The Pulse

In the previous two articles in this series I 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 addition, the evidence for wet vocal quality as a meaningful clinical finding will be discussed.

Patient Information: Male, Age 77

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

Therapist have often relied upon “clinical signs” to assist in determining if a patient is experiencing aspiration. Those signs have included coughing (see "Cough Up The Facts"
previous blog post), throat clearing, wet vocal quality, runny nose, and many others. There is very little empirical evidence to support the correlation of “clinical signs” to an episode of aspiration. A runny nose is often considered to be a salient sign of aspiration; perhaps this is an over generalization.

Speech Pathologists who treat dysphagia often rely on a patient’s cough as a marker of aspiration. Other healthcare professionals have been educated that coughing is a sign of swallowing difficulty. How accurate is this statement in the geriatric population and what are other reasons a patient may be exhibiting a cough?

As speech language pathologists, we are all familiar with the word “competence.” After a good deal of time invested in educational pursuits followed by a nine-month period of supervision, we are awarded our Certificate of Clinical Competence (CCC) from the American Speech Language and Hearing Association (ASHA). The reality is, when I received my CCC, I could hardly consider myself competent in any area of practice.

"Patients enjoy the features and 'seeing' their successes over time. Using the Synchrony sEMG allows us to obtain more reliable data for a scientific approach to therapy.”

Patient Information: Male, Age 79

Diagnosis: Wallenberg - Stroke / Dysphagia

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services after hospitalization due to a stroke. A feeding tube was placed to address his dysphagia (difficulty swallowing). Prior to the stroke, he lived in his assisted living apartment and was able to eat a regular diet.

I am often surprised to learn that terms and concepts I use on a regular basis are different than
I thought. A common term that I have misunderstood for many years is “aspiration pneumonia.”
Recent reading has led me to a new understanding of this term.

This is the third and final installment of our “Exercise in Swallowing Therapy” series. This article will examine some commonly used interventions in light of exercise principles. But first, a quick review. In order to be considered an exercise the activity must meet certain criteria (for more information refer to the two previous articles).

Patient Information: Male, Age 86

Diagnosis: Stroke / Oropharyngeal Dysphagia / Dysarthria

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services due to oropharyngeal dysphagia (difficulty swallowing) and difficulty managing saliva after hospitalization due to a stroke. He was only consuming 0-25% of his meals. Prior to his stroke, he lived at home with family, worked two days a week, and ate a regular diet.