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[Dysphagia] PEG to PO feeding
jzweier <jzweier@comcast.net> wrote:
Pt. developed an
aspiration pneumonia sometime after the PEG placement as well.
** This was more probaly an aspiration pneumonitis due to reflux induced by the PEG, exacerbation of GER and aspiration pneumonitis being the major threat in the use pf PEG.
Upper airway
congestion/throat clearing heard,
** Are you sure this was not the common mucus clearing of GER? What about sensory examination?
Thermal stimulation has been shown several times to have no effect on swallowing. What do you think is the major locus of impairment - sounds like tongue to me with a combination of dysarthria and lack of bolus control implying poor UES opening.While RCVA patients seem to take longer to recover than LCVA, since this patient is only 3 months post-stroke, there is time yet for spontanous recovery - however, the greatest risk factor at the moment seems to be the presence of the PEG, requiring great nursing care and anti-relux positioning. I would advocate for this together with good mouth care, monitor and wait. Are there any comorbidities and what medications are being taken?
In the meantime, trials with ice chips/water may be useful both to monitor progress and to provide practice in swallowing - still the best therapy.
Irene.
So, basically, I'm asking for any feedback regarding what to do at this
point (i.e. OM ex. program again, incl. thermal stim; ice chip trials;
MBS; all of the above; anything I haven't though of???).
Thanks for any help you can provide!
Jill B. Zweier, M.A., CCC-SLP
Petaluma, CA
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