The article “Effects of chemoradiotherapy on tongue function…

The article “Effects of chemoradiotherapy on tongue function in patients with head and neck cancer” (Lazarus) notes replacement of muscle tissue with fibrotic tissue is one cause of impairments in oral and pharyngeal swallowing following radiation treatment for head and neck cancer.

Elizabeth is an 82 year old female diagnosed with Parkinson…

Elizabeth is an 82 year old female diagnosed with Parkinson disease eight years ago. She was brought to the hospital after falling in her home. In the emergency room, Elizabeth was found to have shortness of breath and “crackles” bilaterally in the lung bases. No acute infarction was found on the head CT scan. Elizabeth’s son acted as her historian and reported a history of dysphagia assessed by VFSS five years ago. She has been on a moist mechanical soft diet with nectar-thick liquids since then. Elizabeth received a score of 8/30 on the Montreal Cognitive Assessment (MoCA) administered by social work and presented with significant confusion so a speech therapy consult was ordered. During the clinical swallow evaluation, Elizabeth exhibited no overt s/s of aspiration with single ice chip trials. Delayed cough and vocal changes were observed with 5/6 trials of 3 mL sips of thin water.  Considering her pulmonary status, what would you recommend happen next in her assessment?