The Pulse

Improving Speech and Swallowing Using sEMG and Breathing Therapy Biofeedback

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 64

Diagnosis: Cellulitis / Venous Insufficiency Ulcer / DJD Bilateral Knees

History:
This woman was referred to a skilled nursing facility for rehabilitation services following hospitalization due to cellulitis of her left lower leg. Thirty years ago, she fell and injured her left ankle and developed a venous insufficiency ulcer, which has never fully healed and recently has gotten worse due to the cellulitis. Prior to her hospitalization, she required maximal (> 75%) assistance from her husband for activities of daily living (dressing and bathing) and transfers due to a prior stroke and bilateral knee degenerative joint disease causing knee pain, weakness, and limited range of motion.

Wounds are typically managed with standard nursing care including maintaining a clean wound bed and appropriate dressings and medications. Therapeutic interventions including biophysical agents can be used to directly facilitate and accelerate wound healing. Factors such as pressure, pain, and contracture may delay wound progression or cause wounds to reoccur. Addressing these adjunctive factors related to the wound provides the best overall approach to wound management and limits the risk of reoccurrence.

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.

Individuals with cardiopulmonary conditions often present with dyspnea, severe weakness, poor endurance, limited mobility, and decreased activity tolerance. As their disease state progresses, their ability to perform activities of daily living (ADLs) declines, ultimately leading to a loss of independence. A therapy plan of care that includes breathing exercises, energy conservation techniques (e.g., paced activity, assistive device, task planning), and ventilatory strategies may improve the individual’s breathing and functional performance as well as help maintain independence.

Patient Information: Female, Age 78

According to the CDC, dementia affects one’s ability to remember, think, and make decisions that impact daily activities and safety. Alzheimer’s disease (AD) is the most common type of dementia accounting for 60-80% of cases. As dementia progresses to increased levels of memory loss and confusion, the individual becomes more sedentary and frail. Rehabilitation in this population should be tailored to patient needs addressing cognition, strength, gait, balance, endurance, and function.

Patient Information: Female, Age 64

Diagnosis: Acute Respiratory Failure / COVID-19 / Chronic Obstructive Pulmonary Disease (COPD)

History:
This woman was referred to a skilled nursing facility due to severe debility following a seven week hospitalization due to COVID-19. Her condition was complicated by diabetes, COPD, and pulmonary fibrosis. At the time of hospital discharge, she required 8 liters per minute of supplemental oxygen to maintain oxygen saturation level. Prior to hospitalization she lived with her family in a 2-story home, was independent with walking and all self-care, and worked as a construction supervisor.

Speech-language pathologists (SLPs) are commonly involved in the rehabilitation of patients presenting with cardiopulmonary disorders. Hospitalized patients diagnosed with respiratory diseases, Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF), and those with xerostomia are indicated as risk groups for development of oropharyngeal dysphagia. Additionally, patients who experience prolonged endotracheal intubation have been associated with the development of dysphagia (Malandraki et al., 2016).