Modified Mondays: How low should we go?



Even the most beautifully constructed and well thought out clinical swallow evaluation can lead an SLP to make incorrect assumption, miss out on a needed referral, and set a completely inappropriate plan of care.


This case was a great catch by our Cleveland team-the patient presented clinically with coughing post swallow, as well as multiple swallows per bite/sip. This was interpreted as a sign of post swallow pharyngeal residues, and exercises for strengthening were implemented. Four weeks after the clinical evaluation, the patient was exhibiting decreased symptoms, so an MBS was ordered to check progress.


Our MBS SLP was able to complete a great esophageal view and found that the patient actually had achalasia, or an incomplete relaxation of the LES with lack of esophageal peristalsis. A referral to GI was immediately recommended. This clip is also a great example of why SLPs need to also think/look at the esophagus, as so many symptoms of pharyngeal and esophageal impairments overlap. Check out the links below for some information on achalasia. 

https://www.mayoclinic.org/diseases-conditions/achalasia/symptoms-causes/syc-20352850

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329145/

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