A loud scream and a thump. In Ronald Weber’s memory, the sounds are as clear today as they were more than four years ago. “I found my wife Lilian on the floor by the kitchen,” he remembers. “I immediately called 911.”
Lilian had suffered a serious stroke. After she had been stabilized at a hospital near her home, she was transported to MedStar Georgetown University Hospital. The stroke occurred in her brain stem, leaving Lilian paralyzed on the left side of her body, and unable to speak or swallow. After days of specialized care at MedStar Georgetown, Lilian was discharged and admitted to MedStar NRH for inpatient rehabilitation.
When she arrived at the hospital, Lilian was still relying on a feeding tube for nourishment, she wasn’t able to walk and her speech, vision and hearing were impaired. “She communicated with a letter board,” Ronald says. “Despite all of it, plus the multiple sclerosis that she has been battling for years, Lilian was very brave.”
Lingering Consequence of Stroke
Difficulty swallowing is a fairly common consequence of stroke. Called dysphagia, this complication is the result of damage to the area of the brain that controls the muscles used in both speech and swallowing. In addition to stroke, the disorder can also be the result of other neurological disorders such as Parkinson’s disease, ALS, and traumatic brain injury.
While many patients who suffer dysphagia immediately following stroke recover fairly quickly, for some patients like Lilian the problem lingers. But with a careful evaluation and development of a therapeutic plan by an expert speech-language pathologist patients can and do make improvements.
During her three-month stay at MedStar NRH, Lilian made progress. Still she needed additional physical therapy and her swallowing and speech issues persisted so she continued rehabilitation at NRH Rehabilitation Network Waldorf, Md, center. Key to her recovery was resolution of TMJ brought on by the stroke—and a critically important test called FEES—fiberoptic endoscopic evaluation of swallowing.
Specialized FEES Expertise
“FEES is a painless test that helps us identify the anatomy and functionality of the muscles involved in swallowing,” explains Yvette McCoy, SLP, BCS-S, a speech-language pathologist at MedStar NRH Rehabilitation Network, Brandywine, Md. McCoy is a specialist with advanced training and board certification in the evaluation and treatment of swallowing disorders.
“We are observing patients in real time while they are swallowing food to determine how the system is disrupted. That’s critical to the development of effective strategies to help,” she says. During the test, a very thin, flexible, fiberoptic tube with a small camera is threaded through a nostril and moved through the nose into the throat. Patients are given different consistencies of food and drink, which have been treated with green food coloring to make it visible to the camera, which captures video images that demonstrate how food moves through the throat.
“It’s a safe test that requires no advance preparation,” she explains. “It takes just 30 minutes or so.”
The resulting video provides valuable information about the mechanics of swallowing that helps therapists pinpoint the problem and create a plan to foster safe swallowing. “We can help patients learn techniques that will allow them to swallow without the danger of choking or aspirating food into their lungs,” says McCoy.
“Lilian had her swallowing study last November,” says Ronald. “Yvette observed her and made important recommendations. With some simple changes, for instance, altering the position of her head, Lilian now can more easily swallow. Over time with practice, what was once involuntary after the stroke is becoming voluntary once again.
“It takes practice, and she is doing the work,” says Ronald with pride.