Newsletter :: October 2004

Next Conference – E-Stim and how it relates to Dysphagia

Should I say……………..”Mercy!” Ha! After the “twisting of my arm” and the many calls, emails, and “begging”, I am going to address E-Stim as it relates to dysphagia.

I did 2 articles on E-Stim in 1997 and 1998. This conference will discuss these articles/my research, review swallowing A& P, discuss current trends, protocols, and controversies, get some PT perspective on NMES as well as some SLP’s currently using various E-Stim protocols on adults and infants. No date or time has been set at this time. I will keep you informed.

This conference will not promote any E-stim/NMES device. This is an educational conference, your right to academic freedom. We all have an “ethical responsibility not only to learn from but also to contribute to the total store of scientific knowledge when possible, etc.” (E 9.095 – AMA Policy).

DiagnosTEX QA stats for the month of August

• Decreases alternate means of feeding with initiation of PO = 78%
• Silent Aspiration Diagnosed during the MBSS – 25%
• NPO recommendations – 19
• Compensatory strategies/facilitative techniques implemented on 50 patients to ensure safe PO
• Esophageal dysfunction noted in 28% of the patients.

Medication side effects and allergic reactions

The basic way medications impact a persons swallowing is by triggering an allergic reaction or having side effects. Severe reactions to antibiotics like penicillin and sulfa can cause a stricture of the esophagus. Esophagitis can be caused by simple drugs such as asprin and nonsteroidal anti-inflammatory drugs. Fosamax and Actonel, which are used to treat osteoporosis can actually cause dysphagia, esophagitis, and ulcers. Aging results in a 70 percent decrease in the number of taste buds and a 30 percent loss of muscle mass. The need for protein, calcium, and vitamin D intake increases. The body becomes less thirsty, and a dry mouth is more common and therefore does no feel uncomfortable. Medications such as anticholinergics and psychotropics can cause dry mouth, and diuretics given without adequate fluid can dehydrate. Xerostomia (dry mouth) can be treated easily but health care providers need to informed about the conditions if it is present. SLP’s should know what medications their patients are taking and be able to recognize drug induced problems such as dry mouth when treating the patient for dysphagia.

Dysphagia Tidbit – Muscles

Let’s identify A & P:

Strap Muscles are NOT the inferior and middle pharyngeal constrictor muscles

Strap Muscles – Infrahyoids (Laryngeal Depressors)

• Omohyoid
• Sternohyoid
• Sternothyroid
• Thyrohyoid

See Muscles of the larynx – http://webpages.marshall.edu/~shagamon/muscles.htm

Sling Muscles – Suprahyoids (Laryngeal Elevators)

• Diagastric
• Mylohyoid
• Geniohyoid
• Stylohyoid

One the lighter side

When evaluating a recent CVA patient, I was desperately trying to get some speech or recognition from a male patient. His family had reported no utterances at all since his stroke. Since he was a farmer, I held up a little tractor, thinking this would be familiar and asked him if he could tell me what this was. After numerous attempts on my part, he looked at me and said very clearly, “Lady if you don’t know that is a tractor you’re in worse shape than I am.”