Patient Information: Female, Age 78
Diagnosis: Oral Cancer / Dysarthria / Oropharyngeal Dysphagia
History: This woman, a long-term care resident of a skilled nursing facility, has a history of oral cancer four years ago. At that time, she underwent removal of 50% of her tongue, tissue grafting for her palate, and has resultant decreased jaw movement, oropharyngeal dysphagia (difficulty swallowing), and dysarthria (difficulty with speech production). Additionally, she underwent a tracheostomy (tube inserted into the trachea to assist with breathing) and a feeding tube was placed to provide nutrition due to her inability to eat and drink by mouth. She has received intermittent speech-language pathology services over the four years. Prior to her cancer, this woman had no limitations in eating, drinking, and speaking.
Pre-Therapy Status:
Speech and Voice Assessment:
•Maximum Phonation Time (MPT) 8 seconds.
•Intelligibility at the conversation level 75%.
•Conversation with family 10 minutes via phone with assistance from SLP to translate some communication.
Swallow Evaluation:
•Instrumental swallow evaluation with fiberoptic endoscopic evaluation of swallowing (FEES) revealed aspiration following the swallow with thin and nectar thick liquids, and puree consistency. Residue of liquids and puree noted in the throat, after swallow.
•Functional Oral Intake Scale (FOIS): Level 2; tube dependent with minimal attempts for food and liquid.
•Diet: (NPO) nothing by mouth.
Therapy Information:
•Biophysical Agent/Rehab Technology: OmnisEMG™ Biofeedback and OmniFlow™ Breathing Therapy Biofeedback System.
•Frequency: 4x per week.
•Protocol: OmnisEMG™ Biofeedback utilized to address lingual resistance exercise with diver visualization, effortful swallow and typical swallow interventions with bar graph. OmniFlow™ utilized to address controlled inspiratory lung volume with diamond mine visualization, forced exhalation with pre-historic visualization, and controlled respiratory muscle training with starry road visualization.
•Duration: Eight weeks.
Outcome:
Speech and Voice Assessment:
•MPT 15 seconds.
•Intelligibility at the conversation level 95%.
•Conversation with family 30 minutes via phone with complete independence.
Swallow Evaluation:
•FOIS: Level 3; tube dependent with consistent oral intake of liquid and some foods.
•Diet: Comfort food, including intake of thin water during SLP sessions and puree meals at holidays.
The speech language pathologist commented that the addition of OmniFlow™ made a huge difference in her activity tolerance and outcomes. She added: “over the last 3 ½ years this woman only swallowed 30 repetitions per session, but now executes 100 swallows per session”. This woman’s ear, nose, and throat (ENT) physician performed an endoscopic exam of her pharynx (throat) shortly following initiation of OmniFlow™ therapy and stated; “her pharynx looks the cleanest, without secretions that I have seen, as far back as I can remember. I think she has made significant gains with the work you [SLP] are doing and it is impressive for the anatomic changes she has from her treatments.” This woman is thrilled to drink water consistently and speak with her family on the phone.