[Dysphagia] any experience w/ ataxic dysarthria /spinocerebellar atrophy?

[jocelen.gudgeon at gmail.com (Jocelen Gudgeon)]

Hi - I just evaluated a 56 yo female w/ 11 yr hx of spinocerebellar atrophy
w/ 1 yr hx of increasing dysarthria and dysphagia. Pt's main complaint is
getting "choked" while talking. Voice characterized by low pitch, consistent
glottal fry w/ strained/strangled quality that worsened at times. (Irregular
artic breakdowns were also present). For example, max phonation for "ah" was
3 to 5 seconds w/ increasing strain noted until air stream was cut off -
then it was typical for a coughing episode to occur in which she would take
a deep breath but was not able to expel the air. This led to several weak
coughs and then she was able to finally get a strong cough. (Scary to watch-
even scarier for her) For sustained "s" she was able to maintain airflow
for 10-11 seconds. In conversation there were times the vocal strain
increased until the airflow was stopped and then she'd go into a coughing
episode again.

Is it possible that this stoppage of airflow is a compensatory strategy gone
bad or is this common w/ ataxia?
Any recommendations for reducing tension and freq of choking episodes? Off
the top of my head I had her try making the "s" sound when she felt
increased laryngeal tension during phonation ex's and this did release the
tension.

Hyolaryngeal elevation noted to be reduced- would elevation ex's be
contraindicated for her (lead to more fatigue vs muscle strengthening)? She
c/o food sticking in her throat. Intermittent cough noted w/ water.

Thanks for any thoughts you might have.

-- 
Jocelen Gudgeon MA-CCC/SLP
Speech-Language Pathologist
Jefferson County Health Center
Fairfield, IA  52556
Phone:  (641) 469-4295
Fax:     (641) 469-4288