[Dysphagia] Off-topic: Unusual voice pt

[swlslp at yahoo.com (Sandi Lancaster)]

Just wanted to thank everyone for all the wonderful suggestions and questions about my "unusual voice patient".  Unfortunately, I have not been able to see her for therapy beyond our initial evaluation.  My supervisor contacted Medicare regarding whether this would be a covered service, and unfortunately, she was told it would not be covered.  But I do appreciate everyone's input!  I learned from your thoughtful responses even if I wasn't able to use the suggestions with this particular patient.
 
Thanks everyone!  :)
 
-Sandi Lancaster

Vikki Stefans <vstefans@george.ach.uams.edu> wrote:
This could well be more than vocal, and perhaps you could get coverage for
assisitng in neuropsychological diagnosis or localization; try this search
for info on ways a CVA may affect perception of pitch as well as
production... quite a bit of info on left vs right CVA which may be
pertinent also. Alcock artcle, third one down, and Sidtis, #15 both look
promising.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=2341559

Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.

On Sat, 31 Jul 2004, Sandi Lancaster wrote:

> Irene:
> She reports no change in her swallowing. She has a strong volitional
> cough and strong throat clear. Her loudness level appears normal. I
> don't have access to objective measures of her vocal intensity or
> fundamental frequency, but based on my assessment and patient report,
> her difficulty appears to be limited to mild difficulty with singing
> off-key.
>
> My supervisor has requested that I put her on hold due to questions
> regarding whether Medicare will reimburse for this type of voice
> therapy.
>
> Sandi Lancaster
>
>
> Irene Campbell-Taylor wrote: Sandi I'm not sure
> about the exercises, but the fact that she can't sing a scale as before
> is a strong indication of reduced protection of the airway. Do you have
> any objective infornation on this? Irene.
>
> Sandi Lancaster wrote:
>
> 69 y.o. woman had a CVA several weeks ago. The CVA appears to have been
> fairly mild overall in terms of its effects on her. I received MD orders
> to eval for for "dysarthria in a singer." Her speech in conversation is
> WNL; artic is fine, resonance is fine. She indicated that her voice is
> slightly lower in pitch than before the CVA. No changes noted in vocal
> quality, resonance, or loudness. The real issue to her is that she
> noticed about 1 week post-CVA that she is now singing "off-key". She
> sings in several choirs and so this is of considerable concern to her.
>
> I had her do maximal loudness and quiet voice tasks, as well as high
> pitch and low pitch, all of which she can do WNL. When she goes to do a
> scale, she is, as she reported, slightly off-pitch. (Probably about what
> I am on a good day!)
>

		
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