Dysphagia: Clinical Management in Adults and Children A new clinician was told b
ID: 73621 • Letter: D
Question
Dysphagia: Clinical Management in Adults and Children
A new clinician was told by her supervisor that patients who demonstrate a pharyngeal swallow delay may benefit from the therapeutic intervention of a sour bolus. The clinician was told that the hospital kept a large supply of lemon ice on each floor for this purpose. The clinician was working with a patient who showed slowed eating/swallowing as a result of a partial tongue resection secondary to cancer. After 6 days of therapy with the lemon ice, the clinician did not believe that the swallow delay had improved.
What are the potential reasons why the sour bolus did not help trigger a faster swallow in her patient?
Name a compensatory technique OR a facilitation technique that might this help this patient and explain your rationale.
Explanation / Answer
If the resection is done to such an extent that the patient feels difficulty in chewing and controlling food in mouth, this even result in difficulty in swallowing. At times, there may be lack of enough nervous stimulus due to tongue resection. If nonsensate flap closures are used, this also lead to lack of stimulus for swallowing.
Facilitation techniques that might be helpful are change in posture, like chin down technique enhances the movement of tongue after resection. Alterations of bolus volume, taste, and temperature may be helpful.
In worst cases, electrical stimulation may be applied to initiate neuromuscular functions assciated with swallowing (somatosensory stimulation)
Tongue resection may lead to loss of sensation due to inturrupted nerve function. If tissue flaps are used during surgery, the flaps have no motor function and it lead to loss of propulsion force. If tissue flaps are large and bulky, they may even obstruct bolus passage.
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