[Dysphagia] Swallowing Eval for Tracheotomy patient

[plarghi at msn.com (Patti Larghi)]

Dear Linda,
I don't think your first concern here should be whether or not to try Vital 
Stim with this patient. You should carefully proceed with Speeh Language and 
Swallowing assessment as you would with any other tracheostomized patient. 
Is the patient consistently awake alert? Does this patient spend time on the 
vent? What type of tracheostomy tube does he have ? Does it have a cuff? Can 
the cuff be defalted? Can he tolerate a Passey Muir Speaking Valve?  Is he 
able to be positioned upright? Does he have a reflexive swallow to mouth 
care, lemonswabs or even a single ice chip? Does he manage his secretions ?  
There are prefeeding issues to consider with this type of patient?  I would 
start off very basic or maybe consult a college that has experience with 
this type of patient. Hope this is helpful.
On a side note you will most likely find pros and cons on this list serve to 
the Vital Stim Treatment. I am currently using the treatment with success 
but feel that not every patient with dysphagia is a canidate , besides you 
would need an MBS to decide on the best electrode placement.
Good Luck Patti
>From: Speech and Hearing Centres <speechhearing_my@yahoo.com>
>To: dysphagia@b9.com
>Subject: [Dysphagia] Swallowing Eval for Tracheotomy patient
>Date: Thu, 30 Dec 2004 17:29:56 -0800 (PST)
>
>Dear colleagues,
>
>    I am interested to know if Vital Stim can be used for adult patients 
>with trachetomy, using a metal  tube or non metal tube. This one patient 
>(45 years old) had undergone craniotomy and cranioplasty as well, after 
>being involved in an MVA 3 months ago. He has been on NG tube feeding since 
>  then, though he only regained consciousness from a coma barely a month 
>ago. He seemed to have limited understanding of verbal instructions and 
>would normally coil himself in a foetal position on bed. He is also not 
>able to sit or stand independently yet. No heart problems were reported and 
>his lungs appeared clear as of yesterday's report.
>
>     His physician has requested for a swallowing evaluation and the 
>possibility of him regaining his speech capacity. Here are my queries:
>
>1) What should I look out for in this evaluation?
>2) I am interested to try Vital stim with him. He has not received any oral 
>feeds yet.
>3) Please advise if I can try oral feeds with him with or without Vital 
>stim.
>
>Thank you and wishing everyone a Happy and Joyous New Year,
>
>Sincerely,
>Linda B.
>Speech Language Therapist
>
>
>
>
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