Parkinson's Disease Dysphagia Treatment Case Study
Referring Source: Primary Care Physician
Diagnosis: Mild Oro-pharyngeal Dysphagia
PMH: Dysphagia, history of Parkinson’s Disease
Reason for Speech Langauge Pathology Referral: 83 year old male complaining of having difficulty initiating a swallow, approximately 6-7 times per meal, mild intermittent coughing after swallow.
Previous Modified Barium Swallow Study: An MBSS was completed on 08/30/10 which found decreased laryngeal elevation, premature spillage, pharyngeal delay of 1-2 seconds, and piece-meal deglutition, residue in the valleculae and the piriform sinuses with all PO trials given, no aspiration or penetration was observed. Swallowing therapy was recommended.
Speech Language Pathology Evaluation: A speech language pathology evaluation including a bedside swallow study was completed on 10/20/10.
Inability to trigger swallow response intermittently with all consistencies of food and liquids, as well as slowed oral transit time, stasis in both lateral sulci, stasis on the tongue, decreased laryngeal elevation and intermittent coughing with p.o. intake.
Dysphagia Treatment: Oro-pharyngeal exercises using the ISO Swallowing Exercise Device (ISO-SED) began on 10/20/10.
Exercises included CTAR (Chin Tuck Against Resistance) exercises, JOAR (Jaw Opening Against Resistance) exercises, with the ISO-SED and OMEs (Oral Motor Exercises), until muscles fatigued 2-3 sets per session, 30 minute sessions three times per week.
Results of Dysphagia Treatment: After 4 weeks of therapy, 3 times per week, incidences of difficulty initiating the swallow were reduced from 6-7 times per meal initially to only 1-2 times per meal, and coughing was reduced to only occasionally.
10 days later, upon discharge from speech therapy, there were no further incidences of difficulty initiating the swallow and no further coughing during or after p.o. intake. Oral transit time decreased and oral stasis was reduced to within normal limits.