Mr. Fox is a 39 year old man with an eight year history of Parkinson’s disease. According to medical reports, he is in the moderate stages of the disease (Stage 3). Mr. Fox has reported consistent weight loss over the last 8 months. Until recently, Mr. Fox could continue in his occupation as a professional actor. He has a wife and three young children.
OBSERVATIONS AND ASSESSMENT RESULTS
Oral Peripheral Examination:
An oral peripheral exam was completed to determine the adequacy of the patient’s oral structures and their functions for speech purposes. Examination of the oral musculature revealed structures to be symmetrical, however, Mr. Fox revealed an expressionless facial appearance during conversational interaction. Strength of facial, …show more content…
Fox to identify if a swallowing impairment related to function, activity, and/or participation was present. Mr. Fox was seated at a 90-degree angle in optimal positioning for feeding. Mr. Fox was presented with different consistencies of food and liquid, ranging from thin to thick, to determine if signs of aspiration were present. Mr. Fox was first presented with a small amount of water. The thin consistency appeared to flow adequately, however, Mr. Fox immediately coughed and cleared his throat indicating possible signs of aspiration. Vocal quality was noted to sound wet when asked to sustain the phonation of “ah”. When presented with a thicker consistency, nectar-thick liquid, Mr. Fox adequately swallowed, however, the thicker consistency was held longer in the oral cavity with a 2 second oral transit time, followed by piecemeal swallowing. Lastly, Mr. Fox was presented with a teaspoon size piece of a graham cracker. Mastication duration was approximately 15 seconds in duration indicating difficulty formulating the bolus. Oral transit time was noted to be 3 seconds in …show more content…
Fox to improve safe swallowing skills is dependent on utilizing compensatory strategies to maximize abilities during the progression of the disease. Although Mr. Fox is at risk for aspiration, it is recommended that behavioral and diet modifications be implemented to increase awareness and remain on an oral intake regimen. Additionally, it is recommended that the therapist monitor changes in swallowing through radiographic studies due to the degenerative nature of the disease. Lastly, Mr. Fox is advised to collaborate with his neurologist on possible medications that can improve overall functioning of swallow.
SWALLOWING TARGETS & ACTIVITIES
Mr. Fox may benefit from compensatory strategies and other therapy techniques such as:
♣ The effortful swallow helps to reduce posterior movement of the base of the tongue.
♣ The chin down postural technique can also be utilized by pushing the base of the tongue and epiglottis closer to the posterior pharyngeal wall and decreasing the chance of residue remaining near the valleculae.
♣ The Mendelsohn maneuver can be useful in improving reduced laryngeal movement and prolongation of laryngeal elevation. This maneuver can also improve the overall coordination of the swallow. Practicing with saliva is recommended before implementing food to ensure safety of swallowing.
♣ After initial swallow, taking additional swallows to ensure clearance of foods/liquids and/or remaining residue from valleculae and pyriform
OBSERVATIONS AND ASSESSMENT RESULTS
Oral Peripheral Examination:
An oral peripheral exam was completed to determine the adequacy of the patient’s oral structures and their functions for speech purposes. Examination of the oral musculature revealed structures to be symmetrical, however, Mr. Fox revealed an expressionless facial appearance during conversational interaction. Strength of facial, …show more content…
Fox to identify if a swallowing impairment related to function, activity, and/or participation was present. Mr. Fox was seated at a 90-degree angle in optimal positioning for feeding. Mr. Fox was presented with different consistencies of food and liquid, ranging from thin to thick, to determine if signs of aspiration were present. Mr. Fox was first presented with a small amount of water. The thin consistency appeared to flow adequately, however, Mr. Fox immediately coughed and cleared his throat indicating possible signs of aspiration. Vocal quality was noted to sound wet when asked to sustain the phonation of “ah”. When presented with a thicker consistency, nectar-thick liquid, Mr. Fox adequately swallowed, however, the thicker consistency was held longer in the oral cavity with a 2 second oral transit time, followed by piecemeal swallowing. Lastly, Mr. Fox was presented with a teaspoon size piece of a graham cracker. Mastication duration was approximately 15 seconds in duration indicating difficulty formulating the bolus. Oral transit time was noted to be 3 seconds in …show more content…
Fox to improve safe swallowing skills is dependent on utilizing compensatory strategies to maximize abilities during the progression of the disease. Although Mr. Fox is at risk for aspiration, it is recommended that behavioral and diet modifications be implemented to increase awareness and remain on an oral intake regimen. Additionally, it is recommended that the therapist monitor changes in swallowing through radiographic studies due to the degenerative nature of the disease. Lastly, Mr. Fox is advised to collaborate with his neurologist on possible medications that can improve overall functioning of swallow.
SWALLOWING TARGETS & ACTIVITIES
Mr. Fox may benefit from compensatory strategies and other therapy techniques such as:
♣ The effortful swallow helps to reduce posterior movement of the base of the tongue.
♣ The chin down postural technique can also be utilized by pushing the base of the tongue and epiglottis closer to the posterior pharyngeal wall and decreasing the chance of residue remaining near the valleculae.
♣ The Mendelsohn maneuver can be useful in improving reduced laryngeal movement and prolongation of laryngeal elevation. This maneuver can also improve the overall coordination of the swallow. Practicing with saliva is recommended before implementing food to ensure safety of swallowing.
♣ After initial swallow, taking additional swallows to ensure clearance of foods/liquids and/or remaining residue from valleculae and pyriform