DYSPHAGIA Assessment, Management and Therapy Options Jennifer Bowers Speech and Language Therapist QEUH.

Slides:



Advertisements
Similar presentations
KEY ITEMS IN DYSPHAGIA PROCESS
Advertisements

Swallowing Difficulties
ORAL CAVITY SALIVA SECRETION SWALLOWING
NHS Greater Glasgow & Clyde Advancing Skills in Stroke Care Swallowing problems after stroke.
DYSPHAGIA David Pothier MRCS DOHNS SpR ENT Louise Bredenkamp B Comm Path Speech Therapist.
Cranial Nerves.
PARKINSON’S DISEASE Rebecca L. Gould, MSC, CCC-SLP (561) www. med-speech.com.
SWALLOWING DR. ADEL HUSSIEN DR. AHMED ALANTARY. Objectives: The student should know: - The normal swallowing process and its stages. - Mechanism of each.
Feeding and Swallowing Disorders in Children
Role of the Speech and Language Therapist in Assessment of Oral Feeding Gail Robertson Specialist Speech and Language Therapist.
Lindsey Lorteau, M.S., SLP Speech-Language Pathologist
HEAPHY 1 & 2 DIAGNOSTIC Deborah McKELLAR Fri 30 th Aug 2013 Session 2 / Talk 2 11:05 – 11:22 ABSTRACT This presentation will give a brief outline of the.
Ch. 9 Physiology of Mastication and Deglutition. Introductory Terms Dysphagia: A disorder of swallowing Dysphagia: A disorder of swallowing Bolus: ball.
Copyright © 2008 Delmar. All rights reserved. Unit Ten Dysphagia.
Modified Barium Swallows. Dysphagia Symptom of abnormal swallowing as it relates to aspiration of food and/or liquids, pooling, with or without residuals.
The Role of the Speech & Language Therapist Emma Burke Principal Speech & Language Therapist Bradford & Airedale tPCT Wednesday 12 th March 2008.
Anatomy and Physiology of swallowing
+ Swallowing Disorders. + Common Terms Dysphagia- Another name for a swallowing disorder. Epiglottis Structure that closes off the trachea when swallowing.
1 Velopharyngeal Function 2/17/00. 2 Soft Palate Posterior extension of soft palate Composed of muscular fibers Movement changes volume & shape of the.
Field trip forms must be turned in by Friday if you want to go.
Physiological functions of the mouth ,pharynx & oesophagus
Approach to dysphagia. Definition of Dysphagia The word dysphagia is derived from the Greek phagia (to eat) and dys (with difficulty). It specifically.
Disorders of Swallowing
Physiology of Deglutition
Overview of Ch. 7. * Hard palate * Soft palage * Alveolus, floor of the mouth, tonsil, and anterior faucial pillar * Lateral tongue * Base of tongue.
Ch. 6. * What type of nutritional management is necessary? * Should therapy be initiated and what type? * What specific therapy strategies should be utilized?
Swallowing(Deglutition)
Cranial Nerves Exam.
Cranial Nerves Nestor T. Hilvano, M.D., M.P.H..
Swallowing Disorders Chapter 5. * Identify presence of signs and symptoms of dysphagia * Chart Review * Observation at bedside or at a meal * Determine.
Swallowing (Deglution)
Swallowing Dr Wasif Haq.
Overview of Anatomy From the Head down to the diaphragm.
Chewing & Swallowing. SWALLOWING There are three stages Oral Pharyngeal Oesophageal.
 Series of activities that occur within a matter of seconds.  Traditionally described as a reflex, the process is more properly regarded as a programmed.
Muscles of Mastication. Muscle of Mastication Lateral Pterygoid Medial Pterygoid.
Mixed cranial nerves.
Brittany Zarse Elizabeth Yeager Nathan Webb.  A) Tongue and pharynx movement  B) Hearing and Balance  C) Sense of Smell  B) Visual information.
Chapter 5 Part 2. * Define abnormalities in anatomy and physiology causing the patient’s symptoms * Identify and evaluate treatment strategies that may.
CRANIAL NERVES Health Assessment NUR 211. Anatomy and Physiology Central Nervous System –Brain, spinal cord, motor and sensory pathways Peripheral Nervous.
The palate The palate forms the roof of the mouth. It is divided into two parts: Anterior 2/3 (the hard palate) and posterior 1/3 (the soft palate).
Cranial Nerves VII- XII Review
Malnutrition & Dysphagia Workshop: An Introduction to Dysphagia
Inferior surface of the brain as it appears on gross dissection.
Dysphagia: Management Approach in Stroke
Chapter 7 Physiology of Artic and Resonation Perry C. Hanavan.
SALC07 Biological Sciences Head & Neck 4: The Typical Adult Swallow Flora Wisdom MCRSLT/HPC
Eating and Drinking Dysphagia after stroke This is not an Agored Cymru publication. It has been developed by colleagues from Cwm Taf University Health.
Chapter 3 of Speech and Hearing. Overview Anatomy of Speech Production Respiratory Laryngeal Articulatory/Resonating.
Hospital mealtime volunteers workshop
Regions of the Brain  Cerebral hemispheres  Diencephalon  Cerebellum  Brain stem روند تکامل و تقسیم بندی سیستم عصبی.
Preparation for Medical Practicum
Medical Practicum Goals/Objectives of First Visit Tour of facility
Mouth, Teeth, Salivary Glands, Pharynx & Esophagus
Peripheral Nervous System
Speech Therapy’s Role in Head and Neck Cancer
The Cranial Nerves: A Review
Cranial Nerves Exam.
Nervous System Prof. Abdulameer Al-Nuaimi
Summary of Function of Cranial Nerves
Cranial Nerves.
Carol A. Smith Hammond, PhD, Larry B. Goldstein, MD  CHEST 
CRANIAL NERVES Health Assessment NUR 211 Medical ppt
Physiology of Mastication and Deglutition
Digestion and Nutrition
Peripheral Nervous System
The Cranial Nerves.
CNS + PNS + Cranial Nerves
The Cranial Nerves.
Chapter 11E Nervous System II
Presentation transcript:

DYSPHAGIA Assessment, Management and Therapy Options Jennifer Bowers Speech and Language Therapist QEUH

Whistle stop tour of Dysphagia What is dysphagia? Dysphagia in neurological disorders Assessment of the swallow - the normal swallow - the abnormal swallow Management of dysphagia Swallowing Therapy / Rehabilitation

What is dysphagia? Dysphagia is the blanket term used for difficulty with swallowing An impairment in the ability to chew and/or swallow food/ fluids Dysphagia is often underestimated in neurological disorders Resulting from impairments to the CNS, PNS or local damage to the swallowing mechanisms at any level (oral, pharyngeal, laryngeal).

Food glorious food Nutrition and hydration are vital for life Eating and drinking is, for most people, hugely enjoyable Eating is a central part of home life and many social activities Preparation and consumption of food has many cultural components and plays an important role in society We have to eat and we like to eat!

Swallowing anatomy

Swallowing is an essential function that is carefully regulated by the central nervous system and, in particular, by the cerebral cortex There are many different areas of the cerebral cortex involved in swallowing fMRI shows different areas of the cortex activated for different types of swallow eg. voluntary vs reflexive Input from the peripheral nervous system also vital Damage to, or disease process in CNS/PNS structures associated with swallowing, lead to dysphagia.

Cranial nerves involved in swallowing Trigeminal CN V general sensation from face; motor supply to masticatory muscles Facial CN VII taste from anterior 2/3 tongue via chorda tympani; motor supply to muscles of facial expression including lips Glossopharyngeal CN IX general sensation from posterior 1/3 tongue, soft palate, tonsils, fauceal pillars and pharynx; taste from posterior 1/3 tongue; motor supply to pharyngeal constrictors and to stylopharyngeus Vagus CN X general sensation from the larynx; motor supply to palate/pharynx/larynx; autonomic supply to oesophagus Accessory CN XI motor supply, supplementing vagus; motor supply to muscles controlling head position Hypoglossal CN XII motor supply to intrinsic and extrinsic tongue muscles

The normal swallow There are 3 stages of the swallowing process Oral stage Pharyngeal stage Oesophageal stage

Oral preparatory stage Sensory recognition of food/fluids (sight, smell, texture, temperature) Arousal of appetite Food/fluid in oral cavity Lip seal Chewing and manipulation to form a cohesive bolus drenched in saliva Soft palate is actively lowered to retain food in oral cavity, avoiding naso pharyngeal escape Nasal breathing continues

Oral executive stage Tip and blade of tongue rises and presses the bolus against the hard palate Sides of tongue rise, creating central groove for food bolus Increased tension in muscles of cheeks closes off lateral sulci and prevents bolus falling between jaw and cheeks. Sensory feedback is important Bolus arrives on base of tongue and contacts anterior pillars of fauces triggering swallow

Pharyngeal stage This stage cannot be voluntarily interrupted and will not happen unless reflex is triggered Breathing is halted during this stage For safe accomplishment there must be efficient protection of airway to avoid aspiration Rapid completion of sequence to allow breathing to resume Soft palate raised to stop food entering nasal cavity

Posterior tongue thrust propels bolus into pharynx and pharyngeal peristalsis begins. Epiglottis tips over Hyoid bone moves forward moving larynx to fit under base of tongue Closure of false cords and true vocal cords Pharyngeal peristalsis continues until bolus reaches crico-pharyngeal sphincter Pharyngeal transit time of one second

Oesophageal stage Reflexive and involuntary As bolus approaches, crico-pharyngeal sphincter opens Bolus passes into oesophagus and sphincter closes At the bottom of oesophagus, gastro- oesophageal sphincter opens to allow food into stomach Time taken approx two seconds

Lateral view of bolus propulsion during the swallow, beginning with the voluntary initiation of the tongue A; the triggering of the swallowing reflex B; the bolus passage through the pharynx C; the entry of the bolus through the cricopharyngeal sphincter into the cervical oesophagus D; and the completion of the pharyngeal stage of the swallow when the entire bolus is in the cervical oesophagus E.

Neurological causes of dysphagia CVA (ischemic or hemorrhagic), TBI Hydrocephalus Infective (bacterial or viral) eg. meningitis, encephalitis, TB, cerebral abscess, etc. Tumour eg. malignant or benign Muscular dystrophies, most commonly oculopharyngeal and myotonic Myasthenia Gravis MS MND Neuropathy and myopathy GBS and variants Dementias etc…….

Assessment of Oro-pharyngeal dysphagia General observation Oral and peripheral exam 4 finger placement technique Trials of different textures and consistencies Videofluoroscopy Allows detailed examination of a rapid physiological process, completely objective, permanent record, simultaneous voice recording, allows experimentation with position of patient, standard x-ray equipment, low dosage of radiation.

Management of dysphagia Compensatory strategies - Texture modification - Bolus control measures eg. bolus placement in mouth, types of cups eg. Drinkrite, Novocup - Posture eg. chin tuck, head turn, head tilt - Positioning Manoeuvres eg. supraglottic swallow, Mendelsohn’s

Therapy and Rehabilitation Therapeutic swallowing manoeuvres can mean the difference between a safe and unsafe swallow. Mendelsohn’s Manoeuvre Used to compensate for reduced laryngeal excursion and cricopharyngeal opening Supraglottic swallow Used to compensate for a delayed swallow by aiding closure of the vocal cords and all supraglottic structures, prior to the bolus arrival in the pharynx

Exercises for swallow Shaker Used to increase strength for laryngeal excursion, and width and duration of opening of cricopharyngeus Masako Used for pharyngeal strengthening

As with any therapeutic intervention, treatment for dysphagia is not one size fits all. While many will cope with texture modification or use of an adapted cup, etc, their underlying condition and current presentation will dictate whether use of manoeuvres, postures or exercises is appropriate.