Patient Information: Male, Age 91
Diagnosis: Parkinson’s Disease / Oropharyngeal Dysphagia /
COVID-19
History: This gentleman, a long-term resident of a skilled nursing facility, was diagnosed one and a half years ago with oropharyngeal dysphagia (difficulty swallowing), a complication of his Parkinson’s disease. Since that time he has had known aspiration (liquids entering the airway), altered diet, hospitalization for aspiration pneumonia, and COVID-19. Due to his complaint of his liquids being too thick, he requested to participate in swallowing therapy for possible return to thin liquids. As a result, swallowing evaluation and resultant therapy was initiated.
Pre-Therapy Status:
- Clinical Swallow Evaluation: During assessment with Synchrony sEMG, excessive tongue movement exhibited with elevated amplitute, indicating poor control with liquids. The Mann Assessment of Swallowing Ability (MASA) was administered with a score of 151/200, indicating moderate dysphagia.
- Instrumental Swallow Evaluation with Video Fluoroscopic Swallow Study (VFSS): Labored mastication and excessive tongue pumping observed, creating extended time to initiate a swallow. Discoordinated timing and muscle movement in the pharynx (throat) resulted in decreased airway protection with silent aspiration of thin liquids and residue of solid food remaining in the throat.
- Diet level: Mechanical soft with ground meats and nectar thick liquids.
Therapy Information:
- Modality: OmnisEMG™ Dysphagia System.
- Frequency: 4x per week.
- Protocol Specifics: Effortful Swallow intervention performed with sEMG biofeedback using Kangaroo and Work/Rest cycle visualizations. Therapy included progressive challenging of swallowing ability by increasing repetitions to 100 per session and volume of liquid from single to consecutive sips. Trace display visualization was also utilized to decrease excessive tongue movements for better control of liquids.
- Duration: Four weeks.
- Other Therapy Services Provided: Maintenance SPEAK OUT!® program to improve functional voicing.
Outcome:
- Clinical Swallow Evaluation: Follow-up Synchrony sEMG assessment revealed significantly decreased tongue movement to normal amplitude level, indicating better tongue control while holding liquids. MASA score improved to 185/200, indicating no abnormality detected.
- VFSS: Improved efficiency of mastication, tongue movement, and pharyngeal coordination resulting in timely swallow initiation with no aspiration of liquid. Additionally, solid foods cleared with use of a double swallow.
- Diet level: Regular diet with chopped meats and thin liquids.
This gentleman is pleased with his swallowing therapy outcomes. Despite his progressive neurologic disease, pulmonary complications including COVID-19, and lack of success in prior swallowing therapy he regained functional chewing and swallowing ability with return to drinking thin liquids and greater variety of foods. After learning the results of his final swallow study, he had a smile on his face and exclaimed with joy: “I can eat the food and drink what I want now!”