Periodic botulinum toxin injections for paradoxical vocal fold motion in a child with cerebral palsy: A case study

Purpose This case study describes the clinical course for an individual referred to a speech-language pathologist (SLP) for assessment and treatment of paradoxical vocal fold motion/inducible laryngeal obstruction (PVFM/ILO) who was ultimately diagnosed with diaphragm flutter. This case presentation describes the critical importance of a multidisciplinary approach to identify conditions in the differential diagnosis of PVFM/ILO, which may lead to timely diagnosis and treatment of such conditions. Method Using a case study format with links to pre- and posttreatment videos, the clinical course of a 20-year-old woman presenting with persistent inspiratory stridor and cough during waking time was delineated. Data used to determine the differential diagnosis included careful clinical observation, extensive medical history, and endoscopic laryngeal assessment. Results Using a multidisciplinary approach with professionals from three different treatment centers, the diagnosis of diaphragm flutter was affirmed and successful medical management with an empiric trial of Baclofen was initiated with complete resolution of the dyspnea, cough, and inspiratory stridor over 3 weeks. Conclusions This case study describes a rare condition in the differential diagnosis of PVFM/ILO called diaphragm flutter, characterized by persistent inspiratory stridor and cough that interrupted connected speech and swallowing. SLPs who specialize in the assessment and treatment of PVFM/ILO may encounter this condition. Clinician awareness of the clinical profile for diaphragm flutter is critical for rapid referral to the appropriate medical specialists to achieve timely symptom relief. Supplemental Material https://doi.org/10.23641/asha.14781867

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Effect of multisite botulinum toxin injections on gait quality in adults with cerebral palsy

Disability and Rehabilitation ◽

10.3109/09638288.2014.883443 ◽

2014 ◽

Vol 36 (23) ◽

pp. 1971-1974 ◽

Cited By ~ 3

Author(s):

Claire Marchiori ◽

Nicolas Roche ◽

Nicolas Vuillerme ◽

Raphael Zory ◽

Didier Pradon

Keyword(s):

Cerebral Palsy ◽

Botulinum Toxin ◽

Gait Quality ◽

Botulinum Toxin Injections

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The Effect of Exercise on Respiratory Resistance in Athletes With and Without Paradoxical Vocal Fold Motion Disorder

American Journal of Speech-Language Pathology ◽

10.1044/2015_ajslp-14-0110 ◽

2015 ◽

Vol 24 (3) ◽

pp. 470-479 ◽

Cited By ~ 4

Author(s):

Sally J. K. Gallena ◽

Nancy Pearl Solomon ◽

Arthur T. Johnson ◽

Jafar Vossoughi ◽

Wei Tian

Keyword(s):

Repeated Measures ◽

Vocal Fold ◽

Female Athletes ◽

Exercise Duration ◽

Treadmill Running ◽

Respiratory Resistance ◽

The Difference ◽

Airflow Perturbation Device ◽

Vocal Fold Motion ◽

Paradoxical Vocal Fold Motion

Purpose An investigational, portable instrument was used to assess inspiratory (R i ) and expiratory (R e ) resistances during resting tidal breathing (RTB), postexercise breathing (PEB), and recovery breathing (RB) in athletes with and without paradoxical vocal fold motion disorder (PVFMD). Method Prospective, controlled, repeated measures within-subject and between-groups design. Twenty-four teenage female athletes, 12 with and 12 without PVFMD, breathed into the Airflow Perturbation Device for baseline measures of respiratory resistance and for two successive 1-min trials after treadmill running for up to 12 min. Exercise duration and dyspnea ratings were collected and compared across groups. Results Athletes with PVFMD had lower than control R i and R e values during RTB that significantly increased at PEB and decreased during RB. Control athletes' R e decreased significantly from RTB to PEB but not from PEB to RB, whereas R i did not change from RTB to PEB but decreased from PEB to RB. Athletes without PVFMD ran longer, providing lower dyspnea ratings. Conclusion Immediately following exercise, athletes with PVFMD experienced increased respiratory resistance that affected their exercise performance. The difference in resting respiratory resistances between groups is intriguing and could point to anatomical differences or neural adaptation in teenagers with PVFMD. The Airflow Perturbation Device appears to be a clinically feasible tool that can provide insight into PVFMD and objective data for tracking treatment progress.

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