Case 5

History

• 71 yr old female with right CVA, one month post onset.

Radiographic Findings

• Impaired lingual motility
  • Poor bolus containment in oral cavity
    • Premature entry of (large volume of) liquids into pharynx
      • Laryngeal vestibular penetration
• Decreased oropharyngeal sensation
  • Delayed intiation of pharyngeal swallow

Treatment

• Bolus Texture
  • Controlled volumes of thin liquids (5cc) and semi-solids
    • Improves oral control and oral bolus transport
• Tongue strengthening exercises
  • Improves lingual motility for oral bolus containment and oral transport with improved initiation of pharyngeal swallow
• Thermal application
  • Facilitates initiation of pharyngeal swallow
• Bolos hold exercises
  • Improves oral containment
• Chin Tuck
  • Widens valleculae during pharyngal delay to improve airway protection

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