Stroke and TIA Dysphagia Treatment Case Study
Referring Source: Pulmonology Physician
Diagnosis: Oro-pharyngeal dysphagia
PMH: Diabetes mellitus type 2, hypertension,
Chronic Obstructive Pulmonary Disease (COPD),
Neuropathy, Hyperlipidemia, Sleep Apnea, Obstructive, CPAP
Coronary Artery Disease (CAD), 5v CABG,
Benign Prostatic Hypertrophy (BPH),
Cardio Vascular Attack (CVA) (10 years ago)
Transient Ischemic Attack (TIA) (2 months prior)
Reason for Speech Language Pathology Referral: 74 year old male complaining of intermittent coughing with and without PO intake, which had progressively worsened over the previous two months, pills getting stuck in his throat, and increased hoarseness.
Previous Modified Barium Swallow Study: An MBSS was performed on 12/07/12 which found penetration to the level of the vocal cords with thin consistency liquids, no aspiration, upper esophageal motility within normal limits, decreased cohesion during bolus formation, premature loss over tongue base, impaired anterior and superior laryngeal movement, and mild intermittent incomplete epiglottic inversion.
Initial Speech Language Pathology Evaluation: Speech language pathology evaluation including bedside swallow evaluation was completed on 12/12/12.
Intermittent coughing during PO intake and after PO intake was observed with all food and liquid consistencies.
Dysphagia Treatment: Exercises using the ISO Swallowing Exercise Device (ISO-SED) began on 12/12/12 three times per week.
The exercises included CTAR (Chin Tuck Against Resistance) exercises, JOAR (Jaw Opening Against Resistance) exercises, and OMEs (Oral Motor Exercises) completed until muscle fatigue for 2-3 sets each per 30 minute session.
Results of Dysphagia Treatment: After 4 weeks of therapy, 3 times per week, coughing was reduced to only 2-3 times per day.
2 weeks later, upon discharge from speech therapy, there was no further coughing with or without PO intake.