Stephanie Stensland

Speech Therapy at Ocean Springs Neuroscience Center for Dysphagia Treatment

Therapist: Stephanie Stensland MS, CCC-SLP

From Feeding Tube to Eating by Mouth

Mr. Lee’s Success Story:

After jaw reconstruction in July of 2015, Mr. Lee experienced a paralyzed vocal fold and an immobile epiglottis, causing him to aspirate and need a PEG feeding tube for 100% of his nutrition. He was no longer able to eat or drink anything by mouth. He started outpatient therapy October 1, 2015, at the Neuroscience Center to regain his swallow. Mr. Lee went in for another swallow study soon after beginning outpatient therapy and although his epiglottis had begun to partially move, he was still at high risk for aspiration. He was given home swallowing exercises that he did several times a day and began small trials of water using the Frazier Free Water Protocol. As his swallow reflex became faster and he began to demonstrate better hyolaryngeal excursion, we advanced his intake to purees such as pudding with strict swallowing strategies.

Mr. Lee utilized a multi-step strategy to reduce his risk of aspiration which involved using 1) a left head turn to close off the paralyzed vocal fold, 2) a breath hold to help adduct his working vocal fold, 3) a very small bite of a pureed consistency, 4) use a quick and effortful swallow followed by an immediate cough and 5) another swallow and cough. It was a lot of steps, but it allowed him to eat something by mouth. Over the next several weeks Mr. Lee regained strength and his swallow function through continuous exercises, use of neuromuscular electrical stimulation, manual therapy and therapeutic trials of purees and soft solids. Mr. Lee eventually began eating soft whole food and thin liquids with fewer swallowing strategies as he gained strength and function. Around mid-November, we eliminated swallowing strategies and allowed soft solids and thin liquids at home with use of aspiration precautions. Towards the end of November, he was able to meet nearly all nutritional needs by mouth. Once he was able to demonstrate a nutritive swallow without reports of pharyngeal residue, we began addressing his trismus (incomplete jaw opening) with the use of an OraStretch device.

His hours of home exercises and therapy paid off when he returned to Ochsner on January 18, 2016 to have his PEG tube removed! We are proud to report that Mr. Lee is now discharged from speech therapy and is enjoying meals with his family and friends at home and in restaurants.

Mr. Lee’s perspective:

What was eye opening to you about your experience with head and neck cancer and swallowing disorders?

“I was surprised at how long it took to get it all back. I thought I would be swallowing normally a month after my surgery in July of 2015 and that was not the case.”

What do you think helped you the most throughout your journey from being NPO to eating again?

“A combination of sound instruction and recommendations from great doctors, home health therapy, outpatient therapy and family encouragement.”

What would you consider your turning point?

“When I was able to eat Thanksgiving food with my family…in fact I ate three quarters of a pecan pie the week of Thanksgiving. Also, when I took my first bite of a steak. It was great!”

Mr. Gate.jpg

Mr. Gates’ Success Story

Ocean Springs Neurosciences Therapist: Stephanie Stensland MS, CCC-SLP

Mr. Gates’ responses to questions:

(Stephanie): Can you tell us about what helped you get to this point?

(Mr. Gates): “My exercises had a whole lot to do with it, my Therabite machine and then tasting food got me ambitious to try hard. I was frightened to eat food and scared that I would choke. But I’m now building confidence and eating more. I thank God for helping me out and sending me to the right people.”

(Stephanie): What’s your advice for others going through swallowing problems associated with head and neck cancer?

(Mr. Gates): When you’re feeling your lowest, stick to your exercises and remember your goals. It makes a difference. You’ve got to invest in yourself and know you can do this thing. I still have my times where I have to clean out my mouth and start over, but I always remember my goals.”

Stephanie’s perspective:

Mr. Gates is the perfect example of a patient who has been consistent to come to therapy, comply with swallowing strategies and complete his home exercises. In July 2013, Mr. Gates was diagnosed with head and neck cancer, requiring chemo, radiation, jaw reconstruction and a feeding tube. He was given doctor’s orders to go “NPO” (nothing by mouth) since he was silently aspirating and at risk for aspiration pneumonia. Since then, Mr. Gates has had an ongoing journey of dysphagia therapy. This November, Mr. Gates’ hard work paid off when he was able to pass his swallow study. He has used a combination of approaches to acquire his success: Choosing appropriate consistencies of food, using the supraglottic swallow strategy, following aspiration precautions and gradually increasing the amount of food he consumes on a week to week basis. Treatment involved several types of oral and pharyngeal strengthening exercises, range of motion exercises, manual therapy to help manage stiff scar tissue, use of the Therabite tool, diet changes (starting with purees and honey thick liquids and working up to mechanical soft and thin liquids) and use of the supraglottic swallow strategy. Mr. Gates continues to use his PEG tube for optimal nutrition, but has been able to safely sample all of his home cooking. We are so excited that Mr. Gates is able to eat just in time for the holidays!