Modified Monday: Upon review
Our Akron based team had a patient this week with a lot going on swallowing-wise. However, it wasn’t so much that our SLP missed a potentially important incidental finding in the neck.
The patient presented clinically with some inconsistent throat clearing with all PO. She had a prior MBS study at the acute care hospital following her CVA. The reports from the MBS had not made it to the SNF, the patient reported she “aspirated on some things” and the diet recommendation from the hospital was puree with honey thick liquids. During the study, the patient unfortunately was assessed to have incomplete base of tongue retraction and hyolaryngeal movement contributing to incomplete airway closure and allowing aspiration with all consistencies. Our SLP also noted only an occasional cough response to the aspiration and was unable to find any effective postures or strategies.
In addition to all of these important noted components, upon the review of the study, our SLP also spotted glimpses of a darker area of the anterior neck. It was only visible during the swallow when the laryngeal complex was elevated. Our SLP asked the Radiologist to confirm and comment, he agreed it was a finding that would warrant further investigation and recommended a CT of the neck. (Watch until the end of the clip for a slow-motion excerpt.)
We have mentioned before our use of protocol when it comes to completion of all of our studies, another standard that we hold our teams to is the review of each study. During the swallow, things happen very quickly, and often findings that should be noted are only able to be seen for a few moments. With so many factors to consider and assess, completing a study without a review can only facilitate missing out on not only the components of the swallow, but also important peripheral findings like this one.