Abstract
The present paper reports the effectiveness of postural changes and water-drinking therapy on the swallowing function in a severely dysphagic LMS patient one year after the onset. The posture that resulted in the minimum residue in the pyriform sinuses was identified using a videofluoroscope. Direct swallowing therapy was provided, starting from repetitive 2 ml water drinking and thereafter progressing in incremental steps. The posture, in which the patient's head was rotated to the intact side, which thus allowed for a maximum reduction of the neck tension and while also guiding the bolus flow to the intact side of the oral cavity and the damaged side of the pharynx. At the time of referral, the patient exhibited unilateral facial paralysis and hemiplegia due to a right pontine and cerebellar infarction. The position of the larynx was deviated to the damaged side and the laryngeal elevation and muscular tension in the neck area were both asymmetrical. After undergoing the swallowing therapy, the patient eventually achieved full oral intake. Subsequently, the position of the larynx shifted more medially, laryngeal elevation looked less asymmetrical and the bolus started to pass bilaterally in the pharynx.
