1605 - Finding your voice- Aphonia and Dysphagia in the setting of Foix-Chavany-Marie Syndrome: A Case Report

Case Diagnosis: Foix-Chavany-Marie Syndrome

Case Description: Patient is a 78 year old female with a history of prior right basal ganglia stroke with residual left sided hemiparesis admitted to inpatient rehabilitation after subsequent left MCA stroke complicated by aphonia and dysphagia, diagnosed with Foix-Chavany-Marie syndrome. On admission to acute rehabilitation the patient was maintained on nothing by mouth (NPO) status and was unable to speak/phonate. ENT evaluation demonstrated no mechanical trauma secondary to intubation. She worked diligently with speech language pathology (SLP) and completed two weeks of oral motor exercises, respiratory muscle strength training, and neuromuscular electrical stimulation. Upon discharge, she was able to tolerate a modified diet and had marked improvement in phonation and speech initiation, with the ability to speak short phrases.

Discussions: Neuromuscular electrical stimulation (NMES) lends itself as a useful adjunctive tool for dysphagia and aphonia stemming from a neurologic etiology. Stimulation is superficial and focuses on directing its impulse to the muscles used to speak and swallow, in their respective patterns to inspire coordinated contraction. This therapy improves muscle strength, increases fatigue resistance, improves sound pressure, and helps restore function to the muscle that elevates the larynx. However, it is important to note that to optimize neurologic recovery, mechanical sources of dysphagia and dysphonia need to be ruled out, as they may indicate more aggressive intervention is warranted. Neuromuscular electrical stimulation has been shown to be an excellent resource and improves patient’s return to function greater than with traditional exercises alone.

Conclusions: Neuromuscular electrical stimulation provides adjunctive support in neurological causes of aphonia and dysphagia when administered by speech language pathology and should be built into patient’s individualized rehabilitation prescriptions when appropriate.