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[Dysphagia] RE: Dysphagia Digest, Vol 19, Issue 13
- Subject: [Dysphagia] RE: Dysphagia Digest, Vol 19, Issue 13
- From: DickersC at summa-health.org (Dickerson, Camille)
- Date: Tue Jun 28 12:54:52 2005
Re: 45 y.o. man with quadriplegia and dysphagia
I know there could be a million and one things that could have happened
to this gentleman. I have seen similar characteristics with folks who
have become debilitated after having had multiple visits to acute care.
Debility in older folks and people who are sedentary is not uncommon.
The other thought I had was... Could this person have had a small
infarct say, to the brainstem? How are his salient features of speech?
Any changes? Is there history of hypoxic events that could bring about
neurological changes?
I hope this helps.
Gary Motta M.A., CCC-SLP
Private Practice
877.568.7724
-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of dysphagia-request@b9.com
Sent: Tuesday, June 28, 2005 2:21 PM
To: dysphagia@b9.com
Subject: Dysphagia Digest, Vol 19, Issue 13
Send Dysphagia mailing list submissions to
dysphagia@b9.com
To subscribe or unsubscribe via the World Wide Web, visit
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When replying, please edit your Subject line so it is more specific
than "Re: Contents of Dysphagia digest..."
Today's Topics:
1. No mail (Stacy H. Simon)
2. sterilizing feeding equipment (Sandi Lancaster)
3. Re: CP myotomy? (Vikki Stefans)
4. RE: [asha-div13] Prader Willi Syndrome (Shaker, Catherine S.)
5. RE: sterilizing feeding equipment (Nancy Burnett)
6. RE: RE: [asha-div13] Prader Willi Syndrome (smhjr@surfbest.net)
7. RE: RE: [asha-div13] Prader Willi Syndrome (Dailey, Scott)
----------------------------------------------------------------------
Message: 1
Date: Sun, 26 Jun 2005 20:03:17 -0400
From: "Stacy H. Simon" <shs-slp@worldnet.att.net>
Subject: [Dysphagia] No mail
To: <dysphagia@b9.com>
Message-ID: <000901c57aab$9fc63310$1acc4b0c@eMachineT1100>
Content-Type: text/plain; charset="Windows-1252"
I have not received any e-mail from the group in at least one week. I
was wondering if anyone else has had this problem.
Thanks,
Stacey Simon
------------------------------
Message: 2
Date: Mon, 27 Jun 2005 15:23:27 -0700 (PDT)
From: Sandi Lancaster <swlslp@yahoo.com>
Subject: [Dysphagia] sterilizing feeding equipment
To: dysphagia listserve <dysphagia@b9.com>
Message-ID: <20050627222327.82176.qmail@web60013.mail.yahoo.com>
Content-Type: text/plain; charset=iso-8859-1
Hi all,
Looking for suggestions on quick and easy ways to
sterilize feeding equipment (cups, utensils) used with
dysphagia patients at our clinic...what are other
clinics doing to ensure that feeding equipment is
sterilized?
Thanks in advance,
Sandi
Sandi Lancaster, M.A. CCC-SLP
Speech-Language Pathologist
__________________________________
Yahoo! Mail
Stay connected, organized, and protected. Take the tour:
http://tour.mail.yahoo.com/mailtour.html
------------------------------
Message: 3
Date: Tue, 28 Jun 2005 00:58:24 -0500 (CDT)
From: Vikki Stefans <vstefans@george.ach.uams.edu>
Subject: Re: [Dysphagia] CP myotomy?
To: fay nascimento <dysphagialist@yahoo.ca>
Cc: dysphagia@b9.com
Message-ID: <Pine.GSO.4.62.0506280055530.18436@george.ach.uams.edu>
Content-Type: TEXT/PLAIN; charset=US-ASCII; format=flowed
has he had endoscopy to look for gastritis and GER with esophagitis? He
could be having reflux layngitis too. If endoscopy is not desired,
empiric
trial of Rx for GER and maybe even H. pylori could be done. Pneumonia
can
be due to atlectasis or limited mobility, can he see a pulmonologist or
at
least get PFTs adn CXR?
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 Wed, 22 Jun 2005, fay nascimento wrote:
> I need some input for the following:
>
> 45 y.o. male, adm to hospital April 3, 2005 with pneumonia. He
requested a swallowing assessment as he has been having increasing
difficulty with swallowing at home and wondered whether or not his
difficulty with swallowing has contributed to his current respiratory
problems.
>
> PMHx: chronic respiratory failure and recurrent pneumonia, C5-6 injury
with resultant partial quadriplegia in 1993, cervical fusion, right
vocal cord paralysis and thyroplasty in 1994, chronic pain, Crohn's
disease, bowel resection in 1998, smoking, narcotic use, DVT, pulmonary
embolism, laparotomy for a bleeding duodenal ulcer, theophylline
toxicity, organic brain syndrome and a "tethering" of the right
diaphragm.
>
> Has home ventilation nocturnally and has a tight to the shaft Bivona
#8 trach
> Has G-feeds as well as some oral feeding prior to admission to
hospital
> Diet at home consisted of fairly unrestricted items and included
things like pasta and hamburgers and thin fluids
>
> An MBS was completed when he first got his trach in 2002 and reported
nothing significant with the oral preparatory and oral phases, and the
pharyngeal phase was timely with consistent epiglottic deflection, trace
penetration of thin fluids during the swallow (but ejected with
hyolaryngeal movement), and no other penetration/aspiration. There was
slight vallecular residue with solids that was cleared with a liquid
wash.
>
> Since that time, he has been back a couple of times for pneumonia and
a fall while in his wheelchair.
>
> An MBS was repeated this adm. He has lost a significant amout of
weight and his stoma is huge now around his trach.
>
> He had an MBS repeated at the end of May/05 and found: very slight
hyolaryngeal movement during the pharyngeal swallow and this movement
appeared to triggered in a timely fashion with the head of the bolus
reaching the valleculae. There did not appear to an epiglottic
deflection. All material overflowed the valleculae, the epiglottis ad
entered into the airway. Four attempts were seen to swallow the
material. The UES did not open. The material was aspirated and there
was no coughing response to the aspiration. Upon review, it was
questioned whether a slight protrusion was seen on the posterior
pharyngeal wall about the level of the larynx; ? if it was attempted UES
attempts to open.
>
> He had a laryngoscopy after this as they wondered if there was some
obstruction. There was nothing found, and the ENT dilated the UES. His
suggestion now is repeat MBS and if no improvement, then CP myotomy.
>
> The MBS will be done today. I am not certain what the myotomy may do
in light of this other pharyngeal difficulties (such as decreased HL
movement, Hx of R VF paralysis, silent aspiration).
>
> What has happened (possibly) to this gentleman? What can we suggest?
>
> IF YOU HAVE ANY THOUGHTS/COMMENTS/SUGGESTIONS, they are all welcome!
>
> Thank you.
> Fay
>
> __________________________________________________
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>
------------------------------
Message: 4
Date: Tue, 28 Jun 2005 05:41:40 -0500
From: "Shaker, Catherine S." <CShaker@covhealth.org>
Subject: [Dysphagia] RE: [asha-div13] Prader Willi Syndrome
To: "Hilda Pressman" <hpressman@msn.com>, "Division 13 Discussion
List" <asha-div13@lists.asha.org>
Cc: dysphagia@b9.com
Message-ID:
<3DD3BD5FD259654ABBA8DC218993A51202399D07@WFEXBE01.wfsi.priv>
Content-Type: text/plain; charset="us-ascii"
I would wonder if there is still a level of hypotonia that, while it is
not "overtly noticeable" as in some Praeder Willi infants, it is
interfering with function...what is his sound production like in terms
of differentiated intrinsic tongue muscle control? vowel variety?
strength of consonant contacts? laryngeal control for loudness, pitch
variability? does he babble and if so what is the quality in terms of CV
transitions for example. I find that often these observations in infants
provide insight into true oral-motor control.This then would impact
endurance for feeding (due to oral-motor fatigue, often seen in
conjunction with hypotonia) and precision/control/refinement of skills
with bottle, spoon and cup.
If he required a soft nipple early on does that perhaps reflect some
decreased integrity in intrinsic tongue muscles? When this is the case,
I have typically seen it persist well beyond infancy with Praeder Willi.
Also has the laryngomalacia completely resolved per ENT flexible
fiberoptic laryngoscopy? I have seen some infants diagnosed with
laryngomalacia without overt audible signs. If we do not have objective
data from ENT showing resolution, there may be some compensations on the
infant's part to limit feeding due to stressing airway maintenance.
The other piece may be GI issues. These babies often have associated GI
issues that reduce drive to eat, and impact GI motility (related to
proximal hypotonia) without again the presence of overt signs.
Regarding the Swallow Study, while it sounds like there was no
aspiration, was there any observed difference in swallowing physiology
related to hypotonia? Was there a built in fatigue factor observed?
(i.e. feeding off line and then re-starting fluoro similar to mealtime
length?) often these babies can do ok initially at a meal but then
through the course of a meal, over time, both skills and safety degrade.
If there were airway compromise, perhaps it may be then silent, due to
likely a decreased sensory responsiveness typically seen in the presence
of even subtle hypotonia.
Clinically, what is bolus control like with cup drinking? Is there
active thinning and cupping of the tongue with cup drinking? If not,
this again may reflect less overt but clear problems with intrinsic
tongue control. How effective are the lips at cleaning the spoon? How
stable is the jaw with biting on toys or hard solids?
How is he developing otherwise, e.g. motor control and postural control?
often a decrease in postural control, even subtle, may impact functional
feeding skills in ways you describe.
What types of foods does he prefer? Flavors? The sensory "load" of the
foods he is being offered may not be sufficient for his system with a
level of hypotonia, as hypotonia and hyposensation often go hand in
hand.That may be an avenue of intervention as well.
Just some thoughts.
Keep us posted on this little guy!
Catherine
Catherine S. Shaker M.S./CCC, BRS-S
Speech-Language Pathologist
Board Recognized Specialist in Swallowing and Swallowing Disorders
St. Joseph Regional Medical Center
5000 West Chambers Street
Milwaukee, WI 53210
Phone: 414-447-2797
Fax: 414-874-4104
-----Original Message-----
From: Hilda Pressman [mailto:hpressman@msn.com]
Sent: Monday, June 27, 2005 4:20 PM
To: Division 13 Discussion List
Subject: [asha-div13] Prader Willi Syndrome
I am treating a 10 month old with Prader Willi who had a GT placed at
birth. I have followed him almost from the beginning. He never had
significant oral hypotonia and was readily able to learn to suck from a
bottle using a soft nipple. He initially had laryngomalacia which
interferred with PO feeding to some degree. Swallow study at about 5
months of age was normal. He has acquired skills for bottle drinking,
spoon feeding and cup drinking. The issue is that he continues to take
limited quantities PO and to be dependent on the GT.
I have been advised by two docs who have seen him that decreased
appetite is often an issue in the first year. When I did a literature
search the only problem referred to was the hypotonia. He is now
approaching a year with no significant improvement. We know that he
will get there and that excessive intake will then be a problem but Mom
says that no one else on the Prader Willi listserve appears to present
with a similar problem. Does anyone have any experience with this type
of presentation?
Hilda Pressman, MA, CCC SLP BRS-S
Board Recognized Specialist in Swallowing and Swallowing Disorders
Nutritional Management Associates, LLC
www.nutritionalmanagement.org
---
You are currently subscribed to asha-div13 as: CShaker@covhealth.org
To unsubscribe send a blank email to
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The American Speech-Language-Hearing Association
10801 Rockville Pike
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------------------------------
Message: 5
Date: Tue, 28 Jun 2005 08:56:12 -0400
From: Nancy Burnett <NBurnett@cmh.org>
Subject: RE: [Dysphagia] sterilizing feeding equipment
To: "'dysphagia-bounces@b9.com'" <dysphagia-bounces@b9.com>, "'Sandi
Lancaster'" <swlslp@yahoo.com>, dysphagia listserve
<dysphagia@b9.com>
Message-ID: <5BB4C5CAB0906E47ADC331A9DCABEC6A3A5E02@exch01.cmh>
Content-Type: text/plain
Hi Sandi,
We send plastic cut out cups to CSS where they are cleaned/wahed in the
heat
sensitive cycle of the scientec washer.
Hope that helps.
Regards,
Nancy
Nancy Burnett,
Speech-Language Pathologist,
Cambridge Memorial Hospital,
700 Coronation Blvd.,
Cambridge, Ontario.
N1R 3G2
Telephone: 519 - 621 - 2330 ext 1126/Pager 1104
Fax: 519 - 740 - 4978 Attention Nancy Burnett 3BN
Email: nburnett@cmh.org
> -----Original Message-----
> From: dysphagia-bounces@b9.com [SMTP:dysphagia-bounces@b9.com] On
Behalf
> Of Sandi Lancaster
> Sent: June 27, 2005 6:23 PM
> To: dysphagia listserve
> Subject: [Dysphagia] sterilizing feeding equipment
>
> Hi all,
>
> Looking for suggestions on quick and easy ways to
> sterilize feeding equipment (cups, utensils) used with
> dysphagia patients at our clinic...what are other
> clinics doing to ensure that feeding equipment is
> sterilized?
>
> Thanks in advance,
>
> Sandi
>
> Sandi Lancaster, M.A. CCC-SLP
> Speech-Language Pathologist
>
>
>
> __________________________________
> Yahoo! Mail
> Stay connected, organized, and protected. Take the tour:
> http://tour.mail.yahoo.com/mailtour.html
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
------------------------------
Message: 6
Date: Tue, 28 Jun 2005 17:36:42 -0000
From: smhjr@surfbest.net
Subject: RE: [Dysphagia] RE: [asha-div13] Prader Willi Syndrome
To: CShaker@covhealth.org
Cc: hpressman@msn.com, Dysphagia@b9.com
Message-ID: <380-220056228173642144@surfbest.net>
Content-Type: text/plain; charset=iso-8859-1
I have seen Prader Willi children with submuccousal clefts. Could
this combined with some hypotonia be causing the child swallowing
problems?
---- Original Message ----
From: CShaker@covhealth.org
To: hpressman@msn.com, asha-div13@lists.asha.org
Subject: RE: [Dysphagia] RE: [asha-div13] Prader Willi Syndrome
Date: Tue, 28 Jun 2005 05:41:40 -0500
>I would wonder if there is still a level of hypotonia that, while it
>is
>not "overtly noticeable" as in some Praeder Willi infants, it is
>interfering with function...what is his sound production like in
>terms
>of differentiated intrinsic tongue muscle control? vowel variety?
>strength of consonant contacts? laryngeal control for loudness, pitch
>variability? does he babble and if so what is the quality in terms of
>CV
>transitions for example. I find that often these observations in
>infants
>provide insight into true oral-motor control.This then would impact
>endurance for feeding (due to oral-motor fatigue, often seen in
>conjunction with hypotonia) and precision/control/refinement of
>skills
>with bottle, spoon and cup.
>
>If he required a soft nipple early on does that perhaps reflect some
>decreased integrity in intrinsic tongue muscles? When this is the
>case,
>I have typically seen it persist well beyond infancy with Praeder
>Willi.
>
>Also has the laryngomalacia completely resolved per ENT flexible
>fiberoptic laryngoscopy? I have seen some infants diagnosed with
>laryngomalacia without overt audible signs. If we do not have
>objective
>data from ENT showing resolution, there may be some compensations on
>the
>infant's part to limit feeding due to stressing airway maintenance.
>
>The other piece may be GI issues. These babies often have associated
>GI
>issues that reduce drive to eat, and impact GI motility (related to
>proximal hypotonia) without again the presence of overt signs.
>
>Regarding the Swallow Study, while it sounds like there was no
>aspiration, was there any observed difference in swallowing
>physiology
>related to hypotonia? Was there a built in fatigue factor observed?
>(i.e. feeding off line and then re-starting fluoro similar to
>mealtime
>length?) often these babies can do ok initially at a meal but then
>through the course of a meal, over time, both skills and safety
>degrade.
>If there were airway compromise, perhaps it may be then silent, due
>to
>likely a decreased sensory responsiveness typically seen in the
>presence
>of even subtle hypotonia.
>
>Clinically, what is bolus control like with cup drinking? Is there
>active thinning and cupping of the tongue with cup drinking? If not,
>this again may reflect less overt but clear problems with intrinsic
>tongue control. How effective are the lips at cleaning the spoon?
>How
>stable is the jaw with biting on toys or hard solids?
>
>How is he developing otherwise, e.g. motor control and postural
>control?
>often a decrease in postural control, even subtle, may impact
>functional
>feeding skills in ways you describe.
>
>What types of foods does he prefer? Flavors? The sensory "load" of
>the
>foods he is being offered may not be sufficient for his system with a
>level of hypotonia, as hypotonia and hyposensation often go hand in
>hand.That may be an avenue of intervention as well.
>
>
>Just some thoughts.
>Keep us posted on this little guy!
>
>Catherine
>Catherine S. Shaker M.S./CCC, BRS-S
>Speech-Language Pathologist
>Board Recognized Specialist in Swallowing and Swallowing Disorders
>
>
>St. Joseph Regional Medical Center
>5000 West Chambers Street
>Milwaukee, WI 53210
>Phone: 414-447-2797
>Fax: 414-874-4104
>
>
>
>-----Original Message-----
>From: Hilda Pressman [mailto:hpressman@msn.com]
>Sent: Monday, June 27, 2005 4:20 PM
>To: Division 13 Discussion List
>Subject: [asha-div13] Prader Willi Syndrome
>
>
>
>I am treating a 10 month old with Prader Willi who had a GT placed at
>birth. I have followed him almost from the beginning. He never had
>significant oral hypotonia and was readily able to learn to suck from
>a
>bottle using a soft nipple. He initially had laryngomalacia which
>interferred with PO feeding to some degree. Swallow study at about 5
>months of age was normal. He has acquired skills for bottle
>drinking,
>spoon feeding and cup drinking. The issue is that he continues to
>take
>limited quantities PO and to be dependent on the GT.
>
>I have been advised by two docs who have seen him that decreased
>appetite is often an issue in the first year. When I did a
>literature
>search the only problem referred to was the hypotonia. He is now
>approaching a year with no significant improvement. We know that he
>will get there and that excessive intake will then be a problem but
>Mom
>says that no one else on the Prader Willi listserve appears to
>present
>with a similar problem. Does anyone have any experience with this
>type
>of presentation?
>
>
>
>
>Hilda Pressman, MA, CCC SLP BRS-S
>Board Recognized Specialist in Swallowing and Swallowing Disorders
>Nutritional Management Associates, LLC
>www.nutritionalmanagement.org
>---
>You are currently subscribed to asha-div13 as: CShaker@covhealth.org
>To unsubscribe send a blank email to
>leave-asha-div13-339569X@lists.asha.org
>
>The American Speech-Language-Hearing Association
>10801 Rockville Pike
>Rockville, MD 20852
>Members 1-800-498-2071
>Consumers 1-800-638-8255
>www.asha.org
>
>Privileged/Confidential information may be contained in this message.
> The information contained in this message is intended only for the
>use of the recipient(s) named above and their co-workers who are
>working on the same matter. The recipient of this information is
>prohibited from disclosing the information to any other party unless
>this disclosure has been authorized in advance.
>
> If you are not intended recipient of this message or any agent
>responsible for delivery of the message to the intended recipient,
>you are hereby notified that any disclosure, copying, distribution or
>action taken in reliance on the contents of this message is strictly
>prohibited. You should immediately destroy this message and kindly
>notify the sender by reply E-Mail. Please advise immediately if you
>or your employer does not consent to Internet E-Mail for messages of
>this kind. Opinions, conclusions and other information in this
>message that do not relate to the official business of the firm shall
>be understood as neither given nor endorsed by it.
>_______________________________________________
>Dysphagia mailing list
>Dysphagia@b9.com
>http://lists.b9.com/mailman/listinfo/dysphagia
------------------------------
Message: 7
Date: Tue, 28 Jun 2005 12:44:57 -0500
From: "Dailey, Scott" <scott-dailey@uiowa.edu>
Subject: RE: [Dysphagia] RE: [asha-div13] Prader Willi Syndrome
To: <smhjr@surfbest.net>, <CShaker@covhealth.org>
Cc: hpressman@msn.com, Dysphagia@b9.com
Message-ID:
<A4AA05CE92DACC43886D133DB94A926E0B717762@medicine-exch1.medicine.uiowa.
edu>
Content-Type: text/plain; charset="us-ascii"
Along with hypotonia, I have seen upper airway obstruction (large
adenoids and large tonsils) which can interfere with feeding and result
in obstructive sleep apnea. Hypotonia in the velum probably also
contributes to upper airway obstructions. These kids have fatigued
quickly likely due to hypotonia and the airway issues. ENT evaluations
and eventual adenoidectomies and tonsillectomies have helped but not
completely resolved feeding difficulties.
Scott Dailey, M.A., CCC-SLP
Speech-Language Pathologist II
University of Iowa Hospitals & Clinics
200 Hawkins Dr
Iowa City, IA 52242
(319)356-7030
This e-mail (including any attachments) is covered by the Electronic
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may be legally privileged. If you are not the intended recipient, you
are hereby notified that any retention, dissemination, distribution, or
copying of this communication is strictly prohibited. Please reply to
the sender that you have received the message in error, and then delete
it. Thank you.
-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of smhjr@surfbest.net
Sent: Tuesday, June 28, 2005 12:37 PM
To: CShaker@covhealth.org
Cc: hpressman@msn.com; Dysphagia@b9.com
Subject: RE: [Dysphagia] RE: [asha-div13] Prader Willi Syndrome
I have seen Prader Willi children with submuccousal clefts. Could
this combined with some hypotonia be causing the child swallowing
problems?
---- Original Message ----
From: CShaker@covhealth.org
To: hpressman@msn.com, asha-div13@lists.asha.org
Subject: RE: [Dysphagia] RE: [asha-div13] Prader Willi Syndrome
Date: Tue, 28 Jun 2005 05:41:40 -0500
>I would wonder if there is still a level of hypotonia that, while it
>is
>not "overtly noticeable" as in some Praeder Willi infants, it is
>interfering with function...what is his sound production like in
>terms
>of differentiated intrinsic tongue muscle control? vowel variety?
>strength of consonant contacts? laryngeal control for loudness, pitch
>variability? does he babble and if so what is the quality in terms of
>CV
>transitions for example. I find that often these observations in
>infants
>provide insight into true oral-motor control.This then would impact
>endurance for feeding (due to oral-motor fatigue, often seen in
>conjunction with hypotonia) and precision/control/refinement of
>skills
>with bottle, spoon and cup.
>
>If he required a soft nipple early on does that perhaps reflect some
>decreased integrity in intrinsic tongue muscles? When this is the
>case,
>I have typically seen it persist well beyond infancy with Praeder
>Willi.
>
>Also has the laryngomalacia completely resolved per ENT flexible
>fiberoptic laryngoscopy? I have seen some infants diagnosed with
>laryngomalacia without overt audible signs. If we do not have
>objective
>data from ENT showing resolution, there may be some compensations on
>the
>infant's part to limit feeding due to stressing airway maintenance.
>
>The other piece may be GI issues. These babies often have associated
>GI
>issues that reduce drive to eat, and impact GI motility (related to
>proximal hypotonia) without again the presence of overt signs.
>
>Regarding the Swallow Study, while it sounds like there was no
>aspiration, was there any observed difference in swallowing
>physiology
>related to hypotonia? Was there a built in fatigue factor observed?
>(i.e. feeding off line and then re-starting fluoro similar to
>mealtime
>length?) often these babies can do ok initially at a meal but then
>through the course of a meal, over time, both skills and safety
>degrade.
>If there were airway compromise, perhaps it may be then silent, due
>to
>likely a decreased sensory responsiveness typically seen in the
>presence
>of even subtle hypotonia.
>
>Clinically, what is bolus control like with cup drinking? Is there
>active thinning and cupping of the tongue with cup drinking? If not,
>this again may reflect less overt but clear problems with intrinsic
>tongue control. How effective are the lips at cleaning the spoon?
>How
>stable is the jaw with biting on toys or hard solids?
>
>How is he developing otherwise, e.g. motor control and postural
>control?
>often a decrease in postural control, even subtle, may impact
>functional
>feeding skills in ways you describe.
>
>What types of foods does he prefer? Flavors? The sensory "load" of
>the
>foods he is being offered may not be sufficient for his system with a
>level of hypotonia, as hypotonia and hyposensation often go hand in
>hand.That may be an avenue of intervention as well.
>
>
>Just some thoughts.
>Keep us posted on this little guy!
>
>Catherine
>Catherine S. Shaker M.S./CCC, BRS-S
>Speech-Language Pathologist
>Board Recognized Specialist in Swallowing and Swallowing Disorders
>
>
>St. Joseph Regional Medical Center
>5000 West Chambers Street
>Milwaukee, WI 53210
>Phone: 414-447-2797
>Fax: 414-874-4104
>
>
>
>-----Original Message-----
>From: Hilda Pressman [mailto:hpressman@msn.com]
>Sent: Monday, June 27, 2005 4:20 PM
>To: Division 13 Discussion List
>Subject: [asha-div13] Prader Willi Syndrome
>
>
>
>I am treating a 10 month old with Prader Willi who had a GT placed at
>birth. I have followed him almost from the beginning. He never had
>significant oral hypotonia and was readily able to learn to suck from
>a
>bottle using a soft nipple. He initially had laryngomalacia which
>interferred with PO feeding to some degree. Swallow study at about 5
>months of age was normal. He has acquired skills for bottle
>drinking,
>spoon feeding and cup drinking. The issue is that he continues to
>take
>limited quantities PO and to be dependent on the GT.
>
>I have been advised by two docs who have seen him that decreased
>appetite is often an issue in the first year. When I did a
>literature
>search the only problem referred to was the hypotonia. He is now
>approaching a year with no significant improvement. We know that he
>will get there and that excessive intake will then be a problem but
>Mom
>says that no one else on the Prader Willi listserve appears to
>present
>with a similar problem. Does anyone have any experience with this
>type
>of presentation?
>
>
>
>
>Hilda Pressman, MA, CCC SLP BRS-S
>Board Recognized Specialist in Swallowing and Swallowing Disorders
>Nutritional Management Associates, LLC
>www.nutritionalmanagement.org
>---
>You are currently subscribed to asha-div13 as: CShaker@covhealth.org
>To unsubscribe send a blank email to
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>
>The American Speech-Language-Hearing Association
>10801 Rockville Pike
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>www.asha.org
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End of Dysphagia Digest, Vol 19, Issue 13
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