[DYSPHAGIA] Isolated Chewing Difficulty

[THAMMERLE@PARTNERS.ORG (Hammerle, Terese)]

Hi,  I agree that a neurology work up might be helpful. I would look for a
neurologist with an interest in dysphagia. It seems conceivable that motor
planning specific to chewing behavior might be impaired in the absence of
any other motor planning deficit.  Maybe related to a small lesion--isn't
this pre-frontal area?   On the high end, a PET scan might be interesting.  

In the clinic I would try to r/o peripheral nerve impairment.  With acquired
apraxia wouldn't we expect variable performance and some trouble initiating
behavior.  I might expect her to report less trouble chewing while she's
engaged in another activity like watching TV or listening to music.  I would
expect her to perform most poorly when instructed to chew.  Also, how does
she manage the blenderized diet?  An MBS might provide data re.
abnormalities like timing.  I would probably suggest 6 small meals/day of
soft foods with liquid supplements like milk shakes as opposed to pureed
diet. 

  I do think it's a little odd though that she's not upset by being
restricted to a blenderized diet.  No matter how easy-going she is that's
got to be limiting for a young adult.  I also think sometimes psychological
issues effect voice & swallowing.  Just an avenue to consider;  I'm trying
not to make any offensive implications :)  Certainly all reasonable
diagnoses should be considered.

Would you please update the list-serve if a diagnosis is made?  Terese
> -----Original Message-----
> From:	william conley [SMTP:wconley@houston.rr.com]
> Sent:	Tuesday, November 27, 2001 8:24 PM
> To:	SuzMorris@aol.com; dysphagia@medonline.com;
> icampbell-taylor@excite.com
> Subject:	Re: [DYSPHAGIA] Isolated Chewing Difficulty
> 
> Has she been looked at by neuro for a full workup?  Sometimes progressive
> diseases can show up in the swallow or the voice, and although that is not
> where this woman's problem is, I would check out possible neuro
> involvement.  How is the rest of her strength and endurance?  How long has
> she been on the pureed diet?  what is her overall nutritional status.  It
> can be difficult to maintain adequate nutrition on pureed diets.  I would
> check out those possibilities.  Good luck!  
> 
> 	----- Original Message ----- 
> 	From: SuzMorris@aol.com <mailto:SuzMorris@aol.com> 
> 	To: dysphagia@medonline.com <mailto:dysphagia@medonline.com> ;
> icampbell-taylor@excite.com <mailto:icampbell-taylor@excite.com> 
> 	Sent: Monday, November 26, 2001 4:24 PM
> 	Subject: [DYSPHAGIA] Isolated Chewing Difficulty
> 
> 
> 	A close friend of mine recently shared an unusual feeding pattern
> that 
> 	she has experienced.  She is a 50 year old adult who has no other
> issues 
> 	and is a very skilled and coordinated massage therapist.   She
> describes 
> 	herself as always having had some difficulties getting oral-motor 
> 	planning together for chewing.  She has been a very slow eater and 
> 	describes herself as having to think about how she moves the food in
> her 
> 	mouth rather than experiencing a smooth automatic flow to her
> chewing, 
> 	bolus collection and swallowing.
> 	
> 	Until recently this has not created any difficulties for her other
> than 
> 	"always being the last one at the table to finish a meal".    During
> the 
> 	past month, however, the problem has gradually increased. . .to the
> point 
> 	where eating food that requires chewing is more trouble than it is
> worth 
> 	and she really can't get enough calories from the food she chews
> before 
> 	she is exhausted.   She has shifted to a blenderized diet which she
> can 
> 	handle very easily.  She is a very easy-going person who is not
> upset by 
> 	the current situation, but hopes that things will get better over
> time.
> 	
> 	This sounds more like an apraxic/motor planning issue rather than a 
> 	muscle strength and coordination issue.   All other aspects of
> oral-motor 
> 	function and speech are just fine.  
> 	
> 	Is it possible to have a very circumscribed motor planning problem
> for 
> 	chewing without any other neurological symptoms?
> 	
> 	If so, what causes this and why could she be experiencing a
> deterioration 
> 	in this function now?
> 	
> 	What can she do to help things get better?  What general direction
> would 
> 	you take? 
> 	
> 	My work is entirely in pediatrics and typically when we see
> apraxia-like 
> 	symptoms in learning to chew there are sensory integration issues
> with 
> 	the kids. . .which is definitely not the case here.
> 	
> 	Thanks,
> 	
> 	Suzanne Morris
> 	New Visions
> 	<http://www.new-vis.com>
> 	
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