[Dysphagia] 20 yr old pt s/p craniotomy for ruptured R-thalamic AVM

[malindam at samhealth.org (malindam at samhealth.org)]

I'm posting this for fellow SLP in SNF.
I have a 20 yr old pt s/p craniotomy for ruptured R-thalamic AVM, 12/06, shunt placement 1/07, trach decannulated 1/07, with PEG tube, Rancho level 3-4, deceribrate posture. When arriving at SNF pt demonstrated volitional initiation of swallow upon command. Delay of initiation was aprox 2 sec, with mod reduced laryngeal elevation (to palpation). Only 1 swallow was obtained per day for 3 days when baclophen was increased in attempt to release hyperflexion. Pt was sent back to hosp for baclophen pump trials, unsuccesful, botox injections given in R-arm. Returned to SNF on zanaflex and ativan PRN. Since return pt unable to swallow volitionally. She is being treated for thrush. Using eye blinks for yes/no responses. What can I do for this pt's swallow function?


Malinda Moore, CCC-SLP
Speech-Language Pathologist
Albany General Hospital
541-812-4162



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