Music Therapy Protocol Development to Enhance Swallowing Training for Stroke Patients with Dysphagia

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Music Therapy Protocol Development to Enhance Swallowing Training for Stroke Patients with Dysphagia"

Transcription

1 Joumal of Music Therapy, XLVll (2), 2010, by the American Music Therapy Association Music Therapy Protocol Development to Enhance Swallowing Training for Stroke Patients with Dysphagia Soo Ji Kim, PhD, MT-BC Myongji University Seoul, Korea Considering the devastating condition of dysphagia, it is necessary to provide intensive therapeutic regimen based on interdisciplinary approach. In this aspect, music-enhanced swallowing protocol was developed through a pilot study. Then, the modified protocol from a pilot study was examined with 8 stroke patients in a local hospital. The protocol was designed to improve oral motor control, laryngeal elevation, breathing, and swallowing functions. The dependent variables 'measured included reflex, respiration, and laryngeal functions using the Frenchay Dysarthria assessment. Results from the initial to the midevaluation showed that pitch in the laryngeal category were statistically significant after 6th sessions. After the 12th session, when the final evaluation was compared with the initial assessment, additional categories revealed statistically significant changes. It is recommended that this study should be replicated with a control group and a larger sample using either FEES or video fluoroscopy for scientific data to further substantiate music therapy outcomes in stroke rehabilitation. nysphagia In troduction Dysphagia, or abnormality in swallowing fluids and/or foods, is commonly associated with severe strokes. The incidence of clinical dysphagia ranges from 67% when screened during the first 72 hours after a stroke attack (Hinds & Wiles, 1998) to 43% within the first 7 days post stroke (Wade & Hewer, 1987). Even though most swallowing problems disappear in a short period of time, at least 11% of dysphagic patients still have difficulties after 6 months of recovery (Gordon, Hewer, et al., 1987; Wade & Hewer, 1987).

2 VoL XLVlI, No. 2, Summer Dysphagia can seriously affect a patient's quality of life and potentially lead to death if aspiration occurs. With aspiration, food or liquid enters the airway causing an acute risk for pneumonia, which significantly delays rehabilitation. Malnutrition, which is also associated with poor swallowing, may inapede rehabilitation outcomes and slow recovery (Logemann, 1995). In dysphagia, four stages of the swallowing mechanism are involved, namely, (a) the oral preparatory, (b) oral, (c) pharyngeal, and (d) esophageal stages (Logemann, 1995). Swallowing requires a successful progression of coordinated, sequenced movements to complete all four stages. The physiological elements of swallowing behaviors include the application of tongue pressure on the food to propel it through the mouth, protection of the airway from food intake, and the opening of the upper esophageal sphincter to allow the passage of food into the esophagus (Logemann, 1995). Damage to any of these physiological elements due to stroke may cause patients to exhibit swallowing disorders. Generally, these are due to damage in the central nervous system and/or to the structures of the oral cavity, pharynx, and larynx (Logemann, 1995). Because dysphagia involves a life-threatening risk of airway obstruction and/or aspiration pneumonia, the treatment of the swallowing dysfunction is vital to survival (Perry, 2001). Common signs and symptoms of dysphagia include weak or uncoordinated tongue control, delayed swallowing reflex with pooling or stasis of residue accompanied by reduced pharyngeal motility, and reduced esophageal peristalsis (serial contraction of muscles that push food through the gastrointestinal tract) (Logemann, 1998). Assessments of these common symptoms following stroke are conducted with procedures that include an initial bedside swallowing assessment that incorporates a cervical auscultation and a timed swallowing test. If pharyngeal involvement is suspected, a modified barium swallow study and a FEES (fiber optic endoscopic evaluation of swallowing) are commonly used (Hamdy, 2004; Logemann, 1996). In addition, ultrasound, or manometry, can be used as a diagnostic tool. Once dysphagia is diagnosed, it is managed through (a) diet modification, (b) use of compensatory strategies (see Table 1), and (c) direct treatment until oral feeding is reestablished (Logemann, 1999). Most often, the speech-language pathologists

3 104 Journal of Music Therapy TABLE 1 Compensatory Swallowing Maneuvers 1. Supraglottic swallow: designed to close the airway at the level of the true vocal folds before and during the swallow a. Inhale and hold your breath b. Swallow while holding your breath c. Cough immediately after your swallow without breathing in 2. Super-supraglottic swallow: designed to close the airway entrance before and during the swallow a. Inhale, hold yonr breath and bear down b. Swallow c. Cough 3. Effortful swallow: designed to increase posterior motion of the tongue base during the pharyngeal swallow and thus improve bolus clearance from the valleculae. As you swallow, squeeze hard with all of your muscles 4. Mendelsohn maneuver: designed to increase the extent and duration of laryngeal elevation and thereby increase the duration and width of cricopharyngeal opening. Swallow your saliva several times and pay attention to your neck as you swallow. Tell me if you can feel that something (your Adam's apple or voice box) lifts and lowers as you swallow. Now this time, when you swallow and you feel something lift as you swallow, don't let your Adam's apple drop. Hold it up with your muscles for several times. Note. From Logemann, 1999, p on the rehabilitation team provide direct treatment. A typical therapy program involves progressive exercises designed to improve swallowing function. These are focused on developing the laryngeal closure, a critical mechanism for airway protection during swallowing (Mendelsohn & Martin, 1993). In dysphagia rehabilitation, musical components could be utilized to facilitate oral, vocal, and respiratory functions that restore the swallowing function. There is currently no research, however, that indicates the effectiveness of music therapy on the rehabilitation of the swallowing function following stroke. Music in Speech Rehabilitation Over the past few years, a number of speech training techniques for neurologically impaired patients have been developed at the Center for Biomedical Research in Music (Thaut, 1999). Applying

4 VoL XLVlI, No. 2, Summer those techniques to music therapy sessions for neurologically impaired patients, however, requires in-depth knowledge and extensive experience regarding neurologic diagnoses. With the emergence of neurologic music therapy (NMT) techniques, many studies have been conducted regarding the effectiveness of music on speech and physical rehabilitation for neurologically impaired patients. In particular, utilizing music for speech problems due to Parkinson's disease (PD) has been investigated by multiple researchers (Barry, 2004; Haneishi, 1999). A voice and speech protocol integrated with musical elements was developed to improve intensity level, intelligibility, maximum duration of sustained vowel phonation, maximum vocal range, vocal fundamental frequency, and vocal fundamental frequency variability found in patients with PD (Haneishi, 1999). Another study was also tested music-based voice and speech protocol to improve PD speech (Barry, 2004). The combination of NMT techniques was used in this study as an attditory stimulation. Rhythmic cues have been investigated by Thaut and his colleagues (Mclntosh, Brown, et al., 1997; Thaut, Kenyon, et al., 1999). According to these researchers, rhythm entrains mo[or control, which synchronizes motor movements with auditory rhythmic cues. These cues occur in the brain at subliminal levels of perception; therefore, rhythmic auditory cueing can facilitate the rehabilitation of motor movements without involving cognitive processing. Most research in association with NMT teclaniques has been focused on rehabilitation of motor dysfunctions including gait or arm movements for patients with neurologic disorders. It is obvious that more clinical research regarding the use of music in speech rehabilitation is reqtfired in the music therapy profession. In addition, establishing music-enhanced protocols that address swallowing problems could be significant in stroke rehabilitation considering the importance of the swallowing function. Rationale for Using Music Therapy in Swallowing Training Considering the nature of the swallowing mechanism, two stages of the swallowing process---the oral and the oropharyngeal stages--can be supported by music therapy treaunent. These stages involve voluntary and involuntary movements of the tongue, lips, jaws, and larynx, which patients can learn to control

5 106 Joumal of Music Therapy through verbal or nonverbal exercises, or through vocalization in music. According to Logemann (1996), swallowing treatment includes exercise programs to improve range of motion in the jaw, lips, tongue, and larynx during swallowing. Therefore, singing and vocalization interventions that incorporate these movements may produce significant results for patients who have swallowing difficulties. The theoretical foundation for using music for oral motor and breathing exercises is supported by the laboratory research conducted at the Center for Biomedical Research in Music (Thaut, 1999) in Fort Collins, Colorado. These theoretical foundations are based on the interrelationship between entrainment of music rhythm with act!vity in the motor center of the brain. Several music therapy techniques have been established to achieve functional outcomes in patients who are neurologically impaired. The first of these is Oral Motor and Respiratory Exercises (OMREX) which involves the same physical functions as those that occur in swallowing. This technique is used to facilitate speech and respiratory functions through musical components such as vocalization, singing, chanting, or playing instruments (Thaut, 1999). In this technique, music is utilized as a cueing mechanism and supports the physical functions involved in speech and breathing. Even though this technique was originally developed to improve speech function and respiratory strength, the application of the OMREX can be extended, with appropriate modification, to the rehabilitation of swallowing function. With a scheme of OMREX, the efficacy of breathing and vocalization will be investigated in this study. Several research studies have examined the interaction between breathing and swallowing, (Martin, Logemann, et al., 1994; Martin-Harris, Brodsky, et al., 2003; McFarland, Lund, et al., 1994). Research reveals the following outcomes: (a) the timing of swallows in relation to.the respiratory cycle is fairly regular with 70% of swallows beginning during the expiratory phases of the respiratory cycle, (b) most swallows end with expiration, and (c) swallowing is associated with a brief swallow apnea. Therefore, the precise coordination of breathing and swallowing prevents aspiration (Preiksaitis, Maryrand, et al., 1992). In fact, respiratory control and laryngeal coordination during swallowing protect the airway from becoming blocked (Hirst, Ford, et al., 2002).

6 VoL XLVlI, No. 2, Summer Furthermore, the research findings of Ohmae, Logemann, Kaiser, Hanson, and Kahrilas (1996) support the rationale for breathing exercises. These researchers investigated two breathholding maneuvers; the supraglottic maneuver and super supraglottic maneuver (see Table 1), during the oropharygeal swallow. They concluded that breath-holding maneuvers could induce better airway conditions before a swallow, as well as produce appropriate temporal ch'anges during swallowing. When researchers investigated the influence of rhythmic input on individuals' respiratory patterns, synchronization of breathing and swallowing can be achieved through music therapy-enhanced training (Haas, Distenfeld, et al., 1986). This finding indicates it is important to incorporate breathing control exercises in stroke rehabilitation for better swallowing. In such exercises, the patterned breathing dynamics may be designed to match the patient's current breathing patterns. In this process, the breathing pattern of a patient can be synchronized with exercise cued by ascending or descending melody lines on a keyboard (i.e., inhaling with an ascending melody line and exhaling with a descending melody line). The duration and tempo of the music cued breathing exercises is determined by observing a patient's normal breathing pattern at the beginning of the session. Several research findings show an anatomical and metabolic relationship between breathing, vocalization, and swallowing. One empirical finding in partictdar indicates that neurons related to swallowing and vocalization are also linked to laryngeal, pharyngeal, palatal, and esophageal muscles (Larson, Yajima, et al., 1994). To examine the neural adjustment of normal respiratory activities, the researchers used animal subjects, in which they discovered a close relationship between breathing, vocalization, and swallowing in terms of location and activation of neurons. Incorporating empirical data from previous studies for their research design, they found that extensive regions of the cerebral cortex are involved in respiration. Results may be interpreted to imply that musical rhythm could serve as a pacemaker when rhythmic entrainment occurs with subjects' breathing patterns. The review of related literature suggests that a music therapy swallow protocol for stroke patients with dysphagia may improve swallowing and also contribute to their enjoyment of rehabilitation and ultimately to their commitment and adherence to

7 108 Journal of Music Therapy treatment. Music therapy designed to enhance swallowing will likely provide positive physical and psychological benefits for stroke patients with swallowing disorders. Regarding the effectiveness and efficiency of treatment for stroke, the addition of music therapy deserves some discussion. First, cognitive deficits may appear after a stroke, and thus verbal directions in treatment procedures alone are ineffective for communication with stroke patients who exhibit difficulties in cognitive processing. Second, music therapy-enhanced intervention may facilitate improvement in swallowing function, which contributes to cost-efficient treatment. Physiological mechanisms of oral motor functions, breathing, and vocalization are commonly associated with swallowing function (Logemann, 1998). Adding music therapy to rehabilitation for dysphagic patients may also induce positive speech production and vocalizations. This will occur through increased breath support, intelligible articulation, and auditory comprehension. Third, live music which can be adjusted to an individual patient's pacing during swallowing training can increase the possibility of successful breath control/coordination for dysphagic patients. Research findings showed that using live music is effective in increasing behavioral responses for dementia patients (Sherratt, Thornton, et al., 2004) and increasing dementia patients' engagement with their caregivers (Clair, 2002). Stroke patients also can benefit from the use of live music created by music therapists during intervention, because it can be freely manipulated to suit each patient's needs, increasing the likelihood that each patient will engage in the intervention effectively. Because a music therapist provides individualized interventions depending on each patient's condition, the length, intensity, and repetition of breathing and vocalizing exercises are flexible. In addition, listening to live accompaniment paired with the breathing cycle may generate esthetic enjoyment for patients. In sum, many music therapy-enhanced interventions in swallowing training may have the potential for improving functional outcomes. Musical support during the intervention can serve as a focal point for stroke patients with dysphagia. Research and development of such an intervention, therefore, becomes vital for dysphagia treatment. Despite its significance and the need identified by clinicians, no research was found that

8 VoL XLVlI, No. 2, Summer investigated the relationship between swallowing and music therapy-enhanced intervention. Considering the percentage of stroke patients who suffer from dysphagia, developing music therapy protocols for their treatment is an urgent call. Therefore, the purpose of this study is to investigate the effect of a musicassisted treatment protocol on the swallowing function of stroke patients with dysphagia. The following research questions were answered: 1. Is there a statistically significant difference in swallowing assessment results (Enderby, 1983) following music-enhanced swallowing treatment? More specifically, do results of the Frenchay assessment differ from initial to mid treatment? 2. Is there a statistically significant difference in swallowing assessment results following music-enhanced swallowing treatment? More specifically, do results of the Frenchay assessment differ from initial to treatment completion? Pilot Study Method To develop and test the music therapy protocol, three to five sessions were conducted with seven patients (3 females, 4 males) who had snffered strokes. All patients were diagnosed as right MCA (Middle Cerebral Artery) infarction or pontine infarction and presented swallowing dysfunctions identified by a neurologist. The swallowing difficulties presented by the patients included oral and pharyngeal dysphagia. Participants received one to two individual music therapy sessions a week for 2 weeks. All participants demonstrated abilities to vocalize and verbalize given verbal or musical cues. All participants received individual music therapy sessions. Each music therapy session consisted of a 30-minute music therapy protocol including five segments: (a) 5 rain of singing, (b) 5 min of two-step breathing, (c) 5 min of three-step breathing, (d) 5 rain of laryngeal elevation exercise, and (e) 5 min of singing. A total of 5 min were allowed for all transition between protocol segments during which personal hygiene was managed (i.e., removing saliva after vocalization as necessary). The total protocol duration was 30 min. Each session was videotaped for evaluation.

9 110 Joumal of Music Therapy Results and recommendations of pilot study video analysis The following observations were made throughout the video analysis of pilot study participants (N = 7): 1. All participants could perform each task in the protocol. 2. The length of each segment seemed to be extensive for patients, as manifested by their physical fatigue during and after sessions. Therefore, the protocol for the experimental study was shortened to assure patients' positive engagement. 3. Musical accompaniment (keyboard playing) was rather complex. Therefore, it was simplified for the experimental study so that it better cued breathing responses. Instead of playing expanded harmonization, a clear melody line of either ascending or descending scales was used so that the duration of breath, in or out, was cued for participants. 4. Participants in the pilot study demonstrated ability to vocalize two pitch intervals (C-E or C-G) when they had laryngeal elevation exercises. It was concluded that various pitch intervals could be utilized in the protocol to facilitate a diverse range of laryngeal elevation. Based on observations of the pilot sessions, the music therapy protocol was revised. It was incorporated into a subsequent research study. Fifteen-Minute Research Protocol of the Music-Enhanced Swallowing Treatment Step 1, Warm-up (2 min). Subjects silently yawned to open their throat. They were able to vocalize in a glissando, or slide, from their highest comfortable pitch to their lowest comfortable pitch. For each slide, a vowel sound was used until all vowels were used: 'ah,' 'eh,' 'ee,' 'oh,' and 'ooh'. This warm-up activity was designed to stimulate subjects' laryngeal musculature, to practice speech production, and to stimulate breathing. The pitch range and tempi were adjusted to each subject's functional capabilities. Step 2, Singing 0 rain). Each subject sang his or her song of choice at a moderate tempo for 3 min. The song tempo was controlled by the researcher. The researcher encouraged each subject to sing loudly in order to stimulate vocal production and deeper breathing. This step was designed to encourage the

10 VoL XLVlI, No. 2, Summer subjects' sound production and to enhance positive mood for active participation. Step 3, Two-step breathing (2 rain). The subject was instructed to do two-step breathing (inhale and exhale) using diaphragmic control for 10 consecutive repetitions. The subject breathed in and out as cued by live musical accompaniment provided by the music therapist. The subject inhaled with an ascending melody, and exhaled with a descending melody. The accompaniment not only provided cues for the dnration of the breathing bnt also facilitated flow and contintfity in the breathing. Step 4, Three-step breathing (2 rain). The snbject was instructed to do three-step breathing for 10 repetitions. In this process, the subject breathed in, held the breath for two to three seconds, and breathed out as cued by the live accompaniment. These musical cues were provided in the same manner as in the two-step breathing exercise. On a keyboard, an interval was played in tremolo, i.e., rapid repetition of two notes comprising a musical interval, to cue the duration of breath-holding. Step 5, Laryngeal elevation through vocalization 0 rain). After the three-step breathing exercise, the music therapist played two different notes that were selected fi'om the interval range between G4 to G5 on the keyboard. Based on the results of the pilot study, pitch intervals included a major 2nd, major 3rd, perfect 5th, major 6th, and an octave. The choice of pitch intervals for each participant depended upon the ability to vocally produce the notes (sounds). Some participants could achieve the full array of intervals while others could only replicate a few. The therapist asked the patient to hum notes several times to become familiar with the pitches. The subject was then asked to vocalize the notes making vowel sounds including "aah," "ooh," and "eee" successively, and to repeat them 10 times. This vocalization was designed to facilitate laryngeal elevation and appropriate throat muscle movements. The therapist asked the subject do this exercise following the two-step and three-step breathing exercises to assess muscular development crucial to swallowing. Step 6, Singing for closing (3 rain). The patient sang the song that he or she sang during the warm-up. The researcher prmfided positive verbal comments on the performance and reminded each subject to return for his or her next session.

11 112 Joumal of Music Therapy Protocol Purpose This protocol was designed based on the swallowing maneuvers and laryngeal elevation exercises that are currently used by speech therapists in swallowing rehabilitation following stroke. In order to combine musical elements with swallowing treatment, live keyboard playing was provided to cue responses. The piano playing was supportive of each subject's attempts to follow the protocol. The protocol was first piloted to assure proper protocol delivery, A neurologist observed pilot sessions for three patients. These patients served as subjects in the protocol pilot test, but not in the research study. Based on the neurologist's observation, the protocol was approved for the subsequent research study. Subjects Experimental Study Participants for this study were eight stroke patients with dysphagia who were in-patients at a local hospital in Incheon, South Korea, where patients received physical therapy but no speech therapy due to the absence of a speech therapist in the facility. Subjects were selected from a neurorehabilitation unit after consultation with two neurologists who determined they fit the study criteria. Criteria for participant selection were as follows: 1. The age of the patient was within a range from 50 to 70 years. 2. The patient was diagnosed with stroke-involved oral and pharyngeal dysphagia. 3. The patient was able to follow verbal directions. 4. The patient had no previous experience with music therapy services. 5. The patient was evaluated as safe for oral intake With either modified diet or swallowing management precautions. 6. The patient had no professional musical background. Subjects' profiles are presented in Table 2. Procedures After consenting to participate in the study, subjects who met the criteria were assessed individually by the researcher in a brief interview format. In the interview their willingness to participate

12 VoL XLVlI, No. 2, Summer TABLE 2 Subjects' Profile Data Sex/age Diagnosis Subject 1 M/61 Right MCA infarction Subject 2 M/51 Middle cerebral artery s)aldrome Subject 3 M/52 Middle cerebt,'al artery syndrome Subject 4 M/60 Lacunar infarction Subject 5 M/62 Pontine infarction Subject 6 M/70 Pontlne infa,'ction Subject 7 M/51 Right MCA infarction Subject 8 M/63 Right MCA infarction in the study and their abilities to tmderstand and follow verbal directions were confirmed. Using a questionnaire in this initial interview, the researcher determined musical style preferences, favorite songs, and music education background. While subjects enjoyed singing, they did not have a professional music education. Song preferences indicated by subjects included Korean folk music, religious music, and Korean popular music (see Table 3). Next, each participant was scheduled for a total of 12 individual music therapy sessions which convened three times weekly for a 4- week period. During each individual session, the music therapy protocol was implemented for 15 min, a duration that allowed the greatest level of participation without incurring fatigue. Assessment of swallowing was done by the researcher using the Frenchay TABLE 3 Subjects' Musical BackgrmLnd Informal music acti~it), Formal music education (lessons, ensembles) (singing rooms, church choir etc.) Song preference Subject 1 None Little Korean folk music Subject 2 None Very often Korean popular music Subject 3 None Often Korean popular music and art songs Subject 4 None Often Hymns/folk music Subject 5 None Very often Korean popular music Subject 6 None Often Korean popular music Subject 7 None Often Korean popular music Subject 8 None Often Korean popular music

13 114 Journal of Music Therapy Dysarthria Assessment (Enderby, 1983). The measures were taken three times during the course of the study, conducted once before the first session, at the conclusion of the sixth session, and after the 12th session. Each individual session was held in a large room at the hospital that had a piano for the researcher to use during the sessions. During each 15-minute music therapy protocol, the subject sat in a wheelchair next to the piano, facing the researcher. The researcher turned her upper body diagonally toward the patient so that she could maintain eye contact with the participant. Then the researcher played the piano with her right hand when playing pitch intervals and scales, and with both hands when accompanying the patient's singing. The researcher maintained consistent eye contact with each subject as she played. Each subject performed the protocol as directed by the researcher. Sessions were videotaped for purpose of observation. Assessment Upon recommendation by an experienced speech therapist, participants' swallowing function was assessed using the Frenchay Dysarthria assessment. This assessment is a standardized test of speech neuromuscular activity (Enderby, 1983) and includes objective procedures to analyze breath support, oral motor function, vocalization, and intelligibility. For the purpose of the present study, a speech therapist, experienced in swallowing rehabilitation following stroke, recommended only three sections of the assessment. They were (a) reflex, (b) respiration, and (c) laryngeal categories. Performance of each subject's oral-motor activity was rated on a scale of severity from levels 'a' (normal function) to 'e' (no function). An experienced speech therapist trained the researcher to do the assessment through verbal instructions, modeling, and competency testing with stroke patients. Such training continued until competency consistently met criteria. Results In this study, only 9 conditions in three categories of the Frenchay assessment were evaluated. The reflex section includes cough, swallow, and dribble; the respiration section includes respiration at rest and in speech; and the laryngeal section

14 VoL XLVII, No. 2, Summer TABLE 4 Results of Wilcoxson Si~zed Ranks Test t Value Significance Conditions Initial to mid Initial to completion Initial to mkl Initial to completion A. Reflex Cough I Swallow Drool I* B. Respiration At rest * In speech C. Laryngeal Time Pitch *.024* Volume In speech *.017* * = significant differences. included time, pitch, volume, and in speech. To test the data, the Frenchay scale was converted into numbers fi'om 1 to 8. Mean comparisons, standard deviations, and paired t tests were calculated with SPSS program (see Table 4 and Table 5). The data were tested in two ways: before the intervention and after the 6th session (mid-evaluation), and before the intervention and after the 12th session (final evaluation). The following research questions were answered: 1. Is there a statistically significant difference in swallowing assessment results (Enderby, 1983) following music-enhanced swallowing treatment? More specifically do the results of the Frenchay assessment differ from initial to mid treatment? Among a total of nine conditions, mean scores show that outcomes for respiration at rest, laryngeal time, pitch, vohnne, and speech conditions improved from the initial to the midevaluation. Wilcoxson Signed Ranks test for each condition between the initial assessment and the mid-evaluation assessment revealed significant differences for pitch (p = 0.042) in the laryngeal section (see Table 4 for results of Wilcoxson signed ranks test). There were no statistically significant differences from initial to mid-evahmtion for reflex cough, swallow, and drool, and respiration in speech (see Table 5 for mean scores).

15 116 Journal of Music Therapy TABLE 5 Mean Comparisons and Standard Deviation Mean scores Standard deviation Conditions Initial Mid Final Initial Mid Final A. Reflex Cough Swallow Drool B. Respiration At rest In speech C. Laryngeal Time Pitch Volume In speech Is there a statistically significant difference in swallowing assessment results following music-enhanced swallowing treatment? More specifically, do results of the Frenchay assessment differ from initial to treatment completion? Mean scores show that outcomes for swallow and drool in the reflex section, respiration at rest and in speech, laryngeal time, pitch, volume, and in-speech conditions improved from the initial to the final evaluation. Wilcoxson signed ranks tests for each condition between the initial assessment and the final-evaluation assessment revealed significant differences for four conditions: dribble or drool (p = 0.041) in the reflex section, respiration at rest (p = 0.034) in the respiration section, laryngeal pitch (p = 0.024), and speech (p = 0.017) in the laryngeal section. Discussion This study investigated the effect of music therapy-enhanced swallowing treatment on swallowing function of stroke patients. The dependent variables measured included reflex, respiration and laryngeal functions using the Frenchay Dysarthria assessment. A series of Wilcoxson signed ranks tests was run to find statistical significance among data. Results from the initial to the midevaluation showed that pitch condition in the laryngeal category

16 VoL XLVlI, No. 2, Summer were statistically significant only after six music therapy sessions. After the 12th session, when the final evaluation was compared with the initial assessment, additional categories revealed statistically significant changes. These included the drool, respiration, pitch, and speech conditions. The restdts show significant improvements across reflex, respiration, and laryngeal categories and indicate improved control. Evidence for improved breathing is indicated by the achievement of longer singing durations, up to six notes on a scale, approximately one second per note. The evidence indicates improvements in two primary treatment areas, breathing and laryngeal elevation. Improvements in these areas are particularly important because of their functional relationship to swallowing. It is possible that the protocol used in this study can be used to improve oral motor control, laryngeal elevation, breathing, and improved swallowing function. Considering the negative consequences of swallowing dysfunction, enhancements to traditional swallowing treatments are essential. Applications of the music therapy protocol are desirable not only because music therapy provides enjoyable experiences, but also because it contributes to restoration of the patients' physiological mechanisms for swallowing by providing auditory timing cues and facilitating voice production that replicates the muscle movements involved in the swallowing process. o Limitations Several limitations existed in this study. First of all, assessing swallowing function was a challenge because of the lack of a standardized swallowing measurement. Clinically, a series of observations and a videofluoscopy exam would be critical to swallowing function assessment; however, such procedures were not available to the participants in this study. Second, patients who have swallowing difficulties generally demonstrate several other symptoms including oral-motor dysfunctions or limited cognitive functions. These additional dysfunctions may result in lower participation or withdrawal from music therapy. Fatigue is another factor which may influence protocol participation. Therefore, it is important for music therapists to consider appropriate length and intensity of music therapy interventions for dysphagic patients. In addition, participation is influenced by

17 118 Joumal of Music Therapy the location of the brain lesion. Subjects grouped by lesion area could help clarify the effects of the protocol. Lastly, the weak design of this study lessens the effectiveness of the protocol. Further study with a larger subject sample in an experimental control design is important to confirm the positive effect of music therapy in swallowing rehabilitation. This study served merely to test a music therapy protocol which merits additional study to document outcomes. Music therapy intervention has the potential to increase efficacy and effectiveness in swallowing exercises designed for dysphagic patients to bring about rapid therapeutic progress. Therefore, further research designed for their intensive, short-term music therapy protocol could be meaningful. This project contributed to pioneering one of the least studied areas in the discipline. References Barry, J. (2004). The effects of a music therapy protocol on the speech production of individuals with Parkinson's disease and characteristics of dysarthria: A case study. Unpublished master's thesis: University of Kansas, Lawrence. Clair, A. A. (2002). The effects of.music therapy on engagement in family caregiver and care receiver couples with dementia. American Journal of Alzheimer's Disease and Other Dementia, 17(5), Enderby, P. M. (1983). Frenchay Dysarthria Assessment. College-Hill Press: San Diego, CA. Gordon, C., Hewer, R. L., & Wade, D. T. (1987). Dysphagia in acute stroke. British Medical Journal, 295, Haas, F., Distenfeld, S., & Axen, K. (1986). Effects of perceived musical rhythm on respiratory pattern. Journal of Applied Physiology, 61(3), Hamdy, S. (2004). The diagnosis and management of adult neurogemc" dysphagla." * Nursing Times, 100(18), Haneishi, E. (1999). The effects of music therapy voice treatment on speech and voice problems and mood of individuals with Parkinson's disease. Unpublished master's thesis, University of Kansas, Lawrence. Hinds, N. P., & Wiles, C. M. (1998). Assessment of swallowing and referral to speech and language therapists in acute stroke. Quarterly Journal of Medicine, 91(12), Hirst, L. J., Ford, G. A., Gibson, G. J., & Wilson, J. A. (2002). Swallow-induced alterations in breathing in normal older people. Dysphagia, 17, Larson, C. R., Yajima, Y., & Ko, P. (1994). Modification in activity of medullary respiratory-related neurons for vocalization and swallowing. Journal of Nenrophysiology, 71(6), Logemann, J. A. (1995). Dysphagia: Evaluation and treatment. Folia Phoniatrica Logopaedia, 47, Logemann, J. A. (1996). Screening, diagnosis, and management of neurogenic dysphagia. Seminar in Neurology, 16(4),

18 VoL XLVlI, No. 2, Summer Logemann, J. A. (1998). Evaluation and treatment ofswauowing dhorders (2nd ed.). Pro ed: Austin, TX. Logemann, J. A. (1999). Behavioral management for oropharyngeal dysphagia. Folia Phoniatrica Logopaedia, 51, Martin, B.J.W., Logemann,J. A., Shaker, R., & Dodds, w.j. (1994). Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. Journal of Applied Physiolo~ff, 76, Martin-Harris, B., Brodsky, M. B., Price, C. C., Michel, Y., & Wahers, B. (2003). Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows. Journal of Applied Physiology, 94, Mclntosh, G. C., Brown, S. H., Rice, R. R., & Thaut, M. H. (1997). Rhythmic auditory-motor facilitation ofgait patterns in patients with Parkinson's disease. Journal of Ne~trosurgical Psychiatry, 62(I), McFarland, D. H., Lund, J. P., & Gagner, M. (1994). Effects of posture on the coordination of respiration and swallowing. Journal of Physiology, 72, Mendelsohn, M. S., & Martin, R. E. (1993). Airway protection during breathholding. The Annals of Otology; Rhinology; (ft. Laryngology, 102, Ohmae, Y., Logemann, J. A., Kaiser, P., Hanson, D. G., & Kahrilas, P.J. (1996). Effects of two breath-holding maneuvers on oropharyngeal swallow. Annals of Otology; Rhinology; & LaTyngology, 105, Perry, L. (2001). Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial ewduation of a screening tool for use by nurses. Journal of Clinical Nursing, 10, Preiksaitis, H. G., Maryrand, S., Robins, K., & Diamant, N. E. (1992). Coordination of respiration and swallowing: Effects of bolus volume in normal adults. American Journal of Physiology Regulation Intergroup, 263, R624-R630. Sherratt, K., Thornton, A., & Hatton, C. (2004). Emotional and behavioral responses to music in people with dementia: an observational study. Aging and Mental Health, 8(3), Thaut, M. H. (1999). Training manual for neurologic music therapy. Center for Biomedical Research in Music. Colorado State University. Thaut, M. H., Kenyon, G. P., Schauer, M. L., & Mclntosh, G. C. (1999). The connection between rhythmicity and brain function: hnplications for therapy of movement disorders. IEEE Engineering in Medicine and Biology, 18, 1-7. Wade, D. T., & Hewer, R. L. (1987). Motor loss and swallowing difficuhy after stroke: Frequency, recovery and prognosis. Acta Neurologica Scandanavica, 76,

Swallowing Strategies

Swallowing Strategies Department of Head and Neck Surgery Section of Speech Pathology & Audiology M.D. Anderson Cancer Center (713) 792-6525 Swallowing Strategies 1) POSTURAL CHANGES: a) Chin Tuck: (1) Delayed onset pharyngeal

More information

The Clinical Swallow Evaluation: What it can and cannot tell us. Introduction

The Clinical Swallow Evaluation: What it can and cannot tell us. Introduction The Clinical Swallow Evaluation: What it can and cannot tell us Debra M. Suiter, Ph.D., CCC-SLP, BCS-S Director, Voice & Swallow Clinic Associate Professor, Division of Communication Sciences & Disorders

More information

SWALLOWING DIFFICULTIES IN HD

SWALLOWING DIFFICULTIES IN HD Nutrition, eating and swallowing needs, challenges and solutions Workshop SWALLOWING DIFFICULTIES IN HD Angela Nuzzi Speech and Language Pathologist (SLP) EHDN Language Coordinator - Italy The role of

More information

Dysphagia and Swallowing. Jan Adams, DNP, MPA, RN and Karen Kern

Dysphagia and Swallowing. Jan Adams, DNP, MPA, RN and Karen Kern Dysphagia and Swallowing Jan Adams, DNP, MPA, RN and Karen Kern Scope of the Problem and Incidence 15 million people in the US have some form of Dysphagia. Every year, 1 million people are diagnosed with

More information

Speech and language therapy exercises

Speech and language therapy exercises The Clatterbridge Cancer Centre NHS Foundation Trust Speech and language therapy exercises Rehabilitation and Support A guide for patients and carers Contents Why do I need these exercises?...1 How to

More information

Reluctance or refusal to feed or eat. Understanding Feeding Aversion in a City Full of Foodies. Presentation Outline. Learning Objectives

Reluctance or refusal to feed or eat. Understanding Feeding Aversion in a City Full of Foodies. Presentation Outline. Learning Objectives Understanding Feeding Aversion in a City Full of Foodies Amy Houtrow, MD, MPH Pediatric Physical Medicine & Rehabilitation UCSF Department of Pediatrics June 2, 2007 Learning Objectives Learners will be

More information

Main Aspects of the Management of Neurogenic Dysphagia

Main Aspects of the Management of Neurogenic Dysphagia Main Aspects of the Management of Neurogenic Dysphagia Mario Prosiegel/München German Society of Neurology (DGN) prosiegel@t-online.de DYSPHAGIA October 8-10, 2015 Pavia, Italy Overview Diagnosis Causal

More information

Swallow Function: Passy-Muir Valve Use for Evaluation & Rehabilitation David A. Muir Course Outline Physiology of Swallow

Swallow Function: Passy-Muir Valve Use for Evaluation & Rehabilitation David A. Muir Course Outline Physiology of Swallow Swallow Function: Passy-Muir Valve Use for Evaluation & Rehabilitation Mary Spremulli, MA, CCC-SLP Passy-Muir Clinical Consultant spre713@hotmail.com (949) 833-8255 David A. Muir 23 year-old ventilator

More information

VOICE LESSON #6. Resonance: Creating Good Vocal Vibes. The Soft Palate

VOICE LESSON #6. Resonance: Creating Good Vocal Vibes. The Soft Palate VOICE LESSON #6 Resonance: Creating Good Vocal Vibes Voice Lesson #6 - Resonance Page 1 of 7 RESONANCE is the amplification and enrichment of tones produced by the voice. When we talk about resonance,

More information

The Role of the Speech Language Pathologist & Spinal Cord Injury

The Role of the Speech Language Pathologist & Spinal Cord Injury The Role of the Speech Language Pathologist & Spinal Cord Injury Facts According to the National Spinal Cord Injury Statistical Center (NSCISC) there are approxiamtely 12,000 new spinal cord injuries (SCI)

More information

Endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia

Endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Endoscopic carbon dioxide laser cricopharyngeal myotomy for relief of oropharyngeal dysphagia Difficulty

More information

Stage Transition And Laryngeal Closure In Poststroke Patients With Dysphagia

Stage Transition And Laryngeal Closure In Poststroke Patients With Dysphagia Archived version from NCDOCKS Institutional Repository http://libres.uncg.edu/ir/asu/ Stage Transition And Laryngeal Closure In Poststroke Patients With Dysphagia By: Elizabeth Rachel Oommen Youngsun Kim

More information

VitalStim in Swallowing Rehabilitation

VitalStim in Swallowing Rehabilitation VitalStim in Swallowing Rehabilitation Meghan McAvoy, MS,CCC-SLP Mary Free Bed at Sparrow Hospital Disclosures No financial or non-financial disclosures Control of the swallow Both voluntary and involuntary

More information

Fact Sheet. VitalStim Therapy

Fact Sheet. VitalStim Therapy VitalStim Therapy Fact Sheet Dysphagia, or difficulty with swallowing, is a sorely neglected medical disorder that impacts as many as 15 million Americans, with approximately one million people annually

More information

Class Voice: Review of Chapter 10 Voice Quality and Resonance

Class Voice: Review of Chapter 10 Voice Quality and Resonance Class Voice: Review of Chapter 10 Voice Quality and Resonance Tenor Luciana Pavarotti demonstrating ideal head position, alignment, inner smile, and feeling of up to achieve optimal resonance! Millersville

More information

Department of Pediatric Otolarygnology. ENT Specialty Programs

Department of Pediatric Otolarygnology. ENT Specialty Programs Department of Pediatric Otolarygnology ENT Specialty Programs Staffed by fellowship-trained otolaryngologists, assisted by pediatric nurse practitioners, ENT (Otolaryngology) at Nationwide Children s Hospital

More information

Cover Page. The handle holds various files of this Leiden University dissertation

Cover Page. The handle  holds various files of this Leiden University dissertation Cover Page The handle http://hdl.handle.net/1887/32744 holds various files of this Leiden University dissertation Author: Heemskerk, Anne-Wil Title: Dysphagia in Huntington s disease Issue Date: 2015-04-15

More information

Respiratory Compromise and Swallowing

Respiratory Compromise and Swallowing Speech Pathology and Respiratory Care April 11, 2013 By Angela Parcaro-Tucker, MA, CCC-SLP, LSVT How can Speech Therapy help? 1 Respiratory Compromise and Swallowing Swallowing is a complex sequence of

More information

Surgical Effects on Swallowing DYSPHAGIA AFTER TREATMENT FOR HNC: WHAT CAUSES IT? WHAT TREATMENT WORKS? Surgical Effects on Swallowing

Surgical Effects on Swallowing DYSPHAGIA AFTER TREATMENT FOR HNC: WHAT CAUSES IT? WHAT TREATMENT WORKS? Surgical Effects on Swallowing Susan Langmore, PhD, CCC-SLP, BRS-S Professor, BUMC, BU September 27, 2010 DYSPHAGIA AFTER TREATMENT FOR HNC: WHAT CAUSES IT? WHAT TREATMENT WORKS? Incidence of dysphagia after XRT VA study (Wolf; Terrell

More information

10/26/2017. Diagnostic Tests vs. Screening. Dysphagia Screening: What it is and what it is not

10/26/2017. Diagnostic Tests vs. Screening. Dysphagia Screening: What it is and what it is not Dysphagia Screening: What it is and what it is not Debra M. Suiter, Ph.D., CCC-SLP, BCS-S Director University of Kentucky Voice & Swallow Clinic Lexington, Kentucky ASHA's Preferred Practice Pattern on

More information

Chapter 10 The Respiratory System

Chapter 10 The Respiratory System Chapter 10 The Respiratory System Biology 2201 Why do we breathe? Cells carry out the reactions of cellular respiration in order to produce ATP. ATP is used by the cells for energy. All organisms need

More information

Analyzing Swallow Studies in Pediatrics

Analyzing Swallow Studies in Pediatrics Analyzing Swallow Studies in Pediatrics About the Speaker Robert Beecher, M.S., CCC-SLP was formerly senior speech-language pahologist at the Children's Hospital of Wisconsin in Milwaukee. He is specialized

More information

Video Fluoroscopic Swallowing Exam (VFSE)

Video Fluoroscopic Swallowing Exam (VFSE) Scan for mobile link. Video Fluoroscopic Swallowing Exam (VFSE) A video fluoroscopic swallowing exam (VFSE) uses a form of real-time x-ray called fluoroscopy to evaluate a patient s ability to swallow

More information

Management of oropharyngeal dysphagia

Management of oropharyngeal dysphagia Management of oropharyngeal dysphagia Course Objectives Know the normal anatomy of swallowing Know the normal physiology of swallowing Enumerate different etiologies of oropharyngeal dysphagia Be able

More information

POST POLIO SYNDROME (PPS) AND ITS EFFECTS ON SWALLOWING BY: LINDSAY JORDAN

POST POLIO SYNDROME (PPS) AND ITS EFFECTS ON SWALLOWING BY: LINDSAY JORDAN POST POLIO SYNDROME (PPS) AND ITS EFFECTS ON SWALLOWING BY: LINDSAY JORDAN WHAT IS POST POLIO SYNDROME (PPS)? Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery

More information

Medication for the Terminal Patient Who Can t Swallow. Annette T. Carron, DO Director Geriatrics & Palliative Care Botsford Hospital

Medication for the Terminal Patient Who Can t Swallow. Annette T. Carron, DO Director Geriatrics & Palliative Care Botsford Hospital Medication for the Terminal Patient Who Can t Swallow Annette T. Carron, DO Director Geriatrics & Palliative Care Botsford Hospital Disclosure I have no financial relationships to disclose Route and medication

More information

Pharyngeal Effects of Bolus Volume, Viscosity, and Temperature in Patients With Dysphagia Resulting From Neurologic Impairment and in Normal Subjects

Pharyngeal Effects of Bolus Volume, Viscosity, and Temperature in Patients With Dysphagia Resulting From Neurologic Impairment and in Normal Subjects Journal of Speech and Hearing Research, Volume 37, 1041-1049, October 1994 Pharyngeal Effects of Bolus Volume, Viscosity, and Temperature in Patients With Dysphagia Resulting From Neurologic Impairment

More information

Temporal and Biomechanical Measurements of Upper Esophageal Sphincter (UES) Opening in Normal Swallowing

Temporal and Biomechanical Measurements of Upper Esophageal Sphincter (UES) Opening in Normal Swallowing Temporal and Biomechanical Measurements of Upper Esophageal Sphincter (UES) Opening in Normal Swallowing Youngsun Kim School of Hearing, Speech and Language Sciences, College of Health and Human Services,

More information

Dysphagia Management in Stroke:

Dysphagia Management in Stroke: The 2 nd ESSD congress and was opened by Dr. Pere Clavé, president of the ESSD, and chair of the local organising committee. He extended a warm welcome to delegates, who came from all over world to attend,

More information

Speech Therapy. 4. Therapy is used to achieve significant, functional improvement through specific diagnosisrelated

Speech Therapy. 4. Therapy is used to achieve significant, functional improvement through specific diagnosisrelated Speech Therapy I. Policy Speech therapy services include the diagnosis and treatment of communication impairment(s) and swallowing disorders. Services include speech/language therapy, swallowing/feeding

More information

Dysarthria and Dysphagia: a Neurology Perspective William Meador, MD Assistant Professor of Neurology, UAB

Dysarthria and Dysphagia: a Neurology Perspective William Meador, MD Assistant Professor of Neurology, UAB Dysarthria and Dysphagia: a Neurology Perspective William Meador, MD Assistant Professor of Neurology, UAB 2.11.16 Disclosures I have no relevant conflicts or potential conflicts to disclose regarding

More information

Neuro Q no.1 = Neuro Quran

Neuro Q no.1 = Neuro Quran TRANSDISCIPLINARY RESEARCH SEMINAR CLINICAL SCIENCE RESEARCH PLATFORM 27 July 2010 School of Medical Sciences USM Health Campus Neuro Q no.1 = Neuro Quran Dr.Muzaimi Mustapha Department of Neurosciences

More information

Anatomy & Physiology 2 Canale. Respiratory System: Exchange of Gases

Anatomy & Physiology 2 Canale. Respiratory System: Exchange of Gases Anatomy & Physiology 2 Canale Respiratory System: Exchange of Gases Why is it so hard to hold your breath for Discuss! : ) a long time? Every year carbon monoxide poisoning kills 500 people and sends another

More information

DYSPHAGIA MANAGEMENT IN ACUTE CARE AMANDA HEREFORD, MA, CCC- SLP

DYSPHAGIA MANAGEMENT IN ACUTE CARE AMANDA HEREFORD, MA, CCC- SLP DYSPHAGIA MANAGEMENT IN ACUTE CARE AMANDA HEREFORD, MA, CCC- SLP OVERVIEW Decision making re: swallowing in the medically compromised patient Swallow evaluation vs. Nursing Swallow Screening Instrumental

More information

Sapienza, C.M. (2008, invited). Respiratory muscle strength training. Current Opinion in Otolaryngology and Head and Neck Surgery, 16, 3,

Sapienza, C.M. (2008, invited). Respiratory muscle strength training. Current Opinion in Otolaryngology and Head and Neck Surgery, 16, 3, Pitts, T., Bolser, D., Rosenbek, J., Troche, M., & Sapienza, C. (2008). Voluntary cough production and swallow dysfunction in Parkinson's disease. Dysphagia, 23, 3, 297-301. Epub ahead of print. Cough

More information

The Respiratory System

The Respiratory System 13 PART A The Respiratory System PowerPoint Lecture Slide Presentation by Jerry L. Cook, Sam Houston University ESSENTIALS OF HUMAN ANATOMY & PHYSIOLOGY EIGHTH EDITION ELAINE N. MARIEB Organs of the Respiratory

More information

SWALLOWING: HOW CAN WE HELP

SWALLOWING: HOW CAN WE HELP SWALLOWING: HOW CAN WE HELP Carol Romero-Clark, M.S., CCC-SLP University of New Mexico Hospital Speech Pathology Department November 10, 2017 What happens when you swallow? Mouth (Oral Phase) Your tongue

More information

Cranial Nerves VII to XII

Cranial Nerves VII to XII Cranial Nerves VII to XII MSTN121 - Neurophysiology Session 13 Department of Myotherapy Cranial Nerve VIII: Vestibulocochlear Sensory nerve with two distinct branches. Vestibular branch transmits information

More information

David Markowitz, MD. Physicians and Surgeons

David Markowitz, MD. Physicians and Surgeons Esophageal Motility David Markowitz, MD Columbia University, College of Columbia University, College of Physicians and Surgeons Alimentary Tract Motility Propulsion Movement of food and endogenous secretions

More information

Medicaid Provider Manual

Medicaid Provider Manual 2.4 SPEECH, LANGUAGE AND HEARING THERAPY (INCLUDES ASSISTIVE TECHNOLOGY DEVICE SERVICES) 2.4.A. SPEECH, LANGUAGE AND HEARING THERAPY Definition Prescription Provider Qualifications Evaluations for Speech

More information

USING CUED SPEECH WITH SPECIAL CHILDREN Pamela H. Beck, 2002

USING CUED SPEECH WITH SPECIAL CHILDREN Pamela H. Beck, 2002 USING CUED SPEECH WITH SPECIAL CHILDREN Pamela H. Beck, 2002 Cued Speech is used with children with and without hearing loss for a variety of purposes, such as accelerating the learning phonics or speech

More information

Management of Dysphagia in Stroke. An Educational Manual for the Dysphagia Screening Professional in the Long-Term Care Setting

Management of Dysphagia in Stroke. An Educational Manual for the Dysphagia Screening Professional in the Long-Term Care Setting Management of Dysphagia in Stroke An Educational Manual for the Dysphagia Screening Professional in the Long-Term Care Setting Management of Dysphagia in Stroke: An Educational Manual for the Dysphagia

More information

Progress Report. Date: 12/18/ :15 PM Medical Record #: DOB: 10/17/1940 Account #: Patient Information

Progress Report. Date: 12/18/ :15 PM Medical Record #: DOB: 10/17/1940 Account #: Patient Information Visits From SOC: Address: City, State, Zip: Occupation: Gender: Contact Person: 2 Primary Diagnosis: Other Diagnosis: 4614 Winstead Way Franklin, Tennessee 37065 Patient Information Healthcare - Medical

More information

Laryngoscopy Examinations

Laryngoscopy Examinations Laryngoscopy Examinations Laryngoscopy is a visual examination of the back of the throat where the voice box (larynx) and vocal cords are located. The procedure is done by using hand mirrors and a light

More information

Medtronic ENT Transnasal Endoscopic Procedures Coding Guide. Effective January 1, 2009

Medtronic ENT Transnasal Endoscopic Procedures Coding Guide. Effective January 1, 2009 Medtronic ENT Transnasal Endoscopic Procedures Coding Guide Transnasal Esophagoscopy Laryngeal Sensory Testing FEES FEEST Transnasal Fiberoptic Laryngoscopy Stroboscopy Disposable Sheaths Effective January

More information

Speech Therapy Care in ALS. Brittney Skidmore, MS, CCC-SLP

Speech Therapy Care in ALS. Brittney Skidmore, MS, CCC-SLP Speech Therapy Care in ALS Brittney Skidmore, MS, CCC-SLP I have the following relevant financial relationship(s) in the products or services described, reviewed, evaluated or compared in this presentation.

More information

Unit 14: The Respiratory System

Unit 14: The Respiratory System Unit 14: The Respiratory System See what you already know! 1. Fill in the diagram on your own 2. Collaborate with your partner The Respiratory System The major function of the respiratory system is gas

More information

Influence of Dysphagia on Short-Term Outcome in Patients with Acute Stroke

Influence of Dysphagia on Short-Term Outcome in Patients with Acute Stroke Authors: Shinichiro Maeshima, MD, PhD Aiko Osawa, MD Yasuhiro Miyazaki, MA Yasuko Seki, BA Chiaki Miura, BA Yuu Tazawa, BA Norio Tanahashi, MD Affiliations: From the Department of Rehabilitation Medicine

More information

The 15-Minute Vocal Warm-up

The 15-Minute Vocal Warm-up The 15-Minute Vocal Warm-up Carolyn Wing Greenlee The 15-Minute Vocal Warm-up CD & Booklet 2006 Carolyn Wing Greenlee Copyright 2006, Carolyn Wing Greenlee & Earthen Vessel Productions. Duplication and

More information

ASU Speech and Hearing Clinic Spring Testing. Adult Speech and Language Evaluation

ASU Speech and Hearing Clinic Spring Testing. Adult Speech and Language Evaluation Adult Speech and Language Evaluation ASU Speech and Hearing Clinic Spring Testing Name: DOB:_ Gender: Examiner:_ Date: Instructions: Administer the following screening tools and standardized tests/batteries.

More information

College of Health Sciences. Communication Sciences and Disorders

College of Health Sciences. Communication Sciences and Disorders * 220 AMERICAN SIGN LANGUAGE I AND THE CULTURE OF THE DEAF COMMUNITY IN AMERICA. (3) An introductory course in American Sign Language (ASL), the native language of the Deaf community in America, this course

More information

Critical Review: Does treatment with levodopa improve swallowing function in patients with Parkinson s Disease?

Critical Review: Does treatment with levodopa improve swallowing function in patients with Parkinson s Disease? Copyright 2013 by Siwicky, M. Critical Review: Does treatment with levodopa improve swallowing function in patients with Parkinson s Disease? Siwicky, M. M.Cl.Sc SLP Candidate University of Western Ontario:

More information

Modified Barium Swallow (MBS- VFSS) 7- Apr- 15 Swallowing Course/ MBS & FEES

Modified Barium Swallow (MBS- VFSS) 7- Apr- 15 Swallowing Course/ MBS & FEES MBS / FEES Course Objectives Know the normal anatomy of swallowing Know the normal physiology of swallowing Enumerate different etiologies of oropharyngeal dysphagia Be able to do bedside assessment (KKUH

More information

2013, Bouchat-Laird, N.

2013, Bouchat-Laird, N. Critical Review: The Effect of Expiratory Muscle Strength Training (EMST) on Dysphagia in individuals with Idiopathic Parkinson s disease. Natasha Bouchat-Laird M.Cl.Sc (SLP) Candidate University of Western

More information

P1: OTA/XYZ P2: ABC c01 BLBK231-Ginsberg December 23, :43 Printer Name: Yet to Come. Part 1. The Neurological Approach COPYRIGHTED MATERIAL

P1: OTA/XYZ P2: ABC c01 BLBK231-Ginsberg December 23, :43 Printer Name: Yet to Come. Part 1. The Neurological Approach COPYRIGHTED MATERIAL Part 1 The Neurological Approach COPYRIGHTED MATERIAL 1 2 Chapter 1 Neurological history-taking The diagnosis and management of diseases of the nervous system have been revolutionized in recent years by

More information

Relax! Improve Your Playing by Releasing Tension. Dr. Liz Aleksander and Andrew Morency University of Tennessee at Martin

Relax! Improve Your Playing by Releasing Tension. Dr. Liz Aleksander and Andrew Morency University of Tennessee at Martin Relax! Improve Your Playing by Releasing Tension Dr. Liz Aleksander and Andrew Morency University of Tennessee at Martin Tension Goal when playing: minimize tension Tension radiates to other areas Physical

More information

Efficacy of breathing exercises and relaxation techniques for patients with neurological disorders

Efficacy of breathing exercises and relaxation techniques for patients with neurological disorders Efficacy of breathing exercises and relaxation techniques for patients with neurological disorders Delphine Herrmann Rachael Katz Svetlana Piliavsky Shelley Rice ASHA 2008-CHICAGO WHAT IS THE BENEFIT OF

More information

Evaluation and Treatment of Swallowing Impairments

Evaluation and Treatment of Swallowing Impairments Evaluation and Treatment of Swallowing Impairments JEFFREY B. PALMER, M.D., Good Samaritan Hospital, Baltimore, Maryland JENNIFER C. DRENNAN, M.S., and MIKOTO BABA, M.D., SC.D., Fujita Health University,

More information

Factors Associated With Compliance With Viscosity-Modified Diet Among Dysphagic Patients Jae Seong Shim, MD, Byung-Mo Oh, MD, Tai Ryoon Han, MD

Factors Associated With Compliance With Viscosity-Modified Diet Among Dysphagic Patients Jae Seong Shim, MD, Byung-Mo Oh, MD, Tai Ryoon Han, MD Original Article Ann Rehabil Med 2013;37(5):628-632 pissn: 2234-0645 eissn: 2234-0653 http://dx.doi.org/10.5535/arm.2013.37.5.628 Annals of Rehabilitation Medicine Factors Associated With Compliance With

More information

THE POTENTIAL IMPACT OF VITALSTIM THERAPY ON HEALTHCARE COSTS: A White PaperVitalStim Therapy has significant

THE POTENTIAL IMPACT OF VITALSTIM THERAPY ON HEALTHCARE COSTS: A White PaperVitalStim Therapy has significant Dysphagia THE POTENTIAL IMPACT OF VITALSTIM THERAPY ON HEALTHCARE COSTS: A White PaperVitalStim Therapy has significant Contents potential to dramatically impact the health care costs arising from oropharyngeal

More information

Traumatic Brain Injury for VR Counselors Margaret A. Struchen, Ph.D. and Laura M. Ritter, Ph.D., M.P.H.

Traumatic Brain Injury for VR Counselors Margaret A. Struchen, Ph.D. and Laura M. Ritter, Ph.D., M.P.H. Training Session 3a: Understanding Roles of Members of the Interdisciplinary Treatment Team, Evaluations by Team Members and the Utility of Evaluations Conducted by such Team Members. The Interdisciplinary

More information

Chapter 23. Neural and Voluntary Control of Breathing

Chapter 23. Neural and Voluntary Control of Breathing Chapter 23 Neural and Voluntary Control of Breathing Neural Control of Breathing This topic is still considered unsettled science Exact mechanism for setting the rhythm of respiration remains unknown Currently,

More information

Seniors Helping Seniors September 7 & 12, 2016 Amy Abrams, MSW/MPH Education & Outreach Manager Alzheimer s San Diego

Seniors Helping Seniors September 7 & 12, 2016 Amy Abrams, MSW/MPH Education & Outreach Manager Alzheimer s San Diego Dementia Skills for In-Home Care Providers Seniors Helping Seniors September 7 & 12, 2016 Amy Abrams, MSW/MPH Education & Outreach Manager Alzheimer s San Diego Objectives Familiarity with the most common

More information

Critical Review: Are laryngeal manual therapies effective in improving voice outcomes of patients with muscle tension dysphonia?

Critical Review: Are laryngeal manual therapies effective in improving voice outcomes of patients with muscle tension dysphonia? Critical Review: Are laryngeal manual therapies effective in improving voice outcomes of patients with muscle tension dysphonia? María López M.Cl.Sc (SLP) Candidate University of Western Ontario: School

More information

Compliance Department ELEMENTS OF EAR, NOSE AND THROAT EXAMINATION 11/2010

Compliance Department ELEMENTS OF EAR, NOSE AND THROAT EXAMINATION 11/2010 Compliance Department ELEMENTS OF EAR, NOSE AND THROAT EXAMINATION 11/2010 System/ Body Area Constitutional Measurement of any three of the following seven vital signs: 1) sitting or standing blood pressure,

More information

PM&R Approach to Stroke Rehabilitation A Treatment Plan for Optimum Patient Recovery

PM&R Approach to Stroke Rehabilitation A Treatment Plan for Optimum Patient Recovery PM&R Approach to Stroke Rehabilitation A Treatment Plan for Optimum Patient Recovery Goals of Presentation Improve effectiveness of stroke rehabilitation identify, assess, treat roles of PCP, PM&R, & other

More information

Local Coverage Determination (LCD): Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim Therapy (L34891)

Local Coverage Determination (LCD): Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim Therapy (L34891) Local Coverage Determination (LCD): Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim Therapy (L34891) Links in PDF documents are not guaranteed to work. To follow a web link, please

More information

What are the Challenges? Spreading the Word in NICU. Need for NICU Care: Impact. Baby Trachs: Use of the Passy Muir Valve in the NICU to

What are the Challenges? Spreading the Word in NICU. Need for NICU Care: Impact. Baby Trachs: Use of the Passy Muir Valve in the NICU to What are the Challenges? Baby Trachs: Use of the Passy Muir Valve in the NICU to Optimize Swallowing and Feeding Catherine S Shaker, MS/CCC SLP, BRS S and Cari Mutnick, MS/CCC SLP Florida Hospital for

More information

Disclosures. Primary Methods for Treating UVP. Key Factors Influencing Treatment Planning. Guiding principle with Treatment Planning 2/4/2018

Disclosures. Primary Methods for Treating UVP. Key Factors Influencing Treatment Planning. Guiding principle with Treatment Planning 2/4/2018 Zen and art of vocal mechanics: Key Factors That Influence Unilateral Vocal Fold Paralysis (UVP) Treatment Decisions Julie Barkmeier Kraemer, Ph.D. Professor, Division of Otolaryngology Clinic Director,

More information

There are often questions and, sometimes, confusion when looking at services to a child who is deaf or hard of hearing. Because very young children

There are often questions and, sometimes, confusion when looking at services to a child who is deaf or hard of hearing. Because very young children There are often questions and, sometimes, confusion when looking at services to a child who is deaf or hard of hearing. Because very young children are not yet ready to work on specific strategies for

More information

Activity and Exercise

Activity and Exercise Activity and Exercise Chapter 44 Ra'eda Almashaqba 1 Activity and Exercise refers to the persons rotten of exercise, activity, leisure, and recreation Include: 1. Activity of daily living 2. The type,

More information

ACE Group Fitness Instructor University Curriculum Chapter 3: Group Exercise Program Design

ACE Group Fitness Instructor University Curriculum Chapter 3: Group Exercise Program Design ACE Group Fitness Instructor University Curriculum Chapter 3: Group Exercise Program Design Learning Objectives Upon completion of this chapter, you will be able to: Explain general group exercise recommendations

More information

Hearing the Universal Language: Music and Cochlear Implants

Hearing the Universal Language: Music and Cochlear Implants Hearing the Universal Language: Music and Cochlear Implants Professor Hugh McDermott Deputy Director (Research) The Bionics Institute of Australia, Professorial Fellow The University of Melbourne Overview?

More information

NDTA BASIC ADULT COURSE KEY TO COURSE CONTENT

NDTA BASIC ADULT COURSE KEY TO COURSE CONTENT Topic: Atypical Patterns of Movement Learning outcome(s) that pertain to occupational therapists 1. Identify the influence of atypical patterns of movement on: Postural alignment Transitional movements

More information

Common complaints included: "No one can hear me!" "My voice wears out too quickly." "My throat feels so tight and strained."

Common complaints included: No one can hear me! My voice wears out too quickly. My throat feels so tight and strained. PART ONE OF THREE ARTICLES The George Washington University Speech and Hearing Center in Washington DC has treated clients with voice problems since the 1970 s. One of the most common vocal issues that

More information

Lung Disease and Your Throat

Lung Disease and Your Throat Lung Disease and Your Throat Presented by Beth Causa Speech Pathologist Wollongong Speech Pathology With sincere thanks to Kate Baumwol Speech Pathologist, Western Health (Perth) For sharing the contents

More information

Original Article. Annals of Rehabilitation Medicine INTRODUCTION

Original Article. Annals of Rehabilitation Medicine INTRODUCTION Original Article Ann Rehabil Med 2012; 36: 512-520 pissn: 2234-0645 eissn: 2234-0653 http://dx.doi.org/10.5535/arm.2012.36.4.512 Annals of Rehabilitation Medicine The Effect of Bedside Exercise Program

More information

PRACTICAL SOLUTIONS TO REHAB DEMENTIA CARE PART 1 PROMOTING EACH PERSON S BEST ABILITY TO FUNCTION

PRACTICAL SOLUTIONS TO REHAB DEMENTIA CARE PART 1 PROMOTING EACH PERSON S BEST ABILITY TO FUNCTION The Dementia Problem PRACTICAL SOLUTIONS TO REHAB DEMENTIA CARE PART 1 PROMOTING EACH PERSON S BEST ABILITY TO FUNCTION Efficient, practical & compassionate service is more important than ever before Aging

More information

RELAXATION EXERCISES

RELAXATION EXERCISES RELAXATION EXERCISES Relaxation technique 1: Breathing meditation for stress relief With its focus on full, cleansing breaths, deep breathing is a simple, yet powerful, relaxation technique. It s easy

More information

The Digestive System. Prepares food for use by all body cells.

The Digestive System. Prepares food for use by all body cells. The Digestive System Prepares food for use by all body cells. Digestion The chemical breakdown of complex biological molecules into their component parts. Lipids to fatty acids Proteins to individual amino

More information

Biology 236 Spring 2002 Campos/Wurdak/Fahey Laboratory 4. Cardiovascular and Respiratory Adjustments to Stationary Bicycle Exercise.

Biology 236 Spring 2002 Campos/Wurdak/Fahey Laboratory 4. Cardiovascular and Respiratory Adjustments to Stationary Bicycle Exercise. BACKGROUND: Cardiovascular and Respiratory Adjustments to Stationary Bicycle Exercise. The integration of cardiovascular and respiratory adjustments occurring in response to varying levels of metabolic

More information

TELEMEDICINE APPLICATION FOR OROPHARYNGEAL DYSPHAGIA PATIENTS

TELEMEDICINE APPLICATION FOR OROPHARYNGEAL DYSPHAGIA PATIENTS TELEMEDICINE APPLICATION FOR OROPHARYNGEAL DYSPHAGIA PATIENTS 1 What we will like to explain? Current model of therapy. Face-to-face vs. distance model of treatment. Why e-dis? How e-dis works? Pilot study.

More information

Cleft Palate Speech-Components and Assessment Voice and Resonance Disorders-ASLS-563. Key Components of Cleft Palate Speech.

Cleft Palate Speech-Components and Assessment Voice and Resonance Disorders-ASLS-563. Key Components of Cleft Palate Speech. Cleft Palate Speech-Components and Assessment Voice and Resonance Disorders-ASLS-563 Key Components of Cleft Palate Speech Disorder Type of Disorder/ Causes Hypernasality Resonance Disorder insufficiency

More information

PD ExpertBriefings: Caring for a Person with Late Stage Parkinson s Led By: Joan Gardner, R.N., B.S.N. and Rose Wichmann, P.T.

PD ExpertBriefings: Caring for a Person with Late Stage Parkinson s Led By: Joan Gardner, R.N., B.S.N. and Rose Wichmann, P.T. PD ExpertBriefings: Caring for a Person with Late Stage Parkinson s Led By: Joan Gardner, R.N., B.S.N. and Rose Wichmann, P.T. To hear the session live on: Tuesday, November 22, 2011 at 1:00 PM EDT. DIAL:

More information

Dysphagia Management in TCP. Susan Smith and Vanessa Barkla Speech Pathologists, Ballarat Health Services May 2012

Dysphagia Management in TCP. Susan Smith and Vanessa Barkla Speech Pathologists, Ballarat Health Services May 2012 Dysphagia Management in TCP Susan Smith and Vanessa Barkla Speech Pathologists, Ballarat Health Services May 2012 The role of the Speech Pathologist To assess swallowing status To provide management and

More information

* Produces various chemicals to break. down the food. * Filters out harmful substances * Gets rid of solid wastes

* Produces various chemicals to break. down the food. * Filters out harmful substances * Gets rid of solid wastes * * Produces various chemicals to break down the food * Filters out harmful substances * Gets rid of solid wastes * *Mouth *Pharynx *Oesophagus *Stomach *Small and large intestines * *Changes the physical

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia

More information

Expiratory Retraining Techniques BY: SARAH LEWIS

Expiratory Retraining Techniques BY: SARAH LEWIS Expiratory Retraining Techniques BY: SARAH LEWIS What is Expiratory Retraining? Expiratory retraining techniques include various procedures one may use to alter the ways in which air is expelled from the

More information

Preparing for Your Visit: UW-Health Digestive Health Swallowing Disorders Clinic

Preparing for Your Visit: UW-Health Digestive Health Swallowing Disorders Clinic Preparing for Your Visit: UW-Health Digestive Health Swallowing Disorders Clinic To help you get ready for your visit, the staff of the Digestive Health Center has made this handout for you about:. Where

More information

1. With your toothbrush brush the top and sides of your tongue, while your tongue is sitting on the floor of your mouth.

1. With your toothbrush brush the top and sides of your tongue, while your tongue is sitting on the floor of your mouth. EXERCISES FOR THE TONGUE TONGUE BRUSHING 1. With your toothbrush brush the top and sides of your tongue, while your tongue is sitting on the floor of your mouth. 2. Repeat the individual sections 5 times

More information

The use of a palatal support appliance in the management of hypernasal speech

The use of a palatal support appliance in the management of hypernasal speech Journal of Disability and Oral Health (03) 4/4 The use of a palatal support appliance in the management of hypernasal speech M C G Manley BDS DDPH (RCSEng) MSc, PhD, FDS, H V Johnson BA (Hons) and P Sharpe

More information

Includes mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, anus. Salivary glands, liver, gallbladder, pancreas

Includes mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, anus. Salivary glands, liver, gallbladder, pancreas Chapter 14 The Digestive System and Nutrition Digestive System Brings Nutrients Into the Body The digestive system includes Gastrointestinal (GI) tract (hollow tube) Lumen: space within this tube Includes

More information

Our Topic. Warm-Ups. Warm-Ups: Definition. The Art of the Warm-Up Learning to plan, create, and make the most of choral warm-ups

Our Topic. Warm-Ups. Warm-Ups: Definition. The Art of the Warm-Up Learning to plan, create, and make the most of choral warm-ups The Art of the Warm-Up Learning to plan, create, and make the most of choral warm-ups Choral Methods, MUS356 Fall 2015 The Warm-Up Purpose Types How to plan How to create How to invigorate Some notes Sample

More information

Nursing Perspective on Feeding Evaluation and Treatment. Cyndi Chapman, APRN,MSN,MHCL August 2017

Nursing Perspective on Feeding Evaluation and Treatment. Cyndi Chapman, APRN,MSN,MHCL August 2017 Nursing Perspective on Feeding Evaluation and Cyndi Chapman, APRN,MSN,MHCL August 2017 OBJECTIVES: Participant will understand the nursing assessment regarding feeding issues Participant will be able to

More information

New Mexico TEAM Professional Development Module: Autism

New Mexico TEAM Professional Development Module: Autism [Slide 1]: Welcome Welcome to the New Mexico TEAM technical assistance module on making eligibility determinations under the category of autism. This module will review the guidance of the NM TEAM section

More information

CONCETTI GENERALI SULLE DISFAGIE DI ORIGINE ESOFAGEA

CONCETTI GENERALI SULLE DISFAGIE DI ORIGINE ESOFAGEA LA DISFAGIA ESOFAGEA Pavia, 12.1.217 CONCETTI GENERALI SULLE DISFAGIE DI ORIGINE ESOFAGEA Michele Di Stefano Clinica Medica 1 Fondazione IRCCS Policlinico S.Matteo Università di Pavia Pavia PHARYNGOESOPHAGEAL

More information

Conducting Groups. March 2015

Conducting Groups. March 2015 Conducting Groups March 2015 Agenda Advantages of groups Members of the group Group leader Role of the leader, maximize participation, & use effective communication skills Group participants The forceful,

More information