Patient Information: Female, Age 75
Diagnosis: Supraglottic Cancer / Oropharyngeal Dysphagia / Chronic Obstructive Pulmonary Disease
History: This woman was referred to a skilled nursing facility for rehabilitation services due to progressively worsening swallow function following completion of radiation therapy for supraglottic (throat) cancer. During hospitalization, a video fluoroscopic swallow study (VFSS) was conducted due to dysphagia (difficulty swallowing) indicating aspiration (material entering the lungs), and a feeding tube was placed for all nutritional needs. Prior to the onset of throat cancer, she ate a regular diet.
Pre-Therapy Status:
•Instrumental Swallow Assessment: VFSS performed during hospitalization showed decreased movement of pharyngeal (throat) muscles and cartilage with residue of food and drink in the throat resulting in aspiration with intake of all liquids, puree, and solid foods.
•Clinical Swallow Evaluation: Difficulty managing saliva with required frequent suctioning. Displayed difficulty managing ice chips with resultant wet vocal quality and coughing following intake.
•Functional Oral Intake Scale (FOIS): Level 1; nothing by mouth.
•Diet Modifications: NPO (nothing by mouth) with all nutrition and hydration delivered through the feeding tube.
Therapy Information:
•Modality: OmnisEMG™ Dysphagia System.
•Frequency: 5x per week.
•Protocol Specifics: Using sEMG biofeedback, effortful swallows performed with kangaroo and bar graph visualizations to improve movement of pharyngeal muscles, and tongue against resistance exercise completed using diver visualization to retrain tongue movement, control, and function.
•Duration: Six weeks.
•Other Therapy Services Provided: Cognitive therapy to improve participation in swallowing rehabilitation.
Outcome:
•Instrumental Swallow Study: Follow up VFSS shows no aspiration of any liquids or solid foods.
•Clinical Swallow Evaluation: Manages secretions and consumes liquids and solid foods without any difficulties.
•FOIS: Level 6; total oral diet with no special preparation, but must avoid specific foods or liquid items.
•Diet Modification: Regular diet and thin liquids with need to avoid difficult-to-chew foods. Feeding tube was removed.
Upon reflection of her swallow rehabilitation journey, this woman recalls being told she would not eat again. However, after celebrating her birthday by eating cake with her family, she states, “I am eating everything I want to!” This woman and her family have expressed appreciation for the skilled swallow therapy she received at the facility and the technology available at “just the right time”. She enjoyed the sEMG led exercise, stating, “The whole program was good, with the fish game being my favorite.”