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[DYSPHAGIA] oral dyspagia/e-stin/o-m ex
- Subject: [DYSPHAGIA] oral dyspagia/e-stin/o-m ex
- From: JKuhn@mcw.edu (Kuhn, Joan)
- Date: Mon, 12 Nov 2001 12:03:37 -0600
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Ron,
(I don't want to write an extensive narrative of this issue and would be
glad to talk to you if you call me.) In general.........
Spontaneous recovery occurs in about 95% of the Bells Palsy patients to a
full recovery or a lesser degree. However, the psychological effect during
that time can be devastating for the patients and a home program can be of
great psychological benefit because the patient feels she/he is not totally
helpless in the process. In addition, one of your goals is to prevent the
development of synkinesis while at the same time developing controlled
symmetrical movement. Some of our program's treatment premises are:
1. SLPs are not trained for this type of therapy and should not treat it as
though any facial exercise is good. We have a good background but need
specialized training in facial paralysis, how to develop a therapy program,
the associated eye disorders, when to suggest a gold implant, eye surgery
and on and on. You are not just dealing with a drooping mouth but more
critically with potential permanent eye damage. This is no different than
trying to treat a TEP patient with only limited knowledge of laryngeal and
surgical anatomy and TEPs
2. A tx program should be highly individualized for each patient depending
on a thorough evaluation of the various muscles and muscle groups of the
face, video taping, etc. You need to determine if the patient in front of
you has a strength deficit, a control deficit or a relaxation deficit or a
combination deficit for all muscles & muscle groups..
3. Your tx goal is not to "create movement", but to reduce tension on both
the involved and uninvolved sides and to establish symmetrical, controlled
movements. This is done through a series of exercises, massage, and other
techniques. The ratio of muscle fibers to motorneurons determines how
refined a movement will be--facial muscles have very complex movements. The
use of maximum effort exercises results in an overflow of recruitment to
motor units not targeted in the exercise and this results in atypical facial
expression. Poor therapy can aid in the development of synkinesis.
4. Facial paralysis affects both the paretic and the normal sides of the
face in different ways. To ignore the "moving" side of the face is not good
therapy.
4. The use of e-stim for facial muscles remains unfounded. Facial muscles
are not limb muscles and differ in terms of muscle spindles, and the length
of time the muscle degenerates. Surface EMG can be helpful in some patients
as a feedback device.
5. Therapy does not have to be weekly--competent patients can work on a
solid program at home and come in only for program upgrading and progress
checks. --- very cost effective.
We are hoping to present an ASHA seminar next year on facial retraining.
Joan
Joan C. Kuhn, MS, CCC-SLP
Assistant Administrator
Dept. of Otolaryngology & Communication Sciences
Manager, Communication & Swallowing Disorders
Director, Neuromuscular Facial Retraining Program
Medical College of Wisconsin
414.805.5588
-----Original Message-----
From: Ron McClanahan [mailto:rmcclana@kvmo.net]
Sent: Saturday, November 10, 2001 2:49 PM
To: dyspha
Subject: [DYSPHAGIA] oral dyspagia/e-stin/o-m ex
I am presently co-treating a patient with Bell's Palsy as ordered by her
doc...she received the initial meds/steroid tx....I know the controversy re
tx vs. spontaneous recovery...she is getting some return but wondered about
others and their experience with treatment of Bell's....thanks
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<DIV><SPAN class=800115517-12112001><FONT face=Arial color=#0000ff
size=2>Ron,</FONT></SPAN></DIV>
<DIV><SPAN class=800115517-12112001>
<DIV><SPAN class=650441117-12112001><FONT face=Arial color=#0000ff
size=2></FONT></SPAN></DIV>
<DIV><SPAN class=650441117-12112001><FONT face=Arial color=#0000ff size=2>(I
don't want to write an extensive narrative of this issue and would be glad
to talk to you if you call me.) In general.........</FONT></SPAN></DIV>
<DIV><SPAN class=650441117-12112001><FONT face=Arial color=#0000ff
size=2>Spontaneous recovery occurs in about 95% of the Bells Palsy patients to a
full recovery or a lesser degree. However, the psychological effect during
that time can be devastating for the patients and a home program can be of great
psychological benefit because the patient feels she/he is not totally helpless
in the process. In addition, one of your goals is to prevent the
development of synkinesis while at the same time developing controlled
symmetrical movement. Some of our program's treatment
premises are:</FONT></SPAN></DIV>
<DIV><SPAN class=650441117-12112001><FONT face=Arial color=#0000ff size=2>1.
SLPs are not trained for this type of therapy and should not treat it as though
any facial exercise is good. We have a good background but need
specialized training in facial paralysis, how to develop a therapy program, the
associated eye disorders, when to suggest a gold implant, eye surgery and on and
on. You are not just dealing with a drooping mouth but more critically
with potential permanent eye damage. This is no different than trying to
treat a TEP patient with only limited knowledge of laryngeal and surgical
anatomy and TEPs</FONT></SPAN></DIV>
<DIV><FONT face=Arial><FONT color=#0000ff><FONT size=2><SPAN
class=650441117-12112001>2. A tx program should be highly individualized for
each patient</SPAN> <SPAN class=650441117-12112001>depending on a thorough
evaluation of the various muscles and muscle groups of the face, video taping,
etc. You need to determine if the patient in front of you has a strength
deficit, a control deficit or a relaxation deficit or a combination deficit for
all muscles & muscle groups..</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT face=Arial><FONT color=#0000ff><FONT size=2><SPAN
class=650441117-12112001>3. Your tx goal is not to "create movement", but
to reduce tension on both the involved and uninvolved sides and to establish
symmetrical, controlled movements. This is done through a series of
exercises, massage, and other techniques. The ratio of muscle fibers to
motorneurons determines how refined a movement will be--facial muscles have very
complex movements. The use of maximum effort exercises results in an
overflow of recruitment to motor units not targeted in the exercise and this
results in atypical facial expression. Poor therapy can aid in the
development of synkinesis.</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT face=Arial><FONT color=#0000ff><FONT size=2><SPAN
class=650441117-12112001>4. Facial paralysis affects both the paretic and
the normal sides of the face in different ways. To ignore the "moving"
side of the face is not good therapy.</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN
class=650441117-12112001>4. The use of e-stim for facial muscles remains
unfounded. Facial muscles are not limb muscles and differ in terms of
muscle spindles, and the length of time the muscle
degenerates</SPAN></FONT><SPAN class=650441117-12112001><FONT face=Arial><FONT
color=#0000ff><FONT size=2><SPAN class=800115517-12112001>. </SPAN>Surface EMG
can be helpful in some patients as a feedback
device.</FONT></FONT></FONT></SPAN></DIV>
<DIV><FONT face=Arial><FONT color=#0000ff><FONT size=2><SPAN
class=650441117-12112001>5. Therapy does not have to be weekly--competent
patients can work on a solid program at home and come in only for program
upgrading and progress checks. --- very cost
effective.</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT face=Arial><FONT color=#0000ff><FONT size=2><SPAN
class=650441117-12112001></SPAN></FONT></FONT></FONT> </DIV>
<DIV><FONT face=Arial><FONT color=#0000ff><FONT size=2><SPAN
class=650441117-12112001>We are hoping to present an ASHA seminar next year on
facial retraining.</SPAN></FONT></FONT></FONT></DIV>
<DIV><FONT face=Arial><FONT color=#0000ff><FONT size=2><SPAN
class=650441117-12112001></SPAN></FONT></FONT></FONT> </DIV>
<DIV><FONT face=Arial color=#0000ff size=2><SPAN class=650441117-12112001><SPAN
class=800115517-12112001>Joan</SPAN></SPAN></FONT></DIV></SPAN></DIV>
<DIV><FONT face=Arial color=#0000ff size=2></FONT> </DIV>
<P><FONT face=Arial size=2>Joan C. Kuhn, MS, CCC-SLP</FONT> <BR><FONT face=Arial
size=2>Assistant Administrator</FONT> <BR><FONT face=Arial size=2>Dept. of
Otolaryngology & Communication Sciences</FONT> <BR><FONT face=Arial
size=2>Manager, Communication & Swallowing Disorders</FONT> <BR><FONT
face=Arial size=2>Director, Neuromuscular Facial Retraining Program</FONT>
<BR><FONT face=Arial size=2>Medical College of Wisconsin</FONT> <BR><FONT
face=Arial size=2>414.805.5588</FONT> </P>
<BLOCKQUOTE dir=ltr style="MARGIN-RIGHT: 0px">
<DIV class=OutlookMessageHeader dir=ltr align=left><FONT face=Tahoma
size=2>-----Original Message-----<BR><B>From:</B> Ron McClanahan
[mailto:rmcclana@kvmo.net]<BR><B>Sent:</B> Saturday, November 10, 2001 2:49
PM<BR><B>To:</B> dyspha<BR><B>Subject:</B> [DYSPHAGIA] oral
dyspagia/e-stin/o-m ex<BR><BR></FONT></DIV>
<DIV><FONT face=Arial size=2>I am presently co-treating a patient with Bell's
Palsy as ordered by her doc...she received the initial
meds/steroid tx....I know the controversy re tx vs. spontaneous
recovery...she is getting some return but wondered about others and their
experience with treatment of
Bell's....thanks</FONT></DIV></BLOCKQUOTE></BODY></HTML>
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