Therapy makes life easier to swallow

By SIMON COLLINS

A freak car accident left Jill Meuli thinking she would never eat normally again.

She and her husband, Allan, were driving from their farm near Patea in Taranaki to see their daughter Wendy in Christchurch when a horse jumped at their car and landed on the bonnet.

Its hoof smashed through the windscreen straight into Mrs Meuli's forehead.

Her skull was fractured and seven of the 12 pairs of cranial nerves that send messages from the brain to control the body were damaged.

Four years later, her face is still "crooked" and she speaks with difficulty.

But for two years after the accident it was even worse - she could not swallow. The nerves controlling the 32 muscles that have to act in unison when we swallow were no longer working.

When she left Christchurch Hospital 10 weeks after the accident, a feeding tube was attached to her stomach. She could not eat, but poured liquid nutrients through the tube five times a day.

It was a nightmare.

"I didn't cope very well," she said this week. "I thought sometimes I couldn't go through with it, but I did. You've got to go on."

Today, Mrs Meuli can eat normally again. She is one of the first New Zealanders to benefit from a new technique pioneered by Dr Maggie-Lee Huckabee, an American expert now at Canterbury University.

The technique does not involve any surgery but instead uses a computer to teach patients by "biofeedback" to control their swallowing muscles through a different part of the brain.

Dr Huckabee is one of a handful of experts in the field internationally. She grew up in a military family, and her shift to New Zealand three years ago was her 32nd move in 42 years. She is now a New Zealand citizen.

"After I got here, it became very apparent that this was where I needed to stay," she said.

The Meulis heard about her through an article in the Christchurch Press.

"Allan rang her, not really knowing whether she was taking patients or not. He told her what I was like," Mrs Meuli said.

"She said she thought she could help me and to come on down. So we did. We were going down about every four weeks and having about an hour's treatment every day for a week each time."

At every session, Mrs Meuli tried to swallow. With the "instinctual" part of her brain knocked out by the horse, she had to consciously use the upper part of her brain, the cerebral cortex, to teach her swallowing muscles how to work again.

"I used to have to really concentrate. I used to get terribly frustrated," she said.

Electrodes taped under her chin showed how her muscles were responding and each attempt to swallow showed up on a graph on the computer screen. The more successful, the higher the line on the graph.

A line across the screen showed the target. Mrs Meuli had to train her muscles to swallow hard enough to lift the graph above that line.

Eating was risky, because if the swallowing muscles did not do their job, any food was liable to go down the wrong way, into her lungs.

"I'd have to spit things up. It wasn't very elegant," she said.

"But never mind. We gradually proceeded like that, and it just got better and better.

"She would give me exercises to do in the weeks between sessions. I would come home and have to do that so many times a day.

"And then when I actually started to eat again I had to put down everything that I ate and how much it was and I had to fax it once a week to her. She would ring back and discuss it with me and tell me to try something else. She's an amazing woman.

"After six months - it might have been a bit longer - I could swallow. I started just on baby food, but now I can eat pretty much anything."

Mrs Meuli still has to think consciously when she swallows. "I'm very slow," she said.

Eighteen months later, the Meulis take Dr Huckabee out for dinner every time they are in Christchurch. Just being able to go out and eat normally feels like a precious gift.

It is, in fact, an expensive gift. Dr Huckabee had to raise $180,000 from the Canterbury District Health Board, the Geriatric Medical Research Trust and the university to buy the swallowing workstation used for biofeedback. At the time it was one of only five in the world.

The Canterbury Medical Research Foundation is now paying her to evaluate the system's effectiveness.

Auckland Hospital bought a similar machine last year to apply the technique, with training from Dr Huckabee, and has treated six stroke patients so far.

The hospital's speech and language therapy leader, Alison Paulin, said 5 per cent of stroke victims needed feeding tubes, especially if the strokes damaged the brain stem, which controls their instincts.

"Those are the ones that long term might be able to get off the tubes," she said.

Starship hospital therapist Melissa Keesing said Dr Huckabee's work was exciting.

"She's brilliant," she said. "We are very fortunate to have her here."


www.spth.canterbury.ac.nz