The Pulse

Improving Swallow Ability Using Electrical Stimulation, sEMG, and Exercise

Posted by ACP on Jan 3, 2019 10:47:55 AM

Patient Information: Male, Age 86

Diagnosis: Stroke / Oropharyngeal Dysphagia / Dysarthria

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services due to oropharyngeal dysphagia (difficulty swallowing) and difficulty managing saliva after hospitalization due to a stroke. He was only consuming 0-25% of his meals. Prior to his stroke, he lived at home with family, worked two days a week, and ate a regular diet.

Pre-Therapy Status:
•Bedside Swallow Assessment: Due to oral motor incoordination, observed spillage from the mouth pre-swallow and residue remaining in the mouth post-swallow.
•Swallow Initiation: Onset of swallow observed to be delayed up to 11 seconds during bedside swallow assessment.
•Diet: Mechanical soft diet with nectar thick liquids.
•Functional Oral Intake Scale (FOIS): Level 5; total oral diet with multiple consistences
but requiring special preparation or compensations.

Therapy Information:
•Modality: OmnisEMG™ Biofeedback and OmniStim® FX2 Portable Patterned Electrical Neuromuscular Stimulation (PENS).
•Frequency: 5x per week.
•Protocol Specifics: Upper extremity biphasic PENS head and neck protocol to improve neuromuscular coordination of swallow function. During sEMG with typical swallow retraining, various bolus types were utilized (hot, cold, sour, sweet, carbonated) to achieve quality swallows. Effortful swallows and Mendelsohn maneuvers were performed with sEMG biofeedback visualizations (kangaroo and bow & arrow) to regain coordination, timing, and quality of the swallow.
•Duration: Six weeks.
•Other Therapy Services Provided: Sensory stimulation using various bolus types and straws, dysarthria treatment, and cognitive therapy.

•Bedside Swallow Assessment: No food/liquid loss from the mouth and improved tongue coordination resulting in minimal residual food in the oral cavity after swallowing.
•Swallow Initiation: Greatly improved; swallow initiated within 1 second during modified barium swallow study (MBSS).
•Diet: Regular diet with thin liquids.
•Functional Oral Intake Scale (FOIS): Level 7; total oral diet with no restrictions.

This gentleman is thrilled to achieve his therapy goals, allowing him to be on a regular diet and drink Dr. Pepper again! He now lives in an assisted living apartment and consumes his meal independently.

Topics: Dysphagia, Patient Success Story