The Pulse

This 80-year-old woman experienced severe debility following hospitalization for COVID-19 with pneumonia. She was referred to a skilled nursing facility for rehabilitation services including speech therapy to address poor voice quality, and difficulty breathing while eating. She also required 3 liters per minute of supplemental oxygen. Prior to hospitalization, she had no limitations in speaking and eating.

Dysphagia Research Summaries:

Focused Clinical Application
Synchrony: Skill-Based Typical Swallow Interventions

Improving Speech and Swallowing Using sEMG and Breathing Therapy Biofeedback

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.

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).

Strength training and repetition of motor activity alone is not thought to result in functional recovery where impaired motor performance is the baseline. We know this to be true in movements required for both speech and swallowing in our patients who experience ataxia, apraxia, and other motor disruptions. Encouraging a patient with dysphagia to simply “practice” a dysphagic swallow with no modification to this task, is unlikely to produce a desired effect (Huckabee & McCrae, 2014).

Patient Information: Male, Age 71

Diagnosis: Subdural Hematoma / Oropharyngeal Dysphagia

History:
This gentleman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to a fall, which resulted in a traumatic subdural hematoma (bleeding between the skull and brain). He was then diagnosed with encephalopathy (damage to the brain) and oropharyngeal dysphagia (difficulty swallowing), with a feeding tube placed during his hospitalization to provide nutrition and hydration. Prior to his accident, this gentleman consumed a regular diet and drank thin liquids.

Patient Information: Female, Age 78

Diagnosis: Oral Cancer / Dysarthria / Oropharyngeal Dysphagia

History: This woman, a long-term care resident of a skilled nursing facility, has a history of oral cancer four years ago. At that time, she underwent removal of 50% of her tongue, tissue grafting for her palate, and has resultant decreased jaw movement, oropharyngeal dysphagia (difficulty swallowing), and dysarthria (difficulty with speech production). Additionally, she underwent a tracheostomy (tube inserted into the trachea to assist with breathing) and a feeding tube was placed to provide nutrition due to her inability to eat and drink by mouth. She has received intermittent speech-language pathology services over the four years. Prior to her cancer, this woman had no limitations in eating, drinking, and speaking.