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[Dysphagia] Swallowing and MR
Hi There,
A few things that I would think about in this case... additionally how old
is the patient and I am assuming that MR means "mental retardation"?
How are his lungs? Has he had a bronchitis, or a pneumonia? If not then that
could rule out possible aspiration. If aspiration is not a possibility or a
concern, then I would start thinking about the esophagus for a few reasons;
Typically when patients complain of food "sticking" in the pharyngeal area
it might mean that something is going on in the lower esophageal region, a
term coined as "referred sensation". I learned this term not only from my
own supervisor, but the GI docs use it all the time. I would probably rec
that he go to a GI specialist and then get an Upper GI and possible even an
EGD (the upper GI will have him swallow large quantities of barium and the
Radiologist will take pics of the passage from the UES to the stomach, the
EGD consists of the GI scoping the esophagus to make sure that there is no
erosion and other things etc) Additionally, is there a history of GERD? That
could also be something to consider. Some patients do complain that their
GERD or reflux occurs more often at certain times during the day. This may
be the case with your patient.
I see this a lot, especially when I conduct out-patient Videos. Patients
complain of food "sticking" and when I do the Video I don't find anything,
the swallowing mechanism is fine. Its important that all the aspiration
precautions are being followed when your patient is eating. Not sure if he
is eating at school or at home, but that he is undistracted, sitting upright
etc. I dont know if positioning with your patient is a problem, but that
might be something to think about as well.
Hope that some of this helps. If anything else comes up I would be happy to
help! Send another message to the listserve when you all find out the
outcomes with your patient. Good luck!
Paula Garbin, M.S., CCC-SLP
On 3/31/07, Kristi Cart <cmds_slp2004 at hotmail.com> wrote:
>
> HI,
>
> I am a second year graduate student and currently have a client who has
> been diagnosed with MR who is also having swallowing difficulties. He is
> primarily non-verbal and what communication he does have is very
> inconsistent. When he is eating breakfast, usually cereal and milk, he says
> that he feels something "stuck" in his pharynx. This usually leads to him
> throwing up his stomach contents. His teachers state that he usually only
> throws up at breakfast and very rarely at lunch. He also frequently drools
> and has difficulty forming a bolus during the oral phase. My professor and I
> have suspicions that he may have an esophageal problem, but as of yet he has
> not had a barium swallow test. If anyone has any suggestions as to what I
> could do to help him your input would be greatly appreciated.
>
> Thank you,
> Kristi Cart
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