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.
Pre-Therapy Status:
- Bedside Swallow Assessment: Mild oral residue with puree consistencies and difficulty following commands. Delayed swallow onset of 5-6 seconds was observed prior to swallow initiation. She complained of feeling like food was stuck in her throat.
- Fiberoptic Endoscopic Evaluation of Swallowing (FEES): Revealed bolus formation, propulsion, and swallow response was timely, though the patient displayed piecemeal swallowing of the food. There was also penetration of mechanical soft and puree foods into the airway.
- Functional Oral Intake Scale (FOIS): Level 1; nothing by mouth.
- Diet Modifications: All nutrition and hydration were delivered through the feeding tube.
Therapy Information:
- Modality: OmnisEMG™ Biofeedback
- Frequency: 3x per week.
- Protocol Specifics: Typical and effortful swallows performed with sEMG biofeedback visualizations using kangaroo, bow and arrow, and bar graph activities to relearn and regain function of swallow ability.
- Duration: Ten weeks.
- Other Therapy Services Provided: Oral motor exercises, diet trials, compensatory strategies, and thermal stimulation.
Outcome:
- Bedside Swallow Assessment: Improved laryngeal elevation when swallowing puree and mechanical soft foods. Follows one step commands and independent with self correction during meals. Eats and drinks with no complaints of the food being stuck in her throat. Swallow timing improved with initiation of 1-2 seconds.
- Functional Oral Intake Scale (FOIS): Level 5, total oral diet with multiple consistencies but requiring special preparation (without dentures). The patient attempted to eat regular food but felt like it took too much effort to chew without dentures and preferred the mechanical soft.
- Diet Modifications: Mechanical soft foods and thin liquid; feeding tube removed.
This woman and her family are thrilled that she has accomplished her therapy goals, enabling the removal of her feeding tube! She is now eating and drinking independently in the dining room again.