Hellloooo fellow SLPs
I am a relatively new clinician in an outpatient clinic that primarily serves pediatric patients. I am more interested in adults and did mostly adult medical placements in grad school. As a result, I get to do the majority of the adult evaluations we get. I recently evaluated a Pt for swallowing. Side note: Pt has global communication impairments (making it even more difficult to understand what is going on) Pt presented with extremely delayed oral transit, excessive drooling, and complete inability to swallow and manage secretions. Groping behaviors noted during bolus trials. Prior to my eval, Pt had an MBSS done with silent aspiration occurring on thin liquids. Since MBSS, Pt has been NPO and PEG dependent. When given model to swallow, in addition to visual and tactile cues, Pt was able to initiate swallow and swallow 5 ml of water via spoon during our evaluation. Prior to this, his family reported that he had been unable to initiate a swallow for many days (hence the drooling and poor secretion management). I have not yet seen him for treatment. However, family just updated me and said he had a FEES done this week which reported normal cervical anatomy and transient laryngeal penetration on thin liquids. No significant pharyngeal retention or aspiration was observed. This was per the radiologists report. I will be curious to read SLPs report and recommendations following the FEES. Anywhooooo that’s a little run down. I have no clue where to start with this Pt. The symptoms I can’t describe in any other way besides it seems like he has swallowing apraxia?? This is not something I ever learned about in school and seems to be something you can’t find a lot about in the research. Is this even a real diagnosis? Even if not, what should I do??? Given nearly all clinicians at my clinic are pediatric focused and have limited experience with adults, I don’t have a lot of people to talk to this about. Any tips from similar experiences welcome. Thanks all!