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Final Program


Final Program

TBI

700 - Making The Pill Easier To Swallow: A Case Series

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Intracerebral hemorrhage.

Case Description: This case series includes two patients who were admitted to acute inpatient rehabilitation at Bellevue Hospital after suffering intracerebral hemorrhages. Both patients were diagnosed with severe dysphagia and received nutrition, hydration, and medications through Nasogastric Tubes (NGTs). The NGTs were secured in place via a bridle device, which is tubing looped around the vomer bone and contains a clip to anchor the NGT in the nasal cavity. Bridle catheters prevent recurrent dislodgements, reduce aspiration risk, and assist with maintenance of proper nutrition/hydration in lieu of PO. These patients received dysphagia therapy 2.5-5 hours per week and were able to participate in their individualized treatment plans, without restrictions, despite the presence of NGTs. After receiving intense dysphagia therapy along with repeat swallow studies, patients’ diets were safely advanced to regular solids and thin liquids, decreasing patient and caregiver burden, while also avoiding unnecessary surgical procedures.

Discussions:

Previously, patients were only accepted to the rehabilitation floor with a definitive feeding plan (PEG vs PO diet) and in absence of dysphagia therapy. Acute services are limited with dysphagia treatment due high censuses and emphasis on diagnostic evaluations. Patients are now arriving on the rehabilitation floor closer to onset of impairments given increased use of bridle devices to secure patients’ NGTs throughout the course of therapy. Dysphagia therapy is not only integral for neurological recovery, but also helps maintain the multidisciplinary core of acute rehabilitation. 

Conclusions: Giving TBI and stroke patients an opportunity to receive intensive dysphagia therapy allows for optimal recovery and avoidance of surgical procedures such as PEG tube placement. Acute inpatient rehabilitation facilities should be encouraged to take patients earlier without definitive feeding plans in order to maximize therapeutic outcomes, improve patient quality of life, and to facilitate least restrictive diet upon discharge.