[Dysphagia] swallow apraxia

[GuptaJ at SESAHS.NSW.GOV.AU (Jai Gupta)]

Does he swallows when you ask him to does he cough when you ask him too and can he do spontaneously ..that should answer the question but you have to make sure he understand the command ...if Global Aphasia ,,,can he imitate ??? From your description of the case It does not look to me like swallow apraxia of that helps ...Ta


Jai Gupta. 





-----Original Message-----
From: S. Langer [mailto:s_langer@juno.com]
Sent: Friday, 20 May 2005 10:46 AM
To: Jai Gupta
Subject: RE: [Dysphagia] swallow apraxia



Thank you for your response.  This pt. is not aphonic; she does produce one perseverate utterance with good voicing ("wall white").  I understand the question re: dx.of apraxia in a globally aphasic pt., but in attempting to imitate oral postures, she has lots of oral "groping" behaviors (hence my thought that maybe she has oral apraxia), and when attempting to sing songs or produce automatic sequences, she has oral groping, and imprecise sound production...not a dysarthria-like sound, but a verbal-apraxia-like sound.  So her report says "questionable verbal apraxia"

Truth is, this is not my pt., but my CFY's pt.  She was the one with the original swallow apraxia dx.  I thought it was more of delayed/effortful swallow trigger, but since I was not that familiar
with "swallow apraxia", I presented the question to this group.

And while I appreciated everyone's responses, no one actually answered my question of whether or not this pt. has swallowing apraxia, or -- much more importantly -- what are typical s/s of this disorder, so I could know for future pts.

Thanks again for your response
Sharon



-- "Jai Gupta" <GuptaJ@SESAHS.NSW.GOV.AU> wrote:

This is a interesting question ....I wish life was so easy ....Sara is right to some extent ...but how can we d/d: aphagia v/s swallow apraxia ?? and verbal apraxia in presence of aphonia ??? to add what when on has aphonia and aphagia... I have done search recently there are few paper published in this area ... I too have an interesting patient ..the abstract(not yet accepted) of the paper proposed for Smart Stroke conference coming in July is as follows:

CANNOT SPEAK or SWALLOW: AN UNCOMMON STROKE STUDY

Jai Gupta*(SLP), Chris Turner*(CCC), Deanne Kelly(PT), Jacinta Lwin(OT), Julianne Roberts (CD),
Julie Thompson(SW) and Dennis Cordato (neuroloist).
Stroke Unit, The Sutherland Hospital, South Eastern Sydney Area Health Service.
	`
Not many cases with aphonia, anarthria and dysphagia are reported in literature following left MCA stroke. We present LT an 87-year-old cachexic right dominant English-speaking male who lived independently until admission to Sutherland Hospital, Emergency Department with a left stroke. On admission he showed good auditory comprehension but had aphonia, dysphagia, weakness of left trigeminal, facial, hypoglossal, glossopharyngeal and vagus (specific to swallowing). He also had mild weakness of left upper and lower limb leading to shaky arm and unsteady gait with mild left foot drag. Carotid Doppler showed 80-89% stenosis in left proximal Internal Carotid Artery. This paper will elaborate in the presentation on; a) the use of best practise standards that are in place in our stroke unit for investigation, management and rehabilitation, b) how we managed this client effectively from acute phase to discharge using assistive technologies like manual/magnetic spell-board and LightWriter and c) the positive outcomes and limitations during intervention in meeting his communication, nutritional, hydration, mobility, social, nursing and medical needs.


Jai Gupta.






-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com]On
Behalf Of smhjr@surfbest.net
Sent: Wednesday, 18 May 2005 11:51 PM
To: s_langer@juno.com
Cc: Dysphagia@b9.com
Subject: RE: [Dysphagia] swallow apraxia


If someone has global aphasia how can you diagnose severe verbal
apraxia? It is impossible. People can have verbal apraxia without
swallowing apraxia so using the swallow apraxia to diagnose verbal
apraxia is also not possible.

The simplest way to diagnose swallowing apraxia is to feed the
patient vs having patient self feed. If they do better self feeding
than you are dealing with swallowing apraxia in addition to whatever
systemic problems you have (ie, vocal fold paralysis, facial droop,
etc.).

Sara Hoffman, MS, CCC-SLP

---- Original Message ----
From: s_langer@juno.com
To:
Subject: RE: [Dysphagia] swallow apraxia
Date: Wed, 18 May 2005 02:07:36 GMT

>
>Hi all
>
>What are the signs and symptoms of swallow apraxia?  How can it be
>differentially diagnosed from difficulty initiating/triggering
>swallow for some other reason?
>
>Pt. in question is about 80 yo, s/p CVA with global aphasia and
>severe oral/verbal apraxia. Pt. also has significant OM weakness and
>dysphagia.
>
>Upon admission, when taking cup sips thin liquid, pt. triggered
>swallow only ~1/3 of the time; increased to ~50% of the time with
>nectar-thick.  This is gradually improving; at this point, swallow
>generally triggered after every swallow, but often delayed.
>
>MBS performed this AM to R/O silent aspiration.  Pt. p/w lengthy oral
>prep, decreased A-P transport/lengthy OTT, decreased BOT retraction,
>prem. loss of bolus to valleculae with all trials, and spillover to
>pyriforms with thin.  Swallow delay with solids, increased with
>increased cohesion (min for finely ground...to mod-severe for soft
>solid), but not with liquids.
>
>Questions:
>
>1.  Does this sound like swallow apraxia to you? (why/why not?)
>
>2. What are s/s swallow apraxia?  How can it be differentially
>diagnosed?
>
>3.  What are some tx. techniques/strategies appropriate for this dx?
>
>Would appreciate any thoughts/comments ppl could offer.
>
>Thanks
>Sharon Langer MA CCC-SLP
>
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