Dysarthria and aphagia: a case study of neuromuscular treatment

This case study involves a 44-year-old man with flaccid dysarthria, right hemiparesis, left facial paresis, left vocal fold paralysis, and aphagia following multiple gunshot wounds. He was treated surgically with a tracheostomy, feeding gastrostomy, left temporalis muscle sling, left cricopharyngeal myotomy, hypoglossal nerve anastomosis, and left true vocal fold Teflon injection. After seven years, the patient was referred for speech therapy. The areas of glottic closure, velopharyngeal closure, and tongue strength and mobility were stressed initially in speech therapy. Since these mechanisms were related to his aphagia, it was hypothesized that the oral motor activities used for speech would also aid in swallowing. After nine weeks of intensive practice, gains were noted in strength and movement for the tongue, velum and larynx. Shortly thereafter, he swallowed blender-texture food.