Dysphagia Presentation Auto Saved]

8/7/2019 Dysphagia Presentation Auto Saved]

1/21

When you cant swallow.


2/21

Dysphagia Facts Approximately 300,000 to 600,000 people with

neurogenic disorders are diagnosed with dysphagia.

Swallowing involves the use of 6 cranial nerves. Approximately 40% of patients with dysphagia silently

aspirate.

Swallowing is one of the most complex body reflexes,

yet in the normal adult, this process is automatic,effortless and efficiently performed an average of 600times a day.


3/21

Dysphagia Facts Evidence of dysphagia in 51% of patients with acute

stroke.

Parkinsons dysphagia develops in approximately 50%of patients.

With patients with multiple sclerosis, 34% withdysphagia.


4/21

Phases of the Swallow Oral Phase

Involves the lips, tongue, teeth and cheeks.

The swallow begins when food is presented at the levelof the lips.

Patients must have good labial seal to hold the bolus withinthe oral cavity and to create appropriate pressures to propelthe bolus and initiate the swallow.

Patients with stroke may have labial weakness which allowsthe food to spill out of the mouth.


5/21

Tongue The tongue contains the taste buds allowing us to taste

foods.

The tongue is made up of muscles. The tongue is used to

Move the bolus within the oral cavity for propermastication of the bolus

Propel the bolus posteriorly to initiate the pharyngealstage of the swallow


6/21

Teeth Dentition is important for swallowing and it is

important to assess dentition for appropriate dietrecommendations.

The SLP will need to know if the patient wears dentures,is missing teeth, etc.

Teeth are important for appropriate mastication offoods.


7/21

Cheeks Buccal tension:

Assists in creating appropriate pressures for initiatingthe pharyngeal swallow

Assists in maintaining the bolus

Helps to prevent lateral pocketing of the bolus.


8/21

Pharyngeal Phase Once the food is masticated and reaches the anterior

faucial arches, the pharyngeal stage of the swallow isinitiated.

Within 1-3 seconds the following occurs: Tongue Base Retraction Velopharyngeal closure Pharyngeal constriction Pharyngeal contraction

Hyoid Elevation Hyoid Protraction Hyothyroid approximation Vocal fold closure Upper esophageal sphincter opening.


9/21

Oral Care Microorganisms found in the lungs of elderly patients with

pneumonia originate in the mouth and gingival, making alink between poor oral hygiene and aspiration pneumonia.

Three categories that add to the risk factors that lead toaspiration pneumonia: o Any factor that increases thebacterial load or colonization in the oral-pharyngeal cavity(lack of tooth brushing, xerostomia).

Any factor that decreases the patients resistance to the

inoculums (i.e. malnutrition or ventilator dependency). Any factor that increases the risk of aspiration (i.e. paralysis

from stroke or chronic neurological disease affecting themuscles and nerves involved in swallowing.


10/21

Oral Care Those at risk:Patients who are dependent for oral care.Have large numbers of missing teeth.DenturesHave limited hand dexterityDecreased mental capacityMultiple medical co-morbiditiesImmunosuppressedVentilator dependentReceive non-prandial feedingsHave had a strokeNeurologically impairedHave xerostomiaKnown DysphagiaPoor access to professional dental care.

Dependence on caregivers for oral care.Active smokingDepression.Use of sedative medicationUse of gastric acid-reducing medication.Use of ACE inhibitorPoor feeding position.


11/21

Frazier Water Protocol Patients who are on thickened liquids are often placed

on a Frazier Water Protocol to increase hydration.

Thickened liquids are given with meals andmedications.

Wait for 30 minutes after meal, complete thorough oralcare, then patient can have all the water they want untiltheir next meal.


12/21

Thickened Liquids There are four consistencies of liquids

Thin or regular Normal drinks with no thickening agents added.

Nectar thick liquids Should be the consistency of maple syrup and run off the

spoon like syrup does.

Honey thick liquids

Consistency of honey and should run off the spoon as honeydoes.

Pudding thick liquids Should be the consistency of pudding and plops off the

spoon.


13/21

Medications When patients have dysphagia, they are often ordered

to have their pills crushed or given inapplesauce/pudding.

When passing pills, remember people that havedifficulty swallowing and try to give them one pill at atime.

Check at the end of the med pass to make sure all pillswere swallowed and were not pocketed.


14/21

Food Consistencies Pureed

Baby food consistency, should have no lumps and beeasy to swallow.

Mechanical Soft/Ground Meat

Should only require minimal chewing, no hard/crunchyfoods

Regular No restricitions


15/21

Assessment Techniques by SLP Bedside assessment

Cervical Auscultation Laryngeal elevation Monitor s/s aspiration

Trial consistencies Pulse Oximetry Heart Rate Blue Dye Assessment 3 Ounce water test Bolus Manipulation Task

Instrumental Assessment MBSS FEES Manometry Ultrasound


16/21

Treatment Techniques by the SLP VitalStim-NMES for dysphagia DPNS/FMEP Thermal/tactile stimulation

Myofascial release and manual techniques Oral/Pharyngeal Exercises Exercises with resistance TheraSip Swallowing Trainer IOPI OraLight Ice Finger Laryngeal Mirrors/ThermoStim Probe


17/21

Things to Remember

Patients that self-feed have a lower incidence of aspiration. Feed patients as you would like to be fed, dont shovel food into

their mouth or stick the food into their mouth before theyreready.

Aspiration pneumonia in nursing home residents occurs 10 timesmore frequently than in elderly community dwellers.

Pneumonia is the most common cause of death fromnosocomial infections in the elderly.

Pneumonia results in functional declines and increased health

care expenditures. One study suggests that 70% of patients with a history of

pneumonia aspirated during their sleep. One study suggests that effective oral care can decrase mortality

due to pneumonia by half.


18/21

Bolus Propulsion


19/21

Select Medications that Affect

Swallowing Oropharyngeal function

Sedation, pharyngeal weakness, dystonia Benzodiazepines

NeurolepticsAnticonvulsants*

Myopathy

CorticosteroidsLipid-lowering drugs Xerostomia Anticholinergics

Antihypertensives*Antihistamines*AntipsychoticsNarcoticsAnticonvulsants*

Antiparkinsonian agents*Antineoplastics*Antidepressants*Anxiolytics*Muscle relaxants*Diuretics

Inflammation/swelling Antibiotics*

Esophageal functionInflammation (resulting from irritation bypill)

TetracyclineDoxycycline (Vibramycin)Iron preparationsQuinidineNonsteroidal anti-inf lammatory drugsPotassium

Impaired motility or exacerbatedgastroesophageal reflux

AnticholinergicsCalcium channel blockersTheophylline

Esophagitis (related to immunosuppression)

Corticosteroids *--Various agents in the class.


20/21

Sources American Speech-Language Hearing Association Division

13 (2006). Perspectives on Swallowing and SwallowingDisorders, 15(3), 1-28.

American Speech-Language-Hearing Association (1990).Skills needed by speech-language pathologists providingservices to dysphagic patients/clients, ASHA, 32 (suppl 5),7.

DPNS Manual. Available through the Speech Team Inc.Author: Karlene Stefanokos.

The Source for Dysphagia. LinguiSystems. Author: NancySwigert.

Logemann, J. A. (1998). Evaluation and treatment ofswallowing disorders. Austin, TX: Pro-Ed.


21/21

Sources Carl, L., & Johnson, P. (2005). Drugs and dysphagia:

How medications can affect eating and swallowing.Austin, TX: Pro-Ed.

Palmer, J.B., Drennan, J.C., and Baba, M. (2000).Evaluation and Treatment of Swallowing Impairments.www.aafp.org/afp/20000415/2453.html

Dysphagia Presentation Auto Saved]

Documents

Transcript of Dysphagia Presentation Auto Saved]