Patient Information: Female, Age 78
Diagnosis: Stroke / Oropharyngeal Dysphagia
History: This woman with a history of several strokes had a subsequent stroke that resulted in severe oropharyngeal dysphagia (difficulty swallowing). She had weakness in her lips, tongue, and muscles involved in her swallow, and required a feeding tube for all nutrition and hydration. She was admitted to a skilled nursing facility after discharge from the hospital. Prior to her most recent stroke she ate a normal diet with thin liquids.
Pre-Therapy Status:
•Swallow Assessment: Bedside swallow assessment revealed difficulty with lip and tongue
function during trials with ice chips. A fiberoptic endoscopic evaluation of swallow (FEES)
showed oropharyngeal dysphagia with aspiration (liquid entering the lungs) with liquids
and solids.
•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 and OmniStim® FX2 Portable Patterned Electrical
Neuromuscular Stimulation (PENS).
•Frequency: 3x per week.
•Protocol Specifics: Effortful swallows performed with sEMG biofeedback using Kangaroo
visualization and upper extremity biphasic Patterned Electrical Neuromuscular Stimulation
(PENS) head and neck protocol to relearn and regain function of swallow ability.
•Duration: Nine weeks.
•Other Therapy Services Provided: Oral/pharyngeal muscle strengthening and neuromuscular re-education exercises.
Outcome:
•Swallow Assessment: Bedside swallow assessment revealed no overt signs/symptoms of aspiration with thickened liquids, puree or mechanical soft diet and able to clear oral residue with verbal cues. FEES showed non-silent aspiration with thin liquids only and swallow delay reduced to 1 – 2 seconds for initiation.
•FOIS: Level 5; total oral diet with multiple consistencies but requiring special preparation or compensations.
• Diet Modification: Upgraded to a mechanical soft diet with pureed meats and nectar thick liquids.
Although she had experienced several strokes in the past, her family reported that this was the first one to impact her ability to swallow. They were very appreciative of the therapy she received and state they “never thought she would make it this far!” They were ecstatic the first day she had a bite of food! She is particularly fond of doughnuts and was thrilled when she was able to eat a doughnut again! Her Speech Language Pathologist also did not expect this woman would make such significant progress and believes Synchrony sEMG guided exercises helped her reach this level of improvement.
