Excellence in Action- Quality of Life Restored: A tenacious pursuit in St. Clair, MO!
In February 2020, a patient was admitted to our facility in St. Clair, MO, following a hospitalization secondary to a stroke in the middle cerebral artery. Upon arrival, the patient was extremely lethargic and rarely responded to environmental stimuli. The patient was NPO and relied fully on a G-tube to receive nutrition and hydration.
Soon after admission, the patient was evaluated by Monica, CF-SLP, and it was indicated that in addition to severe swallowing deficits, the patient also exhibited severe cognitive deficits in the areas of memory, attention, orientation, problem-solving, sequencing, and severe expressive language deficits, resulting in difficulty verbalizing wants and needs. Although there were communication barriers, in the beginning, the patient was always able to express his desire to eat and drink by mouth.
During the first two weeks of therapy, the patient exhibited difficulty completing tasks and staying awake throughout his sessions. Monica primarily focused on increasing his orientation and level of alertness. She provided oral stimulation and oral care multiple times per day and made it a priority to educate staff on the importance of oral care.
In his third week of treatment, the resident became much more alert and aware of his environment. Monica’s speech therapy interventions continued to focus on orientation, memory, object naming, and problem-solving, but she also introduced more complex oral motor exercises to strengthen oral and pharyngeal musculature to improve swallow function. Although his lingual range of motion was slow to improve, he was able to complete most exercises when provided with verbal cues and modeling.
Since the patient was more alert and responsive to verbal cues, Monica began to administer trials of ice chips, which he handled with no concerns. Monica palpated his swallow and determined that the patient demonstrated adequate hyolaryngeal elevation and appropriate timing and completeness of the swallow. On the rare occasions that he did cough following the swallow trigger, his cough reflex was always strong. The resident presented with a strong and clear vocal quality throughout each session.
After a few weeks of trialing ice chips with no overt clinical signs or symptoms of aspiration, Monica began administering trials of pudding (which the patient was ecstatic about). Similar to the ice chips, he handled the pudding beautifully. In Monica’s words, “I will never forget the look of pure joy in those eyes when the patient tasted chocolate pudding for the first time in months.”
When the resident proved that he could tolerate pudding without any issues, Monica began administering pureed solids and pudding thick liquids. The patient was so excited to have “real food” again. He even called his wife and started to tear up when he told her that he could taste mashed potatoes again.
Although rehabilitating the resident’s swallowing abilities was speech therapy’s main focus, Monica continued to also address cognition and expressive language. The patient became much more oriented and coherent, and he was able to tell complex stories and even throw in occasional jokes throughout treatment sessions.
The patient’s cognition and expressive language abilities have come a long way, and we are happy to report that the patient is well on the way to achieving goals in those areas. However, the area that speech interventions have spent the greatest amount of time on is swallow function. This patient had a primary goal to eat food and drink liquids by mouth, so this became the primary goal of therapy; to help him achieve just that.
Just four months after a debilitating stroke, which left him unable to speak and to swallow, the patient is communicating at his prior level and is tolerating a diet of pureed solids and nectar thick liquids. Monica has also recently begun administering trials of mechanical soft solids, and he has been doing so great with it, that we predict another diet upgrade in the near future.
We are very proud of Monica and her tenacity for restoring her patient’s quality of life.
We are “ALL IN,” in St. Clair, MO!