Noninvasive Treatment Strategy for Swallowing Problems Related to Prolonged Nonoral Feeding in Spinal Muscular Atrophy Type II

Abstract

A 25-year-old patient with spinal muscular atrophy (SMA) type II was referred due to swallowing problems related to prolonged nonoral feeding. Restriction of jaw movement, neck stiffness, absence of oral food intake, and weakness of the oropharyngeal and laryngeal muscles were considered to be the main factors contributing to the deterioration of his swallowing function. Treatment comprised exercises to improve flexibility of the neck and temporomandibular joint, tactile oral stimulation, passive and active oropharyngolaryngeal exercises, and supraglottic swallowing maneuvers. Treatment was performed for 30 min per day, three times a week, for 7 months. On initial videofluoroscopic examination, the patient was unable to safely tolerate any per-oral nutrition. After 7 months of treatment, the patient's swallowing function had improved to the extent that he was able to resume oral intake of food under supervision, and aspiration was no longer evident. These findings suggest that noninvasive treatment is a possible strategy for enhancing the swallowing function of a patient with SMA type II presenting with swallowing difficulties related to prolonged nonoral feeding.

1st Italian SMA Family Association Consensus Meeting:

“…Swallowing issues are also frequent in children with SMA but there are again limited data on the evaluation and treatment of impairment. It is known that improvement of nutritional status slows disease progression in other neuromuscular disorders [61] but data are still limited in SMA [62][63].…”

Effect of Stomatognathic Alignment Exercise on Temporomandibular Joint Function and Swallowing Function of Stroke Patients with Limited Mouth Opening

“…This indicates the importance of mobility exercises for the TMJ and neck regions in the achievement of airway closure, for decrease of aspiration risk, by facilitating hyoid-laryngeal elevation. Therefore, it is important to encourage this type of exercise to improve orofacial and pharyngolaryngeal movements during swallowing by patients presenting TMJ and neck stiffness, enabling them to re-learn the use of the swallowing-related muscles24 ) . In the present study, the MASA score for swallowing function was >170 points, which indicates the absence of aspiration risk18 ) .…”

“…This finding indicates that stomatognathic alignment exercise, which promotes TMJ and neck mobility and postural correction, can be used to improve swallowing function in a clinical setting. Previous studies have recognised the importance of muscular efforts in the pharyngolaryngeal regions and postural adjustment in maintaining a normal swallowing pattern after stroke2, 24 ) .…”

Role of Sonographic Imaging in Occupational Therapy Practice

“…X ray provides low-dose radiation to patients and is limited to evaluating bones, metal, and radioactive materials. With the exception of dynamic X ray fluoroscopy in the evaluation and treatment of swallowing disorders (Cha, Oh, & Shim, 2010), MRI, fMRI, DTI, and X ray, along with computed tomography and positron emission tomography, are primarily static medical imaging modalities. These static images have a discrete place in occupation-centered intervention for patient education and as a measurement tool.…”