Latrobe Regional Hospital1
Background or Problem/ Issue:
The Speech Pathology service in Gippsland (at Latrobe Regional Hospital), receive a large amount of referrals for both inpatients and outpatients who present with dysphagia. We offer swallow rehabilitation to those presenting with dysphagia from a range of aetiologies. In 2018 we found a gap in therapy resources, according to evidence based practice, for those people who may benefit from biofeedback whilst participating in swallowing therapy. Through attendance at Professional Development days and benchmarking we identified a potential solution to this gap.
Surface Electromyography (SEMG) is a cost-effective, mobile biofeedback tool which assists in the relearning of physiological swallowing patterns with the use of a visual aid. It has had high praise among many metro organisations in its success for dysphagia rehabilitation with various clienteles and should be considered in regular practice. Implementation of this resource at Latrobe Regional Hospital would allow access to these clients in Gippsland.
Method or What you did?
We sourced the NeuroTrac device and electrodes from Sportstek, installed the NeuroTrac program onto 3 accessible computers and 1 allied health laptop, provided in-services to the Speech Pathology team and developed a manual to assist with ongoing use and updates.
To use the device, electrodes are placed in a superior-inferior position on the patient’s larynx (below the thyroid notch and above the hyoid) with a controlled electrode on the wrist of the patient. The patient is instructed to swallow which transmits measures of muscle movements to the program and displays this movement in an online line graph. This graph shows muscle relaxation and peaks when a patient swallows.
The patient is instructed to initiate a saliva swallow every 30 seconds; they are given a bolus stimulus every 10 swallows to assist with saliva production.
The Speech Pathologist uses the online line graph to educate and encourage patients on different swallowing exercises, as these can be easily identifiable on the program by the patient while completing therapy.
Results or Outcomes:
The technology has been used in both inpatient rehabilitation and community outpatients at Latrobe Regional Hospital with 3 patients and is currently being used with 1.
Participant’s average age was 74 (67-80) years old and cause of dysphagia varied (brainstem strokes, aneurysm rupture, radiotherapy treatment to the Larynx, and mandibulectomy). Prior to therapy, 2 participants were NBM, 1 on teaspoons of thin fluids and 1 on mildly thick fluids.
All showed improvement to their swallow, resulting in at least 1 level of upgrade in diet or fluids. One participant was upgraded from NBM to FWD and thin fluids after 2 months of therapy.
The device not only facilitates physiological improvements to swallow but also swallow compensation for airway protection.
Conclusions or Practice Implications:
A new, effective and evidence-based rehabilitation technique is now offered to every client deemed appropriate at Latrobe Regional Hospital.
Taylor has been working at Latrobe Regional Hospital for 2 years now since graduating from Charles Sturt University in 2018. Taylor has experience in most areas of Speech Pathology around the hospital including, acute, subacute, community, radiotherapy, Videofluoroscopy and paediatric care. She enjoys working with acute stroke inpatients and learning about laryngectomy care.