Jen’s Dysphagia Blog

A game changer for head and neck cancer patients

The more I use myofascial release and manual therapy (MFR) at my clinic, the more I am convinced that it may be the “secret sauce” that helps my patients who have dysphagia after head and neck (H&N) cancer get better.   You can check out my previous blog about myofascial release for a little more information about what MFR is.  Today’s post is an update on what I’ve learned after many years of providing this treatment.

What I have found to be true:

Stiffness makes structures not move, and not moving creates weakness

The fibrotic tissue (scar tissue) that can form after radiation treatment results in decreased movement of the swallowing structures. When we swallow, there is A LOT of movement that happens to protect our airway and propel the food/liquid through our pharynx (throat).   The scar tissue reduces that movement which is sort of like putting the swallowing muscles in a cast.   Muscles in a cast can’t move to do their job and not moving then creates weakness due to disuse atrophy (if you’ve seen an arm or leg when a cast is removed, you know what I mean).   The primary principle I use in planning all my swallowing therapy is to go to the source of the problem and fix that to improve functioning.   MFR allows me to go after the source of the swallowing difficulty (stiffness and tightness) for patients after head and neck cancer.

Loosen it up, then make it stronger

If we go back to thinking about stiffness like a cast, trying to exercise a muscle that is stiff or restricted in movement is like trying to exercise a body part that is in a cast. If it can’t move, it just can’t be done.  I’ve found that if I loosen up the swallowing mechanism first that the exercises and therapy that follow are much more effective.  And when the swallow system can move better AND gets stronger from exercise, it is better able to do its job of protecting the windpipe and squeezing food and liquids through the pharynx.

Swallowing exercises for patients with dysphagia after H&N cancer may not be effective alone:

A recent study was published in the journal Head & Neck that evaluated the efficacy of electrical stimulation during swallowing therapy with this population.   Not only was the electrical stimulation found to not be effective, but the authors found that basic swallowing therapy didn’t improve swallowing much either.  They state “For patients with head and neck cancer with moderate to severe dysphagia caused by radiation therapy, current behavioral therapies are of limited help in reversing long-term dysphagia” (Langmore 2015).   That conclusion is a real bummer for us clinicians because we’re in the business of trying to help people, and to hear that standard treatment doesn’t work is discouraging.  But since I started using myofascial release with my patients, I have found swallowing therapy with this population IS effective.  So, I’m wondering, if the patients in that study had myofascial release as part of their therapy would the outcomes have been different?   Hmmmm.  Sounds like a good future research project.

Many patients get better…but not everybody

I find the single biggest predictor of success with this therapy is a patient’s motivation and willingness to complete a home program every day. For this treatment to be effective and stay effective, MFR must be completed on the throat for a few minutes every day.  As part of my treatment program, I spend an entire session instructing my patients on how to do self-MFR and what they should be feeling for when they do it.  I’ve also trained family member how to do it if self-MFR is not an option. In return, my patients have come back and shown me many creative ways to assist with effective self-massage.  One patient with arthritis used the bottom of a pill bottle instead of a knuckle to do the massage, and another patient constructed a massage tool out of small PVC pipe.  And yet another patient used the flat end of a hairbrush to take the place of fingers doing the work.  Whatever it takes to get the job done!

 

To me, adding myofascial release to my therapy with patients who have stiffness in their swallowing system after head and neck cancer treatment just makes sense. And I have seen the positive outcomes that have followed that line of thinking.  While no medical treatment works for every patient, I have found MFR to be a real game changer in my swallowing therapy with these patients.

Swallowing therapy and dementia

One of most common questions I am asked when I teach the VitalStim Therapy course is about how to do swallowing therapy with patients who have dementia or cognitive impairments. I think the answer is not what most people expect.  But first a little background about the dilemma of swallowing therapy with patients who have dementia and why this question is so frequently asked.

elderly womanSwallowing therapy has advanced significantly in the last decade, and dysphagia clinicians have many options for swallowing exercises and compensatory techniques to help patients improve their swallowing function.   However, with all the advancements in swallowing therapy, it is difficult to improve the swallowing function with patients who have cognitive deficits for several reasons.

Patients with dementia are often unable to complete swallowing exercises which can have rather abstract directions, such as “swallow hard”.   Even if the patient can follow guided directions, it can be difficult for a person with dementia to remember why they are being asked to do seemingly strange exercises, such as “stick your tongue out and swallow” and as a result they may understandably refuse to do the exercises.

Unfortunately patients with dementia are often the very patients that need swallowing therapy the most.   Memory problems can make it impossible to consistently remember to use compensatory strategies, such as a chin tuck, to improve swallowing safety.  Without exercises or strategies, the only safe swallowing option for many patients with dementia is a distasteful diet modification, like thickened liquids or pureed food.   But diet changes are often not a viable solution since many confused patients won’t consume food and drinks that “just don’t seem natural”.   This can lead to dehydration, malnutrition, and decreased quality of life for the patients and frustration for the dysphagia clinician that wants to help the patients get better.

So, how do you improve swallowing function with a patient that can’t do swallowing exercises, is unable to use compensatory strategies, and refuses modified diets?    I have found that if a patient has a weak swallow and is cognitively intact enough to eat or drink, then they may benefit from the addition of VitalStim (electrical stimulation therapy) during oral intake.   The rationale is simple.  The best exercise for swallowing is swallowing which occurs repeatedly during eating/drinking.   If electrical stimulation is applied during oral intake, it can help to exercise the muscles during the natural activity of swallowing.  The patient is then receiving swallowing therapy without having to do anything but eat or drink.

If you are familiar with electrical stimulation and the buzzing/prickly sensation that accompanies it when it is first turned on, you may be thinking: how is a patient with dementia going to tolerate the sensation of this therapy?   Below are some tips for VitalStim with patients who have dementia:

  • Turn up the intensity of the electrical stimulation as tolerated. This means that you may at first get to an intensity level that is sensory only.   After about 5 minutes the prickly sensation will decrease, and you can then increase the intensity a little more.   Keep going until you get signs of therapeutic intensity as taught in the VitalStim course (audible swallow, better swallow with electrical stimulation, etc.)
  • Don’t talk about the electrical stimulation during the application as this will likely be confusing to the patient. While increasing the intensity, talk about the food that the patient is going to eat or some other topic of interest.    A patient with cognitive deficits is not going to be able to tell you if they “feel the grab” with the stimulation, and they will probably not understand if you ask if the stimulation level is “OK”.   If the patient cannot verbally communicate, consider body language and facial expressions and use the non-verbal signs of therapeutic intensity.
  • Follow other well-known strategies for working with patients who have dementia such as eating in a natural dining setting, such as the dining room, with real plates and silverware. This can help get your patient cognitively into the task of eating. You may want to consider getting something for yourself to eat during the session too, as it can be pretty unnatural for many patients to eat if you’re not eating as well.
  • Remember, applying electrical stimulation with no concurrent swallowing or pharyngeal muscle activity is unlikely to result in any change in functioning. So you can’t just apply the electrical stimulation and have the patient sit there as this will not exercise the swallowing muscles.
  • Above all else, use your clinical judgement. If a patient is not cognitively intact enough to attend to a bolus placed in his or her mouth, then this treatment is not for them.   If a patient is not safe for PO intake due to aspiration or aspiration risk, you may want to limit oral intake to tiny ice chips during therapy.     The use of VitalStim does NOT prevent aspiration, so consider the results of the swallowing evaluation in deciding if oral trials are right for your patient.

Of course, not all patients who have cognitive deficits tolerate the application of electrical stimulation during a meal.   Some patients will be too distracted by the stimulation to participate in this therapy.  But I have found more times than not, I have been able to improve swallowing function with patients who would have been otherwise unable to participate in swallowing therapy due to cognitive deficits with the use of this therapy.  The bottom line is just because someone has dementia does not mean that they are not a candidate for swallowing therapy.

 

 Contact Carter Swallowing Center

We’ve Moved

Exciting news as we have moved the Carter Swallowing Center to a new location beginning March 1, 2014.

We are only a very short distance from our old location!

Our new address is now:

3470 S. Sherman St. Suite 2
Englewood, CO 80113

You can find directions on our Contact page.

Our phone number is still 720-880-6232

-Jen Carter

Swallowing Therapy Success Featured on Local News

One of the Carter Swallowing Center patients’ success story was featured on CBS Channel 4 News at Noon on Monday.

Joanna started at the Carter Swallowing Center being unable to swallow any foods or liquids, including her much needed medication which she could not crush and put in her feeding tube.  Her not being able to eat was made worse by the fact that she is a wonderful chef for whom eating and enjoying food is a huge part of her life.  To say that she was motivated to improve her swallowing is an understatement.

Joanna came the Carter Swallowing Center to do therapy 3 times a week and did a home swallowing exercise program daily between sessions.  In therapy we used VitalStim Therapy as well as sEMG biofeedback and had her practice swallowing with these devices to build back up the strength in her swallowing muscles.   As she says in the news segment, she started to make progress right away and after 6 weeks of treatment she is now able to eat whatever she wants.  

Joanna, whom I have come to know as someone who routinely makes lemonade from lemons, used her culinary skills along the way to create delicious dishes that were within the range of what she could safely swallow.   In fact, she is currently working on a gourmet cookbook for patients with dysphagia.  Stayed tuned for more info on when those tasty recipes become available!

 Contact Carter Swallowing Center

A puree diet can taste GOOD

Think puree consistency foods are terrible?   Well, I have to admit that most are.  However, I am currently working with a woman with dysphagia that happens to be a gourmet chef, and she has completely made me re-think puree consistency food.   During each therapy session she would bring in another one of her puree culinary creations for me to sample, and it was absolutely delicious!

This patient has progressed to being able to eat solid foods and no longer needs to eat her puree delights, but she is seriously considering creating a gourmet cookbook for other patients with dysphagia.   Below is a sample recipe that she has shared with me.

Black Bean Soup Caribe

Take a trip to the tropics with this luscious soup.  The velvety black beans are given high notes of lime, ginger, and garlic, then finished with a dollop of sour cream and silken smooth avocado.

Serves 4 generously. (“Honey” thick liquid consistency; can be thickened to puree with drink thickener if need be )

Ingredients:

Puree food CAN be delicious

2 Tablespoons butter

1 large clove garlic

1-inch cube fresh ginger

¾ cup onion, fine dice

1 teaspoon smoked paprika

Scant ¼ teaspoon chipotle powder

1 carrot, peeled and diced

3 x 15oz cans of black beans,

including the liquid and sediment

1 cup water

Salt  to taste

 Garnish

 ½ avocado

½ cup sour cream

1 lime

Finely diced red onion

Finely diced tomato

Lime wedges

How to make it:

Finely mince garlic and ginger and add along with onion to the butter in a sauté pan.  Gently sauté until everything is translucent.  Add smoked paprika (also known as Spanish paprika) and the chipotle powder and stir until well blended and fragrant.

Add the carrots and beans*; use the cup of water to rinse the cans out, taking care to get all the juice and sediment. (They add flavor and color to the soup.) Bring to a boil, reduce heat, cover and simmer for 15 minutes.

Remove from heat. Because  bean skins can be tough, you may need to process the soup in batches to get it perfectly smooth, stopping processor and scraping down the bowl every few minutes.  Don’t be alarmed if it seems to be taking a long time – every processor is different.

*If sharing the soup with people who have no swallowing issues, I reserve about ¼ of the beans processing them and add them back to their bowls when serving.

Garnish:

Mash the avocado and push through a fine sieve.  Stir in some salt and a good squeeze of lime juice. Stir sour cream to loosen it and add a dollop to each bowl, followed by a second dollop of avocado.

I garnish my plate as shown in the photo – a pretty plate whets the appetite.  The flowers are to remind me not to eat the garnish from the rim of the bowl

For the folks who are getting the ‘regular’ version, top with the diced  red onion and tomato, and grate a little lime zest on top.

To drink:

Piña Colada

Mango or Guava Nectar

© Joanna Jordan Dyson 2012

If you try this recipe, let us know what you think!

 Contact Carter Swallowing Center

 

 

Minimizing the Risk of Aspiration Pneumonia

One of the most serious health risks to patients who have difficulty swallowing is that of developing aspiration pneumonia. “Aspiration” is the medical term for when food or liquids go into the wind pipe (trachea) and then into the lungs when swallowing. Repeated aspiration can eventually lead to pneumonia.

Of course the best way to reduce the risk of aspiration pneumonia is to have a thorough swallowing evaluation from an experienced speech pathologist who can identify what foods and drinks are safest for you and what type of therapy may help improve your swallowing.

In addition to consulting with a speech pathologist, there are other things you can do to lessen the chance of pneumonia even more.

Research (Langmore et al, 1998) has identified some surprising factors that put a person who has difficulty swallowing at a greater risk of aspiration pneumonia:

  •  Poor oral care/dependency on others for oral care:   The presence of aspiration during swallowing is bad enough already, but it can be further worsened by what is aspirated.   Poor oral care results in higher amounts of bacteria in the mouth, and these oral bacteria can contribute to pneumonia if they make their way to the lungs.  If oral care is not good, food, liquid, and even saliva will pick up this oral bacteria and transport it to the lungs if it is aspirated.   So while it’s bad that the food, liquid, or saliva has entered the lungs, the problem is made even worse by the addition of the oral bacteria as well.   So oral care that includes scrubbing the tongue and gums with a toothbrush and using a good antiseptic mouth rinse reduces the risk of oral bacteria entering the lungs.
  •  Dependency on others for feeding.    An unfortunate fact is that in many health care facilities the people who assist patients in eating are often under pressure to feed as many patients as possible in a short amount of time.   This can result in large bites of food being presented too quickly, and a rushed meal doesn’t allow for strategies that can help with swallowing difficulty such as doing extra swallows for each bite or taking sips of liquid to rinse away particles of food.   This all adds up to a greater risk of aspiration and pneumonia.  If you have a family member in a health care setting with difficulty swallowing, inquire about if the staff has been trained on dysphagia and the risk of aspiration during feeding.   The caregivers who feed patients likely do not know that they may be putting their patients at risk with the feeding techniques they use.
  • Poor pulmonary clearance and weak cough.  Speech pathologists love it when people cough.  OK, that sounds a little strange, but coughing is the body’s natural protection against aspiration so a strong cough reflex, particularly for someone who has dysphagia, is good.   If the cough is weak, that can often be improved in swallowing therapy.  In addition to having a strong cough, another natural deterrent of pneumonia is being physically active, and any amount of physical activity is better than sitting still in a bed or chair all day.  A person who gets out of bed and moves around is less likely to develop pneumonia than someone who is not as active.  
  • A dry mouth fosters increased oral bacteria.  A common side effect of many medications is a dry mouth or Xerostomia.   When saliva is decreased, oral bacteria can build up and increase the risk of gingivitis and tooth decay.   This brings us back to the first point about oral bacteria traveling to the lungs.  Lungs and oral bacteria just do not mix.   If your medications cause dry mouth, talk with the doctor who prescribed the medication to see if another medication that does not have that side effect could be substituted.
  • Lying down after eating.   The risk of aspiration doesn’t go away after the meal is over.   People with difficulty swallowing can have small particles of food remain in the throat after swallowing.  Gravity is our friend in these instances, and the longer a person stays upright the better chance these particles have in making their way to the stomach.  If the food particles stay in the throat, it is much easier for them to fall into the airway as soon as the person lies down.    There is also the risk of stomach contents, which increase after eating, coming back up into the throat and being aspirated when lying down.  So stay upright and let gravity work in your favor for as long as possible after eating.
  • Smoking.   Add aspiration pneumonia to the long list of health risks that can result from smoking.    Smoking increases the “pollution” in the mouth and decreases pulmonary function for clearing aspiration.   A dirty mouth and poor ability to cough is a recipe for disaster for someone with dysphagia.   So the risk of aspiration pneumonia is yet another reason to quit smoking.

So in addition to following the medical advice provided by your doctor or speech pathologist, arm yourself with these defense mechanisms to further decrease your chances of aspiration pneumonia.

Staying healthy while you recover from dysphagia  is what it’s all about!

 

  Contact Carter Swallowing Center

Langmore S, Terpenning M, Schork A, Chen Y, Murray J, Lopatin D, Loesche W.  Predictors of Aspiration Pneumonia: How Important Is Dysphagia? Dysphagia 13:69–81 (1998).

photo courtesy of Massdistraction Flickr Creative Commons License

Fighting Parkinson’s with the Lee Silverman Voice Treatment (LSVT®)

Many patients with Parkinson’s disease have difficulty not only with swallowing but with communicating as well. One of the most researched treatments for patients with Parkinson’s is the Lee Silverman Voice Treatment (LSVT®) program, which is available at the Carter Swallowing Center.

What is LSVT?    The program is based on some key principles of why specifically patients with Parkinson’s have reduced clarity of speech and subsequently diminished ability to communicate.   Part of the disease process of PD results in a decreased ability of the patient to accurately sense and hear the loudness of their own speech.     Thus patients with this condition speak at a very soft volume because when speech is at a normal loudness, the speech is perceived as being too loud.    When cued to speak loudly, PD patient hear themselves as yelling or screaming.   So just telling a patient with Parkinson’s to “speak up!” won’t work because the disease has impaired the person’s ability to self-regulate the volume of their speech.

So the LSVT program intensely works to increase loud speech and “recalibrate” a person with PD’s ability to judge the loudness of their speech so that they can internally cue themselves to be loud enough.  This means that the person with PD will be able to speak loud enough to be heard without someone else constantly reminding them to speak louder.     The dramatic impact this has on communication is simply amazing.

The other unique aspect to the LSVT program is that it is designed to make the significant improvements in communication by focusing on the most effective, yet most simple instruction for the patient.  The reason for this is the more simple the instructions, the easier to generalize and use outside of speech therapy.   By just training a patient to be “LOUD”,  the program has been found to improve the rate of speech, articulation precision, intonation, breath support, facial expression, and of course, the volume of speech.

The impact this treatment can have on a person’s speech is dramatic which you can see in this before/after video…

What does the research say about LSVT?:    There have been numerous studies showing that after LSVT patients with PD can demonstrate a 2-4 decibel increase in loudness which equates to a 40% perceptual change in volume.   And the even better news is that these changes have been found to last for 2 years after treatment.   The LSVT instructors said that the changes can actually last longer 2 years, but that is just the amount of time that was monitored in the study.

Some other interesting findings in the research about LSVT include….

  •  PD patients have been found to have improvements in dysphagia (difficulty swallowing)  following LSVT which include better oral transit time (how long it takes to move food/drinks in the mouth toward the throat), decreased oral residue (food remaining in the mouth after the swallow), improved bolus formation (holding the food or drink cohesively in the mouth), and decreased pharyngeal stasis (food remaining in the throat after the swallow).   So speech AND swallowing can both get better with this program.
  •  LSVT is also emerging as being effective for a broader range of diagnoses besides Parkinson’s disease.  The other conditions that this treatment may be appropriate for include Parkinson’s Plus, stroke, Multiple Sclerosis, Ataxia, and changes in voice related to normal aging.
  •  Children with Cerebral Palsy and Down Syndrome have also benefited from LSVT…not just adults.   Research has found a significant improvement in communication for children with these diagnoses after LSVT.
  •  A new program, LSVT BIG, has also been developed to help improve the functional movement of patients with Parkinson’s disease using the same concepts of intensity, amplitude, calibration as LSVT LOUD.  So the program helps patients maintain the speed and amplitude of movements which are impacted by Parkinson’s disease.   Check out this video about the impact LSVT BIG has on patients’ lives…

 

Given how LSVT can dramatically change the lives of people with Parkinson’s disease, I am proud that it is one of the many  speech and swallowing programs offered at the Carter Swallowing Center!

Have you treated someone using LSVT or been a patient treated with the LSVT program?  Please share your LSVT success stories!

 Contact Carter Swallowing Center

photo courtesy of deovolenti Flickr Creative Commons License

2012: Providing Dysphagia Education for Patients and Clinicians

Happy New Year! I am eager to start the new year and launch all my new plans for the Carter Swallowing Center. For me 2012 will be all about Reaching Dysphagia Patients and Teaching Dysphagia Clinicians…

Reaching dysphagia patients:   Anyone who has ever heard me talk about my swallowing center for more than 5 minutes has probably heard about my dream for the clinic:  I want any patients who have dysphagia and want to get better to be able to find my clinic so that I can help them recover their swallowing function.   My previous job as a dysphagia clinical specialist for VitalStim allowed me an opportunity to learn about all the latest treatments for difficulty swallowing so that I could then teach VitalStim customers about these dysphagia treatments.   While that was a fun and intellectually stimulating job, the more I learned the more I missed treating my own patients.   In January 2011 my dream of creating my own swallowing clinic where patients can have access to all of these great new treatments began to take form (see my blog about that journey).

So, for 2012 my quest continues to spread the word about all of the new possibilities for treating dysphagia and to let patients and doctors know that difficulty swallowing CAN get better!    I have plans to speak to more patient groups and physician offices about the latest treatments for dysphagia.  One group that I feel can particularly benefit from these new treatments are patients who have been treated for head and neck cancer and are unable to swallow after the cancer treatment.   Check out my other blog post about the treatments for this population.   What is so exciting about reaching out to this group is that until very recently, swallowing therapy for this population was just not that effective.  The tough fibrotic tissue that forms on the neck after radiation treatment limited what could be done.   It has been exciting to see several of my patients that had not benefited from previous attempts at swallowing therapy successfully respond to the new dysphagia treatments I provided.  In 2012 I hope to help a lot more patients know about the new options available that could help their swallowing.

 

Teaching dysphagia clinicians:   As a speech pathologist that treats patients with dysphagia, I feel fortunate to have a job that I absolutely love.  I enjoy my job so much that even when I’m not at work, I love talking about dysphagia (OK, I admit that’s a little geeky).  So an equally rewarding part of my job is being able to teach other clinicians who treat dysphagia and hopefully help enhance the swallowing therapy that their patients receive.  For 2012, I will be continuing to teach the CIAO Seminars VitalStim certification course around the country.   After I took the certification course myself in 2005, VitalStim Therapy changed the way I do swallowing therapy.  So it is very rewarding to be able to “pass the torch” and show other clinicians how to use this modality.   I will also continue teaching a 2-day Dysphagia Evaluation and Treatment course.  This course really dives into all of the latest swallowing treatments so it again allows me the opportunity to not only share what I have been able to learn about dysphagia but also to hear great ideas from other dysphagia clinicians.  I always say that we clinicians all have a lot to learn from each other, so I am also excited to be starting the Denver Dysphagia Rounds which will allow us Denver dysphagia clinicians a chance to come together 4 times a year to share ideas and learn from one another.

In addition to traveling to teach speech pathologists around the country, I am excited to announce that I have 2 webinars about dysphagia that should be available on the CIAO Seminars website any day now (links to the courses to follow).  One is a 3 hour course on esophageal dysphagia and the role of the SLP, and the other is a 1 hour course on the neurophysiology of swallowing.  I hope that both of these tools will be valuable to dysphagia clinicians out there and that the format of an on-demand webinar will be able to reach a broader audience.

 

To me, it’s all about spreading the word about therapy for difficulty swallowing.   Letting patients and doctors know that treatment is now much more than just thickening liquids (yuck) and helping other clinicians learn about all of the new advances in dysphagia treatment.  So here’s to 2012…may that many more people be able to recover their swallowing function this year!

What are your plans and goals for 2012??

 photo courtesy of Ludie Cochran Flickr Creative Commons License

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Hot Topics in Dysphagia Research

Speech pathologists from all over the world meet at the Dysphagia Research Society conference every year to present and discuss the latest and greatest in swallowing research.  Many of these studies eventually go on to be published in peer-reviewed journals, but since publication can be a time-consuming process, the DRS presentations allow a sneak peek at the most current findings in dysphagia research before they are even “hot off the press”.

Of the dozens and dozens of presentations given at the 2011 conference, below are the hot topics that I believe might lead to significant differences in swallowing therapy…

Adherence to Swallowing Exercises on Swallowing Outcomes for Head and Neck Cancer Patients.

This study evaluated the effectiveness of prescribed swallowing exercises on improving therapy outcomes with patients following treatment for head and neck cancer.   The exercises prescribed included the Shaker, Mendelsohn maneuver, supraglottic swallow, falsetto glides, Masako, and effortful swallow.

Conclusion:  Patients who performed swallowing exercises during radiation treatment had significantly higher outcomes at 6 months, 1 year, and 2 years after radiation treatment.  These results suggest that adherence to swallowing exercises may be effective in preventing decline in swallowing-related quality of life after radiation treatmentUniversity of Texas MD Anderson Cancer Center (Shinn E, et al).

Jen’s comments:  The study further supports the hopefully growing trend of referring patients who are being treated for head and neck cancer to a speech pathologist BEFORE they develop swallowing problems.   There are increasing reports that doing swallowing exercises and myofascial release before, during, and immediately following radiation treatment (vs. years after radiation when dysphagia has gotten severe) can significantly help preserve strength and range of motion of the swallowing mechanism.

 

Training for Dysphagia with Metronome Improves Swallowing Function in Parkinson’s Disease

Twenty patients with Parkinson’s Disease and moderate dysphagia were divided into 2 groups.  The experimental therapy consisted of cervical stretching, lingual exercise, and deglutition of jelly to the rhythm of six beats of a metronome.  The control therapy was identical but without the metronome.  When the subjects were evaluated with a Modified Barium Swallow study, the amount of residuals in the valleculae and pyriform sinuses when swallowing jelly was decreased after training with the metronome vs. training without the metronome.

ConclusionTraining with the metronome during swallowing was effective for shortening oral transit time and decreasing the amount of residuals in the pharynx for patients with Parkinson’s disease.  University of Health Science, Kobe, Hyogo, Japan.  (Nozaki S, et al.)

Jen’ comments:   Patient’s with Parkinson’s disease often have significant difficulty with coordination of the swallow which eventually leads to weakness and dysphagia.  The use of the metronome likely helps improve coordination and control during the swallow, which are some of the most challenging aspects to treat with this population.   It will be interesting to see more details about this type of therapy as it is researched further.


Effects of Effortful Swallow on Esophageal Peristalsis

Esophageal dysfunctions are typically treated using medications with varying success.  This study manometrically examined the effects of an effortful pharyngeal swallow to assess the impact it may have on esophageal function.  The effortful swallow yielded greater esophageal amplitudes and longer esophageal duration which decreased incomplete bolus clearance.

Conclusion:  The effortful swallow may offer a behavioral manipulation of esophageal dysfunction.  Further studies will determine its clinical potential in patients with esophageal dysmotility. Wake Forest University, Winston-Salem NC (Butler, et al)

Jen’s comments:  While speech pathologists have many available treatments to effectively treat oral and pharyngeal dysphagia, we currently have no tools to actively improve esophageal dysfunction.  So these are very promising findings.

 

McNeill Dysphagia Therapy Program (MDTP) (2 studies)

Independent Evaluation and Outcome Data with Moderate to Severe Chronic Oropharyngeal Dysphagia

Five patients (1 stroke, 4 head and neck cancer) who were an average of 7.7 years post onset who had all failed previous trials of traditional swallowing therapy completed 15 sessions of MDTP.  Four out of five showed marked improvements in all measurements of swallowing.

Conclusion:  The positive outcomes of MDTP can be generalized to different clinical programs.  MDTP is emerging as a promising therapy for patients with chronic, mod-severe oropharyngeal dysphagia.  Antwerp University Hospital (VanNuffelen G, et al)

Jen’s comments:  Previously the research about MDTP had only been conducted by the developers of the program at University of Florida, so it is great to see that the high level of success with this program  for patients with chronic dysphagia is being replicated elsewhere.

 

Improved Temporal Coordination of Swallowing Following MDTP

Eight patients with chronic dysphagia completed 15 sessions of MDTP.  The patients demonstrated significant changes in timing of swallowing speed.

ConclusionDysphagia therapy with MDTP improves timing of physiologic events during swallowingUniversity of Florida (Lan Y, et al)

Jen’s comments:  Since the MDTP program is designed to restore both strength and speed of swallowing function, both which are vital for normal swallowing, it is not a surprise that the program would result in improved swallowing speed.  This is likely one of the first studies about MDTP to objectively document this change in swallowing speed as a result of the treatment.

 

A complete list of all the presentations given at the 2011 DRS conference can be found in the December issue of Dysphagia (2011) 26:432–47.

 photo courtesy of rosefirerising Flickr Creative Commons License

Contact Carter Swallowing Center

 

 

 

Dysphagia Documentary Now on YouTube

The first time I saw Swallow: A Documentary, it brought tears to my eyes (hokey, but true). Not tears because of how tragic dysphagia is for the 2 adults and 1 child in the movie, but tears of joy because of the HOPE that these patients have for getting better.   Part of my dream in starting a swallowing center in Denver was to offer patients more hope that their swallowing can get better, so this movie is right up my alley.

The movie debuted at the ASHA convention last week (followed by roaring applause from the audience of speech pathologists). As Dr. Peter Belafsky (an ENT at UC Davis) says in the movie, swallowing difficulty is “underrated in the medical community”. This movie was created to increase awareness and bring much needed attention to the millions of people living with this condition.

I’m so glad to see that this film is now available for millions to see on YouTube.  It’s a short 15 minute documentary-

I’d love to hear what you think of the movie- please shoot me an email or post on the Carter Swallowing Center Facebook page after you have a chance to watch it. And if you like it, pass it on to someone you know. It’s things like this that can help put dysphagia on the medical radar!

 

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