Tagged "dysphagia"


Ask a Therapist: Sensory Feeding For An Infant With Medical Issue

Posted by Deborah Grauzam on

Dear Lori,

I attended the Sensory Feeding Course in England in June, and would like to thank you for a full two days of professional input.  Before I left Manchester, I had already thought of how I was going to utilize some of the techniques in my therapy sessions.

You had mentioned that you would not mind answering questions, so I hope you do not mind me taking advantage of the very generous offer.

I have my first appointment to see a 4 month old boy with feeding problems next week.  Mom reports that he breast fed nicely (after an initial period of latching difficulty, and the need to suck using a nipple shield). After 1 week, baby got floppy, stopped feeding, and was taken to hospital, where he stayed for a few weeks. He is currently being fed through a nasal feed tube.  Although he is reported to have a strong suck, he does not suck on breast for long. Bottle feeding has the same results.  This child has had extensive genetic testing, endoscopy (up to larynx), videofluroscopy, and EMG--all without any abnormal findings. He is scheduled for an endoscopy to investigate the esophagus.  He has reflux, and I was told that milk came through the nose.  The ENT did not find any sub-cutaneous cleft, nor velo-pharyngeal insufficiency.  He will also have an MRI.  The current medical opinion seems to indicate problems with swallowing.   All this information was received by phone. I have not seen any reports, as yet.

My goal for the session (aside from meeting and assessing the child), is to show mom the oral and sensory-motor stimulation techniques and massages (as well as hand, foot and body massages).  I also would like to introduce some pre-feeding activities, to try to prevent, or, at least minimize oral sensitivity and aversion to food taken orally.

Question: With a dry spoon (Beckman E-Z feeder), shall I introduce spoon feeding with a front feed, or side feed technique? I am inclined to do both, as they involve different oral motor movements.  However, I do not want to instill incorrect feeding behaviors.  (This is the first time that I am working with an infant).

I would like to thank you in advance for your input.

Best regards,

You are absolutely welcome to ask questions! I am so glad you have been able to use the techniques in your therapy.  I am wondering if this baby was tested for food allergies. Does he have reflux? What are his bowels like? Was he scoped? Do you know if they explored inflammation of the intestines or colon?  Does he have infantile spasms? There sounds like there is an underlying medical issue which has not been identified yet. I agree that your best course of action is to address his underlying oral sensory motor skills to support feeding. At 4 months of age and with so many unanswered medical questions I would not want to start spoon feeding just yet. 

When you do get ready to address spoon feeding if he has low tone, I would recommend side spoon feeding with either the small maroon spoon or the EZ spoon. Good luck with this little one!

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: OPT with Adult suffering from MSA

Posted by Deborah Grauzam on

Adult Speech Therapy

Hi!

I am a trained speech-language pathologist, working in Sweden. I have taken part of the video-based course in the OPT-method and have very positive experiences from using the program with my former clients in a children’s rehabilitation center.

Now I work with elderly patients, primarily suffering from stroke but also with a wide spectra of neurological diseases.

This week, I met with a patient suffering from syndrome MSA, earlier misdiagnosed as Parkinson's. My colleague have worked with his dysarthria inspired by the Lee Silverman-method, which had a mildly effect on his difficulties with controlling the airflow. I proposed that we should try the instruments from OPT as a complement which the patient felt very positive about.

Though the patient recently started to experience difficulties with chewing food I wonder if it would be appropriate to work with the bite-tubes? We are all aware that his condition will continue to progress and that he most likely will suffer from dysphagia, not far from now. What are your thoughts about training when the patient have a progressive disease?

Best regards

Hi, Your email was referred to me for a response as I have been using OPT with adults for many years and have seen significant progress in both stagnate conditions and degenerative conditions such as MSA.  I am so pleased you see the benefits of this work and encourage you to continue to implement the techniques with your adult clients.

As a matter of fact I have just completed my newest book on using OPT with adults and am hoping it will be available for purchase within the next 6 months.    
In the case of a degenerative disease the hierarchy of intervention would remain the same as would the criteria for success to progress to the next level in each activity.  The major change is that your goal will be to maintain function rather than to improve function.  That is not to say in the initial phase of the disease the client will not progress but as the disease progresses the gain will become first minimal, then only maintaining and finally reducing.  
 
As you are working with these clients be aware of their fatigue and do not push them higher than their highest level before failure in each activity during the therapy session or for daily practice.  
 
You mentioned you are using the Bite-Tubes and that is wonderful.  I would also suggest the Horn Blowing Hierarchy and the Straw Drinking Hierarchy if the client is approved for thin liquids such as water or juice.  You can begin the Straw Hierarchy with liquids and if the client develops a pharyngeal phase dysphagia you can continue to use the Straw Hierarchy without liquid.  Instead use twenty 1 inch cubes of paper.  Have the client use the designated straw to pick up the piece of paper, to hold it for 10 seconds and then to rotate the head to drop the paper.  Remember to rotate to alternating sides of the body to ensure symmetrical muscle involvement. This technique has proven to be very beneficial for clients as a maintenance activity as the disease progresses.  
 
I hope this has answered your question but if not please feel free to email me.  
 
PS:  I loved my time in Sweden and hope to return there some day to teach and visit with friends.       
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