The Pulse

In the previous two articles in this series we examined the evidence concerning the clinical indictors of coughing and a runny nose. The conclusion was, both indicators provide us with weak information concerning swallowing function. In this edition, the evidence for wet vocal quality as a meaningful clinical finding will be discussed.

Patient Information: Female, Age 80

Diagnosis: Mixed Incontinence

History: This woman, an independent living resident with a 40-year history of incontinence, was referred to outpatient therapy due to increased incontinence episodes. She had mixed incontinence (impaired urge sensation and pelvic floor muscle weakness) resulting in decreased socialization. She was considering the use of a pessary (a insertable prosthetic device that may help with stress incontinence) and took medication for overactive bladder.

Patient Information: Male, Age 77

Diagnosis: Oropharyngeal Dysphagia / Hypoxic Respiratory Failure / Childhood bulbar polio
with paralyzed vocal cord

What do you do in your free time?
On Saturdays, as time allows, I hike with a group of buddies and all our dogs. We have some amazing trails here in No. Nevada!  I’m also the music director in my church – I have a worship band, arrange all our music, and play guitar/sing with a wonderful group of musicians and vocalists. They make even me sound good.  Other than that, I’m quite boring – but I love to eat and love to cook. I am very thankful for my family, good friends, a beautiful area to live in, stellar coworkers, hot showers and Sunday afternoon naps. 
 
How long have you been with ACP? 
I’ve been with ACP for 4+ years.  Time flies when you’re having fun. I love ACP and what we do.
 
What is your career background? 
In my short college career, I majored in music, theater and dance, which prepared me for… not a whole lot.  I’ve been an Exec Assistant/Facilities-Office Manager for more years than I care to admit. I started in the Fire Protection and Mechanical Engineering field, which I loved, and later moved into Healthcare, and eventually 14 years at a disease management company, Alere Medical, from startup to acquisition by a large, international company. I supported the CEO and Executive Team, interfaced with the Board of Directors, and project managed the building of Alere offices all over the country: Reno, Orange County, Denver, Columbus, Chicago, Miami. We acquired several companies and then ultimately sold Alere to Inverness Medical (who is now known as Alere).  A fun ride and once-in-a-lifetime experience!
 
What inspired you to work with ACP? 
After the Alere offices closed in Reno, I accepted an office manager position at a financial services company. They were a great group of people, but the business left me feeling uninspired. Being a (big) handful of years away from retirement, I wanted to find a job that would spark a little passion again. When I saw an ad for a support position at ACP where a friend worked, I decided to check it out. Then I met Debbie – who wouldn’t want to work for Debbie? The rest is history.

Therapist have often relied upon “clinical signs” to assist in determining if a patient is experiencing aspiration. Those signs have included coughing (see "Cough Up The Facts"
previous blog post), throat clearing, wet vocal quality, runny nose, and many others. There is very little empirical evidence to support the correlation of “clinical signs” to an episode of aspiration. A runny nose is often considered to be a salient sign of aspiration; perhaps this is an over generalization.

Patient Information: Male, Age 49

Diagnosis: Pneumonia / Neuropathy

History: This gentleman was found by EMS unable to get out of bed and covered in soiled bedding with insect infestation, and reported he hasn’t been out of bed for “quite some time.” He
was admitted to the hospital with pneumonia, then transferred to a skilled nursing facility
for rehabilitation services.

Range of motion (ROM) deficits may affect an individual’s ability to move, care for themselves, or perform typical daily activities including self-feeding, walking, and dressing. Decreased ROM is a common deficit addressed regularly by rehab professionals in all settings. Contractures arise from shortened muscle or other joint structure restrictions, leading to reduction in mobility and deformity with resultant reduced function.
• Prevalence of contractures in nursing homes is estimated at 55% with significant functional and medical consequences. (Offenbächer, 2014)
• Patients who are immobilized for a prolonged period are at risk of developing joint contractures, which often affect functional outcomes. (Born, 2017)

Patient Information: Male, Age 96

Diagnosis: Fall / Compression Fracture

History: This gentleman was referred to a skilled nursing facility following hospitalization due to a fall in his garage which resulted in a thoracic compression fracture of the spine. Prior to the fall, he lived at home and was independent with ambulation, driving and mowing his yard.

Patient Information: Female, Age 77

Diagnosis: Esophageal Cancer / Muscle Weakness

History: This woman was referred to a skilled nursing facility for rehabilitation services due to
weakness and a decline in functional mobility after hospitalization due to esophageal cancer
and feeding tube placement. Prior to her hospitalization she was living alone in a senior
living apartment with an elevator and was independent for transfers and activities of daily
living with her manual wheelchair due to prior bilateral below knee amputation.