Case 10

History

• 63 yr old male who suffered left CVA
• Dysarthria
• Right Vocal Fold Paralysis

Radiographic Findings

• Mild decreased lingual strength and mobility
  • Mild amount of oral residue on tongue dorsum and palate
• Mild decrease in tongue base retraction
  • Mild Vallecular residue
• Delayed and incomplete laryngeal closure
  • Penetration and aspiration during swallow
• Right pharyngeal weakness
  • Residue on the right pharyngeal wall and pyriform sinus.
• Paralysis of right arytenoid-true vocal fold complex
  • Incomplete airway closure

Treatment

• Bolus Texture
  • Thickened liquids and thin purees
    • Facilitate oral control
    • Initiation of pharyngeal swallow
    • Aspiration prevention
• Nasogastric Feeding
  • Ensure adequate nutrition/hydration
  • Prevention of Aspiration
• Right head turn
  • Direct bolus flow to left (unaffected) side.
  • Decrease PE segment tone
• Tongue strengthening
  • Improves lingual motility for bolus containment and oral transport with improved initiation of pharyngeal swallow

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