A person swallows approximately 500 times per day. That morsel of information was not on Richard Slosberg's mind when he laid down for a nap in June of 1998. Nor could he imagine that he would not be able to eat for the next eight years because he couldn't swallow.

That same day Richard's aunt, with whom he lived, was concerned because Richard complained of being tired and never took a nap during the day. He was 58 years old and a practicing attorney with an active life style. Not recalling the specifics of what happened whiled he "napped", the day ended with Richard being admitted to the hospital. He had suffered a CVA (cerebral vascular accident) - a stroke. The left side of his brain, the area that affects speech and swallowing, had been damaged.

Yonca Berk-Giray with patient Richard Slosberg. Small electrodes are attached to Richard's throat to stimulate the muscles involved in swallowing.

After a week in the hospital Richard was stabilized medically and he transferred to New England Rehabilitation Hospital of Portland. He could not walk or swallow and had a breathy, soft voice at the time of admission. He began a three-month course of intensive physical therapy, occupation therapy and speech therapy to improve his level of function.

When Richard was discharged to a skilled nursing facility, he could walk using a walker and could speak but only in a high pitch typical for patients who have had their vocal cords affected by a CVA. He was not able to swallow or eat, a condition called dysphagia, so he received medications and nutrients from liquid meals poured through a "PEG" (percutaneous endoscopic gastromstomy) tube.

Following a two week stay at the skilled facility, Richard moved to a new residence where he lived alone. He received visiting nurse services for a month during which time he learned to gain independence and provide care for himself. Subsequently, other than periodic visits to his personal physician, Richard's medical care for his dysphagia had ended. He was to begin an 8 year journey of self-reliance and adapting to the life-altering condition he was left with after his stroke.

Richard and Yonca share a laugh during his therapy lunch.

Richard continued his law practice, working out of his home. His life prior to having a CVA centered around friends and family but he soon realized that much of his socialization occurred at eating events. While he resumed his friendships and interacted with family, the side effects of his dysphagia and voice disorder were uncomfortable for those with him, especially when eating was involved.

At the insistence of his daughter, Richard went to John Hopkins Hospital in 2006 for an evaluation of his vocal cords and swallowing disability. An operation was performed on his vocal cords and while his voice tone improved he still did not have the ability to swallow. He was sent home with oral-pharyngeal exercises.

Having read an article about a treatment called VitalStim® Therapy for individuals with swallowing disorders, a family member encouraged Richard to discuss the therapy with his primary care physician. His physician was dubious about the therapy being successful for Richard as he had had the dysphagia for eight years. Not to be discouraged, Richard called New England Rehab Hospital and talked with Yonca Berk-Giray, a licensed Speech Language Pathologist certified in VitalStim® Therapy. Yonca and Richard discussed his medical history and Yonca advised him to come in for an evaluation. Having the same concerns as his physician, Yonca was skeptical about the therapy being effective as he was 8 years post stroke. Therapy is most successful when it is started as soon as possible following the CVA. However, Richard's physician made the referral to New England Rehab Hospital's Outpatient Speech Therapy department for a complete evaluation and treatment. Richard also had a modified Barium Swallow test which determined that the VitalStim® Therapy may be helpful after all.

Richard started therapy with Yonca on June 28, 2006. Initially, he had a dilatation procedure where the sphincter on top of the esophagus is stretched to sufficiently allow food to be swallowed. This procedure was performed once a week for four weeks to allow for slow stretching and to avoid tearing. Yonca was able to provide swallowing therapy during this time. Following the dilatation, Richard was better able to tolerate more solid foods.

Yonca has been treating Richard for several months using VitalStim® Therapy while he eats. Neuromuscular electrical stimulation is applied by attaching electrodes to the throat stimulating the muscles. At first he started eating and swallowing thickened liquids, then soft foods and, as his muscles got stronger, he was able to eat a full meal! Richard has many steps to follow in this process. When he takes a bite, he must turn his head to the left in order to send the food down the strong side of the throat. Once he has swallowed, he then clears his throat and swallows again to make sure that he does not have any residue in his throat. To Richard these steps are a fair trade for being able to enjoy tasting food once again.

Despite the odds against Richard's accomplishments with VitalStim® Therapy, he can eat most foods at home now and often orders take-out from his favorite Chinese restaurant. As an added bonus, he no longer has to use his PEG tube. Yonca and Richard are currently working on social eating skills that will allow Richard to expand the number of settings in which he can eat. It is apparent that Richard is a highly motivated patient and is willing to work hard with Yonca to overcome the barriers he has faced for the past eight years. When the satisfied smile comes over his face as he eats his therapy lunch of haddock with Newburg sauce, Richard will tell you that he knows the sweet taste of success!

2007 NERHP Speech Language Pathologist named Champion.