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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?

SLPs can prescribe medications for the treatment of GERD and LPR.

The optimal age a child can effectively participate in orofacial myofunctional therapy usually ranges from 3-5 years old.

Anterior spill of bolus, drooling

Oral motor exercises are the BEST exercises for swallowing.

With head rotation (postural technique) to the weak side, the bolus is directed down the strong side of the pharynx.

This maneuver is used to increase the extent and duration of laryngeal elevation and thereby increase the duration and width of cricopharyngeal opening.

List two different specific recommendations that we can make to help alleviate GERD/LPR symptoms other than changing a patient’s diet. (2 pts)

Identify the stage of the swallow associated with each function.

The Yale 3 oz water protocol is a screener.