Local therapist helps people get swallow back
Nov 08, 2012 (Clay Center Dispatch - McClatchy-Tribune Information Services via COMTEX) --
Not many critical-access hospitals have a speech pathologist and swallowing specialist, but, Clay County Medical is fortunate to have one that is now full-time, hospital staff said at Tuesday's Lions Club meeting.
Speech pathologist Brenda Bohnenblust said the hospital's support in continuing education prompted her get a master's degree in speech pathology. She started this sort of work on an on-call basis but she didn't make that into a full-time job until she went back to school at Kansas State University to learn swallowing, which is now a large part of the therapy she offers.
The swallowing portion of her job "really built the program," Bohnenblust said. This part of the job restrengthens what's needed to swallow and in some cases, re-teaches how to swallow. Her patients are usually older patients, but occasionally she sees younger patients who are handicapped or have had an injury in an accident.
Swallow therapy starts in radiology. Bohnenblust showed a few videos from radiology that showed how people have trouble with swallowing. These videos help Bohnenblust "dissect" what's causing the difficulty in swallowing.
Swallow issues range in severity, and include not being able to swallow liquid, food, or pills, swallows where liquid or food get into pockets or down the wrong tube into the lungs, delayed or weak swallows.
Bohnenblust's therapy uses a range of techniques to help people get their swallow back or to swallow better, such as using a chin tuck, or other treatments. Some situations call for some "hard decisions," such as putting in a feeding tube or calling in hospice.
Bohnenblust's treatments sometimes involve getting into the mouth and intentionally trying to make people gag to help them get their swallow back by building up throat muscles. There's usually a lot of spitting and gagging, so she uses a lot of Kleenex and rubber gloves, but she has yet to actually cause someone to throw up, she said.
Another treatment called "vital stem therapy" uses a machine with electrodes attached to the front of the neck that stimulate swallowing. While the electrodes are in place, the patients practice eating and swallowing, she said. Depending on what they want to happen, the electrodes are placed at different places at different times, she explained.
"We turn it up where we want it to grab but not hurt or burn because we want those muscles to know, hey, we need to swallow," Bohnenblust said.
Treatments include tongue-strengthening exercises and techniques to strengthen the posterior wall of the tongue or the tongue blades. The tongue is an important part because the act of the tongue pushing up against the roof of the mouth, such as in a dry swallow, is what initiates a swallow.
"Sometimes you have to push that tongue to get yourself to swallow," Bohnenblust said. "So if someone has a weak tongue because they've had a stroke or because they have Parkinson's, or just generalized weakness, the swallow's going to be hard. So we try to strengthen that tongue again."
Bohenblust also offers a therapy that's not as supported in the field, but it's one she said she's seen help people get their swallow back. This treatment, called "deep pharyngeal neuromuscular stimulation" by taking freezer-chilled lemon swabs and dabbing certain points in the back of the mouth, the throat, and roof of the mouth to stimulate the swallow. This usually causes a strong gag, which is what you want.
"All these stimulate the muscles back where I can't reach them," Bohnenblust said.
Bohnenblust said she only tries this therapy if they're "between a rock and a hard place and really need to get their swallow back.""If someone can't swallow, it helps to get it back," she said. "Even though the research isn't there as much to back it up, I've seen where it has helped some of my patients."
This treatment helped a 40-year-old get her swallow back after an airbag deployment in a deer accident caused her to have trouble swallowing.
She also stimulates swallowing by thickening liquids and mixing foods. For example, people who have trouble swallowing pills, she recommends they try putting them in applesauce or pudding and swallowing them that way.
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