Bulbar Dysfunction and Associated Cardiopulmonary Considerations in Polio and Neuromuscular Disease

Many individuals with progressive neuromuscular conditions, including post-po-liomyelitis, develop severe bulbar dysfunction, which adversely affects quality of life and can indirectly exacerbate cardiopulmonary insufficiency. The incidence of dysarthria and dysphagia appears to increase as patients advance to the point of requiring ventilatory assistance. In a study of post-poliomyelitis ventilator users, the incidence of dysphagia was found to be 50 percent by contrast to approximately 21 percent in non-ventilator users. The incidence of dysarthria and dysphagia is even higher for patients with some advanced neuromuscular conditions. Various therapeutic interventions, including prevention of the fatigue and hypoventilation associated with inspiratory muscle insufficiency, can improve communication, swallowing, and nutrition. The use of noninvasive expiratory muscle aids can eliminate aspirated food and airway secretions. Quality of life can be significantly improved and life itself can be prolonged for some ventilator users by maintaining effective communication and good nutrition. Surgical methods for managing dys-phagia may be used as a last resort. Key Words: Dysarthria—Dysphagia—Mechan— ical ventilation—Duchenne muscular dystrophy-Neuromuscular disease-Car-diopulmonary failure—Poliomyelitis