The Pulse

Hypertonia is a common impairment associated with a wide range of neurological conditions and can significantly impair function and lead to joint pathologies. The use of biophysical agents including patterned electrical neuromuscular stimulation (PENS), TENS-LVPC motor stimulation to acupoints, and subthermal ultrasound over GTOs may assist in tone reduction (ACP, 2019). Research supports the use of electrical stimulation as an adjunctive tool in the treatment of hypertonicity which may facilitate improved range of motion and mobility.

Patient Information: Male, Age 73

Diagnosis: Chronic Obstructive Pulmonary Disease (COPD) exacerbation.

History: This gentleman was referred to a skilled nursing facility for rehabilitation services to address significant weakness and functional decline after an exacerbation of COPD.

Patient Information: Female, Age 69

Diagnosis: Heart Failure / Dysphagia

History: This woman, a long-term rehab center resident, was admitted to the hospital due to heart failure which resulted in dysphagia (difficulty swallowing). A feeding tube was placed and she was not allowed to eat or drink by mouth. Following hospitalization, she was referred to speech therapy with a goal to return to eating a regular diet and drinking thin liquids independently in the dining room.

What do you do in your free time?
My free time is usually spent with my 3 kids at their sports. My girls play softball. They play on a travel team year round and also play on spring and fall ball teams. My son plays baseball and just this year started playing soccer. I stay busy with practices, games and tournaments! 
 
How long have you been with ACP? 
2 years
 
What is your career background? 
Most of my career background is administrative. I worked as an Admissions Assistant for a For Profit College. I was in that position for about 2 years until they moved all admissions on grounds and turned our department into Career Services. I stayed with the college as the Career Services Assistant for another year until my position was dissolved. Before working at the college I was an Office Manager for a loan company. 
 
What inspired you to work with ACP? 
What inspired me, and continues to inspire me, to work with ACP is what we do for our customers and, in turn, the patients. 

As speech-language pathologists (SLPs) we often make diet recommendations. The unfortunate reality is we have scant information to direct these decisions. There is some evidence concerning the impact of volume and viscosity on swallowing kinematics (Barikroo, 2015; Chi-Fishman, 2002; Miller, 1996; Nagy, 2015; Watts, 2015). However, a systematic review (Steele, 2015) revealed little evidence to guide practice with respect to different degrees of modifying solid foods for patients with dysphagia. This means SLPs must rely on the sound understanding of the mastication process to make these decisions. Unfortunately, the system is quite complex and difficult to evaluate. This article represents the first of a series related to mastication that will address how mastication works and some possible assessment methods. Armed with this knowledge, SLPs may formulate more informed recommendations as part of a comprehensive patient care plan.

Hypertonia is defined as excessive muscle tone which leads to stiffness with movement or inability to move a joint and often occurs with neurological conditions such as upper motor neuron lesions (CP, CVA, TBI, SCI, MS) and basal ganglia disorders (PD, Huntington
disease, Dystonia). While the terms spasticity and hypertonia are often used interchangeably, spasticity is actually a subtype of hypertonia in which muscle tone is increased by the speed of joint movement. (NIH, 2019)

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.