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[Dysphagia] minimassager, facial massage
I know of no evidence that massage is of any benefit whatsoever. The work that has been done on facial nereve paralysis - very limited- has addressed Bell's palsy, which is, of course a peripheral not a central impairment. One large study found no effect with massage.
Treatment of Bell's palsy with combination of traditional Chinese medicine and western medicine]
Hua Xi Kou Qiang Yi Xue Za Zhi 2004 Jun;22(3):211-3
Wang XH; Zhang LM; Han M; Zhang KQ; Jiang JJ
It is disturbing to find clinicians applying various and sundry "treatments" without ever having identified the cause of the impairment. No treatment can be implemented without knowing the cause of the problem yet this vital information seems to be consistently ignored in dysphagia management. It is probably the reason that the typical clinical exam fails so often in identifying salient features. I am told by many who are aware of the practice and standards of those teaching in the field that it is rare to find that the important anatomy and physiology has been properly taught and that many, if not most believe that an oral peripheral examination is the most that need be applied. If this is true, it is disturbing indeed. I am persuaded that it probably is true as I find that few of the people I teach in workshops and seminars are aware of the components of a full clinical examination and are surprised at how easily and quickly they can isolate the necessary variables for str
uctured
management and development of outcome measures.
Irene.
I have a patient with diagnosis encephalopathy in one of my SNF buildings. She had a right CVA back in the spring with a long hospitalization, SNF (not my building) for a month, rehospitalization, reSNF (same as last one), home and back to my facility after failing at home. She has some residual left-sided weakness with occasional drool at rest. Diet texture is mechanical soft with ground meat and thin liquids. She is physically capable of masticating regular but has no desire to.
Anyhow, she was seen this past week by another therapist in my company in coverage for me. The therapist documented providing the patient with mini-massage (with one of those little vibrator-type massagers) x5 minutes and 30 reps of sustained facial massage to affected side.
My question for the group is, is this treatment indicated in this patient? Is there any research to support this or not support this? How about in patients with a more recent onset? I know that one of the books I've seen on oral-motor maybe the Source for Dysarthria, instructs how to perform sustained massage but is there any proof of benefit for the patient? I have seen patients demo increased labial ROM immediately post facial massage but then return to baseline.
Thanks for your input,
Linda A. Zanchi, MA CCC-SLP
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