Medical Practicum Goals/Objectives of First Visit Tour of facility Cog/Language Screening MoCA and/or SLUMS Observe patients during mealtime Observe Patient consuming alternate diet Oral Motor Exam

When will we go? You will go for 2 hours, 1x this term It is nice to go during mealtime, therefore; Fridays 11-1 Monday or Tuesday 4-6

How do I sign up? Via SIGN UP genius DO’s – Please carpool if possible email me with questions or concerns elisep@uoregon.edu PLEASE DON’T- email me via sign up genius

Liquid & Texture Modification in Patients with Dysphagia Spring 2017

Swallowing Screening Have you ever watched people at mealtime? Dentition Managing secretions Pacing ( fast or slow) Feeding themselves? Coughing or choking

GOAL Primary goal in dysphagia therapy is to meet nutrition and hydration needs by mouth – while minimizing the risk of aspiration

Approaches to Treatment of Dysphagia Compensatory strategies Compensate for lost function Do not target change in swallowing physiology Strategies include posture modification, diet texture modification etc. Used during meals Facilitation strategies Intended to change selected aspects of swallow physiology No food needed to teach maneuvers Other

Compensatory Strategies Posture modification Modification of bolus volume Modification of liquid and food consistencies Modification of how food is presented to patient Enhancing sensory input Special eating utensils

Facilitation strategies Swallowing maneuvers - examples Effortful swallow Supraglottic/Super-supraglottic swallow Mendelsohn maneuver Physical Exercises - examples Head-lift exercises Oral-motor exercises to increase vertical, lateral ROM of lingual movements in cancer patients

Other considerations Reducing distractions during meals Assistance during feeding Support with oral hygiene

Study – thickened liquids Diet texture modification and thickening liquids should be used as a last resort (Logeman, 1998) Large-scale study with stroke, PD, and dementia patients - compared chin-tuck and thickened liquids (Logeman et al., 2008; Robbins & Hind, 2008) Part I (N=742) - Eliminating aspiration 49% aspirated on all 3 interventions Honey-thick liquid < nectar-thick liquid < chin tuck Part II (N=515) - Preventing pneumonia Pneumonia within 3 months occurred in 52 participants (11%) Lower incidence of pneumonia in patients randomized to nectar-thick than those on honey-thick

Using thickened liquids Factors to consider (Garcia et al Using thickened liquids Factors to consider (Garcia et al., 2005; Mills, 2008) Absorption of water by the digestive system Patient acceptance of thickened fluid Mixing characteristics Starch-based thickener – unstable, thickens over long period of time, varies across liquid types Xanthan-gum thickener – more stable over time & across liquid types & different temperatures Absorption of water by the digestive system

Diet Texture Modification National Dysphagia Diet NDD Level 1: Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability). NDD Level 2: Dysphagia-Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing). NDD Level 3: Dysphagia-Advanced (soft foods that require more chewing ability). Regular (all foods allowed).

COMING SOON http://iddsi.org/wp-content/uploads/2013/07/IDDSI-Print-Post-Poster-1-What-is-IDDSI.pdf

References Garcia, J. ,Chambers, E., & Molander, M. (2005). Thickened liquids: Practice patterns of speech-language pathologists. American Journal of Speech-Language Pathology, 14(1), 4-13. Logemann, J. A., Gensler, G., Robbins, J. A., Lindblad, A.S., Brandt, D. K., Hind, J. A. et al. (2008). A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease. Journal of Speech, Language, and Hearing Research, 51, 173-183. Mills, R. H. (2008, October 14). Dysphagia Management: Using Thickened Liquids. The ASHA Leader. Robbins, J., & Hind, J. (2008). Overview of Results From the Largest Clinical Trial for Dysphagia Treatment Efficacy. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 17(2), 59–66. Sharpe, K., Ward, L. Cichero, J., Sopade, P., & Halley, P. (2007). Thickened fluids and water absorption in rats and humans. Dysphagia, 22, 193-203.