Question
I am currently working with an infant who has a history of seizures, which are controlled through medication. He is 11 months now, with low tone, reduced head control, severe hearing loss bilaterally, difficulty managing his secretions (coughing observed
Answer
This sounds like a very interesting patient. I am assuming that his condition is stable and that he does not have a progressive disorder. You also do not indicate his respiratory history, cognitive status, reflux status, nor the volume and type of PO intake at this time, therefore specific recommendations would not be wise. However, knowing that he has obtained a swallow study, you should have access to a wealth of information. The purpose of a swallow study is not typically to determine if aspiration is occurring or not, but to provide you information about the swallow that would specifically help your patient. If he was safe on the few swallows observed with the MBSS (which showed him tolerating discrete bolus sizes and types in a limited period of time), use that to your advantage. One of the best ways to improve the swallow is to allow a patient to practice in a controlled situation. Based on the MBSS study, other important factors would include: where was he triggering the pharyngeal swallow, if the study shows any pooling or residue, or if reflux was observed, to name a few. Consider what you are currently doing and ask if any of the activities are increasing oral secretions thus potentially challenging his airway protection. You mention that he does cough during your sessions, but do not indicate if the coughs are productive or not. This piece of information is vital to determine airway protection abilities as you increase his endurance for PO intake.
Dr. Donna Scarborough has been a practicing speech-pathologist for 13 years serving populations across the lifespan. She teaches the dysphagia, trach and vent course at Miami (OH)University and serves on the ASHA Division 13 Research Committee.
