Pediatric Medullary Stroke, Severe Dysphagia, and Multimodal Intervention.
Laura Brooks, Nikhila Raol, Steven Goudy and 1 others
PMID 34705083WHAT IT FOUND
In a child with severe swallowing failure after medullary stroke, Botox, cricopharyngeal myotomy, and intensive speech therapy were followed by movement of thin liquids and solids with left head tilt and no aspiration.
Key findings
01The first VFSS showed severely impaired upper esophageal sphincter opening, no movement of bolus into the esophagus, and aspiration without a cough response.
02After cricopharyngeal myotomy, VFSS showed part of the bolus moved through the upper esophageal sphincter 5 times with strategies, but pyriform residue was silently aspirated.
03At outpatient follow-up, solids and thin liquids moved adequately through the pharynx, upper esophageal sphincter, and esophagus with left head tilt, and no laryngeal penetration or aspiration occurred.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a case report, so it cannot show that any treatment works for other children. Several treatments were given together, including Botox, intensive speech therapy, surgery, positioning, and suctioning, so the contribution of any one component cannot be separated. The paper reports limited access to the outside MRI information, so the stroke details cannot be fully verified. Therapy choices were individualized because the patient's age and discomfort prevented teaching certain exercises, so this is not a standardized protocol. The paper does not report follow-up beyond the described inpatient and outpatient swallow studies.
The easy way to misread this
Do not read this as evidence that Botox, cricopharyngeal myotomy, or intensive speech therapy caused the swallowing improvement. This was a case report, and multiple procedures, therapies, and positioning strategies were used together, so the contribution of any single component cannot be separated.