Stroke and PEG Tube Dysphagia Treatment Case
Reason for Referral: Male stroke survivor, 18 months post CVA, with a PEG tube, NPO status since the stroke. Patient complained of painful dry throat, but coughed severely when he tried to swallow, so he spit out all saliva into a cup, day and night for the previous 18 months.
Previous Modified Barium Swallow Study: Patient had two Modified Barium Swallow Studies since his stroke and both indicated he needed a PEG tube and NPO status due to aspiration of all consistencies, including his secretions.
Initial Speech Language Pathology Evaluation: Patient presented with right side paresis of facial and lingual musculature. Upon attempt to perform a dry swallow, he began coughing severely. Decreased laryngeal elevation was observed during the swallow.
Dysphagia Treatment: Patient received 30 minute treatment sessions twice per week and also completed home exercises independently daily. Dysphagia treatment exercises consisted of CTAR (Chin Tuck Against Resistance) and JOAR (Jaw Opening Against Resistance) with the ISO Swallowing Exercise Device and OMEs (Oral Motor Exercises) until the muscles fatigued, 2-3 sets per session.
Results of Dysphagia Treatment: Within 2 weeks of doing the swallowing exercises, he was able to swallow without any coughing or pain. He was able to gradually progress to tolerating a p.o. diet with only mild and occasional overt signs or symptoms of aspiration/penetration.