Karen Jackman Specialist Speech & Language Therapist DYSPHAGIA Karen Jackman Specialist Speech & Language Therapist

Overview Dysphagia definition Normal Swallow Signs/Symptoms of Dysphagia Role of SLT Diet Consistencies, Thickeners Treatment & Positioning

Dysphagia (dis-fay-juh) Difficulty swallowing Not a disease but a symptom of other disorders that may affect swallowing Can be present in any 3 of the stages of swallowing

Oral Stage Oral preparation-Chew the food and mix with saliva Oral stage – requires normal musculature and coordination with respiration Lasts only 1-1.5 seconds normally

Pharyngeal Phase Begins once the bolus passes tongue base Sensory receptors send signal to brain to trigger swallow Airway closed Lasts 1 second or less

Video fluoroscopic Image of Pharyngeal stage of swallow

Oesophageal Stage Takes place from the time the bolus enters the upper esophageal sphincter (UES/ cricopharyngeus) until it passes through the lower esophageal sphincter (LES) Time varies from 8-20 seconds

Signs & Symptoms Dysphagia Coughing before, during or after the swallow Frequent coughing during or after a meal Recurrent pneumonias Weight loss Wet, gurgly vocal quality Temperature spikes Increase in secretions Patient complains of having difficulty Logemann, 1998

Significance Pneumonia Malnutrition Dehydration Strokes aspiration pneumonia rates highly correlated with morbidity rates (40%) (Aviv, 2001) Malnutrition 47% of patients with dysphagia experience (Elmstahl, Bulow, Ekberg et al., 1999) Dehydration Strokes 45% prevalence

Role of SLT Assess Dysphagia Diagnose Make appropriate diet and liquid recommendations Treatment

Assessments done by SLT Bedside Swallow Evaluation (BSE) Videofluoroscopy (Logemann, 1998)

Diagnosed by SLT Based on clinical signs/symptoms presented during BSE SLT assesses stages of swallowing Assess if dysphagia present and recommend diet/liquids

Diets & Thickened Liquids

Diet recommendations: food Thin Puree Cold Soft smooth Puree Soft Fork Mashable (no bread) Normal Diet (softer options) Normal diet

Thickened Liquids Naturally Thick Tomato Juice Stage 1 Syrup like Yoghurt like Stage 3 Thick custard

Treatment by SLT Swallow Maneuvers Exercises Diet Modifications Alternative Feedings Patient & Family Education Exercises Diet Modifications Sensory Stimulation Electrical Stimulation Compensatory Strategies/Postural Techniques Ertekin, Keskin, Kiylioglu et al 2001

MOUTH CARE! Oral infections are a major contributing factor in chest infections. Don’t forget mouth care, especially if they are NBM.

REFERRALS Referrals for SALT can be made by any qualified member of staff and must be written (ideally, first two pages of the SAP) and then phoned through to extension 1417 or faxed to 261067. Appropriate-Is the patient conscious and well enough to be assessed?

References Aviv, J. (2001). Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEEST). Retrieved September 24, 2003, from eMedicine.com. Elmstahl, S., Bulow, M., Ekberg, O., Petersson, M. & Tegner, H. (1999). Treatment of Dysphagia Improves Nutritional Conditions in Stroke Patients. Dysphagia 14: 61-66. Ertekin, C., Keskin, A., Kiylioglu, N., Kirazli, Y., Yagiz, O.A., Tarlaci, S & Aydogdu, I. (2001). The Effect of Head and Neck Positions on Oropharyngeal Swallowing: A Clinical and Electrophysiologic Study. Archives of Physical Medicine and Rehabilitation 82. Logemann, J.A. (1998). Evaluation and Treatment of Swallowing Disorders. Austin: Pro-Ed. Palmer, J.B., Drennan, J.C. & Baba, M. (2000). Evaluation and Treatment of Swallowing Impairments. American Family Physician. Speiker, M.R. (2000). Evaluating Dysphagia. American Family Physician.

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