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DanC33

Swallow Study Questions

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Hello, I just had a swallow study done and was curious if you could please translate into English. It says....

 

 PT has oropharyngeal dysphagia with intermittent depuration of thin liquids. PT demonstrated chin tuck and Mendelsohn maneuver independently though out exam but premature spillage persisted. Impaired bolus control. Spillage and trace aspiration resulted in coughing. 

 

1.)Premature spillage seen into the valleculae and piriformis with thin liquids and into the valleculae with nectar thick liquids.

2.) Slight delay in swallow initiation

3.)Subtle amount of laryngeal penetration and aspiration with thin liquids vs. artifact from cricoid cartilage  

 

 

Also I had a swallow study done 7/2013  that one said my swallowing was a little slow but fine. (no dysphagia)

 

Does this mean that I am progressing a little fast? or is this normal?

 

Thanks

Dan

 

 

 

 

 

 

 

 

 

 

 

 

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Dan,

 

Changes in swallowing are frequently found in PD.  It has been reported that as many as 95% of people with PD have dysphagia (Bird, Woodward, Gibson, Phyland, & Fonda, 1994; Logemann, Blonsky & Boshes, 1975; Potulska, Friedman, Krolicki & Spychala, 2003).  When dysphagia is present it has a negative impact on quality of life by interfering with the ability to take medications, maintain hydration and nutrition, and may result in aspiration pneumonia.  Pneumonia is one of the leading causes of death in PD (Beyer, Herlofson, Arsland, & Larson, 2001; D’Amelio, Ragonese, Morgante, Reggio, Callari, Salemi & Savettieri, 2006).  Even when there are no difficulties with swallowing, mealtimes can be effortful for people with PD possible causing them to fatigue easily and eat less.

 

My take on the results of your MBS are that you have mild symptoms of dysphagia that have gotten somewhat worse since 2013.  I recommend that you start a swallow exercise program because your swallowing safety and efficiency are compromised by muscle changes as a result of PD.  A speech-language pathologist can help you determine which exercises are right for you.  Start the exercises as soon as possible.

 

Sincerely,

Leslie Mahler, PhD, CCC-SLP

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My doctor has sent over an order for me to begin working with an SLP but I am waiting on insurance to authorize it. In the mean time, is there any foods or beverages that I should be careful with or flat avoid? The only thing that was mentioned at the time of the study was "no rice or crackers until you can begin working with an SLP".    

 

Thanks Dr. Mahler for all you help an advice.

 

Dan

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Dear Dan,

 

I wish I could give you a general safe swallow recommendation answer BUT I can't without evaluating you in person and here is why.  Although people with PD share a common etiology there may still be heterogeneity within the population regarding the causes of swallowing problems.  Having said that, I can tell you that raw fruits and vegetables are typically more difficult for someone to chew and swallow than cooked fruits and vegetables.  Cut your food into small pieces so the effort of swallowing can go into controlling the food and safely moving it to the stomach rather than in prolonged chewing.  If you are having trouble with pills you could try putting them in yogurt, pudding or applesauce (whatever you like that is a similar consistency) and see if that helps.  These are things for you to consider before you meet with a speech-language pathologist who is an expert in people with PD.  Below is some more information on swallowing changes associated with PD that may help.

 

There are a number of reasons why swallowing can be "difficult" for a person with PD and it is important for the health care team to understand these issues.  Appropriate treatment techniques to address swallowing disorders in PD need to address the motor and sensory components.

 

Dysphagia can occur in all stages of swallowing in people with PD.  Typical changes associated with the oral phase of swallowing can include:

  • Reduced tongue strength => tongue and/or palatal residue
  • Reduced anterior to posterior tongue coordination and lateralization => decreased bolus formation & transport
  • Lingual rocking during bolus formation
  • Lingual tremor
  • Prolonged ramplike posture
  • Piecemeal deglutition

(El Sharkawi et al., 2001; Volonte, Porta, & Comi, 2002; Hunter et al., 1997; Bushmann et al., 1989; Robbins et al., 1986)

 

Typical changes associated with the pharyngeal phase of swallowing include:

  • Delayed pharyngeal response
  • Delayed triggering of the swallow reflex
  • Impaired motility with residue in valleculae and pyriform sinuses
  • Penetration and/or aspiration

(El Sharkawi et al., 2001; Leopold & Kagel, 1997 ; Potulska et al., 2003; Robbins et al., 1986)

 

Aspiration before the swallow may occur as a result of premature material spilling over the tongue base with and reduced vocal fold closure.  Aspiration after the swallow may occur secondary to significant amounts of pharyngeal residue that is aspirated when respiration is resumed (Robbins et al., 1986) or incoordination of breathing and swallowing (Gross et al., 2008).

 

Please write again if you have additional questions. 

 

Sincerely,

 

Leslie Mahler

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There is not one swallow exercise program to which to post a link.  See a speech-language pathologist to determine if swallowing exercises are even the right solution to your swallowing disorder.

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The best method for assessing aspiration pneumonia is a combination of a behavioral assessment of swallowing, medical history, assessment of current diet, blood work, and a chest x-ray if needed.  Aspiration pneumonia potentially has serious health consequences and should be evaluated and treated in a timely manner.

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