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65 yr old male with a history of post-poli syndrome was admit for SOB with subsequent respiratory failure and eventual multi-system failure. Prolonged mechanical ventilation and eventually trached. Hospitalization was for approximately 4 months. Seen for a Video Swallow Study after initial clinical bedside swallow evaluation. At that time patient was tolerating a Passy-Muir Valve during the day on trach collar. Video Swallow Study revealed normal oral transit. There was significant decreased tongue base retraction, minimal laryngeal elevation, poor epiglottic inversion and poor pharyngeal contraction bilaterally resulting in significant valleculae and pyriform residual with all consistencies with eventual silent laryngeal penetration and aspiration with all consistencies. Compensatory strategies did not aid in clearance or improve protection. Two weeks later he was seen for follow-up video swallow study. Patient was medically stable, physically stronger and decannulated. There was absolutely no change in his swallow function. In fact, swallow function in the neutral position was non-functional with what seemed like bilateral bulbar deficits. With a chin tuck, the patient demonstrated a completely functional and safe swallow with clearance of all residual without aspiration or penetration. Never in the history of chin tucks had a virtually non-functional swallow become so functional. Still perplexed. Not a fan of compensation, but this was impressive! Now it’s time to rehabilitate !!!

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