://www.springerlink.com/(lhm4sbqtbgngl4z4ahqt55ng)/app/home/contribu
tion
..asp?referrer=parent&backto=issue,4,11;journal,21,35;linkingpublication
resul
ts,1:100357,1




-----Original Message-----
From: Irene Campbell-Taylor [mailto:eripley@yahoo.com]
Sent: Thursday, January 12, 2006 12:53
To: Heidi.Bassani@amedd.army.mil; dysphagia@b9.com
Subject: [Dysphagia] Cited reference


  The following article, and its content re clinical exam vs VFSS should
be read in its entirety:Clinical utility of the modified barium swallow.
Dysphagia. 2000 Summer;15(3):136-41.Martin-Harris B, Logemann JA,
McMahon S, Schleicher M, Sandidge J.
 The misguided tendency to refer to the modified barium study only as a
tool for identifying aspiration and the appropriate utilization of the
examination for identification of underlying abnormality in swallowing
physiology are explained.



Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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------------------------------

Message: 3
Date: Fri, 13 Jan 2006 12:03:08 EST
From: Namp304@aol.com
Subject: Re: [Dysphagia] Cited reference
To: LOBSTERPAM@aol.com, DRolfe@nsccahs.health.nsw.gov.au
Cc: dysphagia@b9.com
Message-ID: <27b.321a911.30f9374c@aol.com>
Content-Type: text/plain; charset="US-ASCII"

 

I agree!
 
 
In a message dated 1/12/2006 10:11:59 PM Central Standard Time,  
lobsterpam@aol.com writes:

below,  but if it said that VFSS was "ONLY" used for identification of
aspiration,  then I would be appalled at afifure of 80% believing that.
But if it didn't  specify the "ONLY" then I can understand the figure of 
80% (and
am  wondering why not higher)...as you can identify aspiration via MBS  
(although
granted it is only a snapshot, so you may not see it on that  occasion).







------------------------------

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