The Pulse

Improving Swallowing Ability Using Electrical Stimulation, sEMG, and Exercise

Posted by ACP on Nov 19, 2019 3:36:43 PM

Patient Information: Male, Age 77

Diagnosis: Oropharyngeal Dysphagia / Hypoxic Respiratory Failure / Childhood bulbar polio
with paralyzed vocal cord

History: This gentleman was admitted to the hospital with bilateral pneumonia, which resulted in hypoxic (deprived of oxygen) respiratory failure. This was likely related to complications from post-polio syndrome. He underwent a Modified Barium Swallow Study (MBSS) which showed silent aspiration (material entering the lungs) of all food and liquid. No food or drink by mouth (NPO) was recommended and a feeding tube was placed for all nutrition and hydration. He was then referred to speech therapy. Prior to hospitalization he had usual swallowing function and ate a regular diet.

Pre-Therapy Status:
•Clinical Swallow Assessment: Difficulty breathing, excessive coughing and throat clearing, and wet vocal quality.
•Instrumental Swallow Assessment with Modified Barium Swallow Study (MBSS): Showed aspiration (material entering the airway) with liquids and solids due to deficits with tongue retraction and pharyngeal constriction.
•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: 5x per week.
•Protocol Specifics: Effortful swallows performed with sEMG biofeedback using bar graph visualization. Quantity and texture of liquid and solid foods were varied to challenge and progress during effortful swallows, with 67-97 swallow repetitions performed per session.
•Duration: Two weeks.
•Other Therapy Services Provided: Oral motor exercises.

•Clinical Swallow Assessment: No difficulty observed.
•Instrumental Swallow Assessment: MBSS showed improved airway protection and tongue retraction with no aspiration noted.
•FOIS: Level 5; total oral diet with multiple consistencies but requiring special preparation or compensations.
•Diet Modification: Upgraded to a mechanical soft diet with ground meats and thin liquids.

This gentleman and his family were told that he may never eat or drink again due to the severity of his swallowing impairment. He was highly motivated to work on his swallowing, and he and his family were extremely impressed with the Synchrony Dysphagia Solutions system! His family found benefit in the fact that Synchrony provided real time data and visual feedback on his swallowing effort. The family attended every session and cheered him on to “swallow hard” as he worked with the speech language pathologist (SLP). When the family learned he was no longer aspirating food and drink and could eat again, his wife told the SLP, “you gave him his life back!”

Topics: Dysphagia, Patient Success Story