Patient Information: Female, Age 66
Diagnosis: Hemorrhagic Stroke / Oropharyngeal Dysphagia
History: This woman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to suffering a hemorrhagic stroke. As a result, she was diagnosed with altered mental status and oropharyngeal dysphagia (difficulty swallowing) and a feeding tube was placed to provide nutrition and hydration. Prior to her stroke, this woman ate a regular diet and drank thin liquids.
Pre-Therapy Status:
•Swallow Evaluation: Clinical Swallow Evaluation (CSE) revealed poor secretion management, significant verbal and tactile cueing to initiate swallow with ice chips, significantly delayed and inconsistent swallows, poor lip seal, and impaired tongue function.
•Functional Oral Intake Scale (FOIS): Level 1; nothing by mouth.
•Diet: NPO (nothing by mouth) with all nutrition and hydration delivered through the feeding tube.
Therapy Information:
•Modality: OmnisEMG™ Dysphagia System.
•Frequency: 3x per week.
•Protocol Specifics: Effortful swallow intervention performed using sEMG biofeedback with bar graph visualization to improve swallow ability. Number of repetitions progressed each session.
•Duration: Six weeks.
•Other Therapy Services Provided: Oral/pharyngeal muscle strengthening exercises including tongue against resistance and chin tuck against resistance.
Outcome:
•Swallow Evaluation: CSE revealed prompt swallow initiation, functional saliva management due to increase in swallow frequency, improved lip seal, and improved tongue function. Instrumental swallow study with Video Fluoroscopic Swallow Study (VFSS) revealed functional oropharyngeal swallow with prompt swallow initiation and no aspiration or pentration observed.
•FOIS: Level 7; total oral diet without restrictions.
•Diet: Regular solids with thin liquids.
This woman was excited to eat and drink again after swallowing therapy! Use of biofeedback increased her participation in therapy by maintaining her motivation. The speech language pathologist commented, “the visual biofeedback was helpful to increase this woman’s understanding of how to perform the exercises. The Bar Graph visualization provided her with a tangible goal to work toward during exercises.”