The Pulse

Patient Information: Male, Age 72

Diagnosis: Muscle Weakness / General Debility

History: This gentleman had a fall and was hospitalized due to a femur fracture. He experienced multiple medical complications and surgeries and was admitted to a skilled nursing facility. He was transferred to this skilled nursing facility for long-term care two and half months after his fall and was referred to therapy due to weakness, balance deficits, inability to walk and inability to perform self-care. Prior to his fall he lived at home and was independent with all mobility and activities of daily living (ADLs).

Patient Information: Male, Age 75

Diagnosis: Peripheral Vascular Disease / Falls / Muscle Weakness

History: This gentleman was referred to a skilled nursing facility with severe debility after hospitalization due to a fall at home. Following the fall, he laid on the floor for two days before being discovered by his home health nurse. At the time of hospital admission, he suffered from acute renal failure, altered mental status, and infected wounds on both legs. Prior to the fall, this gentleman lived alone, walked with a straight cane, and was independent with all self-care, household and community activities.

What do you do in your free time?
Free time? What is this ‘free time? We have horses, we kayak, cross country ski, and volunteer at our community water system.

How long have you been with ACP? 
1.5 years
 
What is your career background? 
I’ve been in various manufacturing entities for several decades as an Operations Manager, Quality Manager, Project Manager, Engineer, and Production Manager. I have 3 college degrees and 3 professional certificates. I’ve worked domestically and internationally as a geologist and geophysical technician and spent time in state and federal governments.

What inspired you to work with ACP? 
I was mainly inspired to move on from where I was working and I am grateful to be a part of the kindest organization I’ve ever encountered.

Hypertonia is a common impairment associated with a wide range of neurological conditions and can significantly impair function and lead to joint pathologies. The use of biophysical agents including patterned electrical neuromuscular stimulation (PENS), TENS-LVPC motor stimulation to acupoints, and subthermal ultrasound over GTOs may assist in tone reduction (ACP, 2019). Research supports the use of electrical stimulation as an adjunctive tool in the treatment of hypertonicity which may facilitate improved range of motion and mobility.

Patient Information: Male, Age 73

Diagnosis: Chronic Obstructive Pulmonary Disease (COPD) exacerbation.

History: This gentleman was referred to a skilled nursing facility for rehabilitation services to address significant weakness and functional decline after an exacerbation of COPD.

Patient Information: Female, Age 69

Diagnosis: Heart Failure / Dysphagia

History: This woman, a long-term rehab center resident, was admitted to the hospital due to heart failure which resulted in dysphagia (difficulty swallowing). A feeding tube was placed and she was not allowed to eat or drink by mouth. Following hospitalization, she was referred to speech therapy with a goal to return to eating a regular diet and drinking thin liquids independently in the dining room.

As speech-language pathologists (SLPs) we often make diet recommendations. The unfortunate reality is we have scant information to direct these decisions. There is some evidence concerning the impact of volume and viscosity on swallowing kinematics (Barikroo, 2015; Chi-Fishman, 2002; Miller, 1996; Nagy, 2015; Watts, 2015). However, a systematic review (Steele, 2015) revealed little evidence to guide practice with respect to different degrees of modifying solid foods for patients with dysphagia. This means SLPs must rely on the sound understanding of the mastication process to make these decisions. Unfortunately, the system is quite complex and difficult to evaluate. This article represents the first of a series related to mastication that will address how mastication works and some possible assessment methods. Armed with this knowledge, SLPs may formulate more informed recommendations as part of a comprehensive patient care plan.

Hypertonia is defined as excessive muscle tone which leads to stiffness with movement or inability to move a joint and often occurs with neurological conditions such as upper motor neuron lesions (CP, CVA, TBI, SCI, MS) and basal ganglia disorders (PD, Huntington
disease, Dystonia). While the terms spasticity and hypertonia are often used interchangeably, spasticity is actually a subtype of hypertonia in which muscle tone is increased by the speed of joint movement. (NIH, 2019)

In the previous two articles in this series we examined the evidence concerning the clinical indictors of coughing and a runny nose. The conclusion was, both indicators provide us with weak information concerning swallowing function. In this edition, the evidence for wet vocal quality as a meaningful clinical finding will be discussed.

Patient Information: Female, Age 80

Diagnosis: Mixed Incontinence

History: This woman, an independent living resident with a 40-year history of incontinence, was referred to outpatient therapy due to increased incontinence episodes. She had mixed incontinence (impaired urge sensation and pelvic floor muscle weakness) resulting in decreased socialization. She was considering the use of a pessary (a insertable prosthetic device that may help with stress incontinence) and took medication for overactive bladder.