Copyright © 2008 Delmar. All rights reserved. Unit Ten Dysphagia

Copyright © 2008 Delmar. All rights reserved. Chapter 40 Normal Swallow Function and Dysphagia

Copyright © 2008 Delmar. All rights reserved. 3 Dysphagia Difficulty swallowing that occurs when impairments affect any of the four phases of swallowing that puts a person at risk for aspiration

Copyright © 2008 Delmar. All rights reserved. 4 Dysphagia Team approach is required: –SLP –Dentist –Dietician, PT, RT, OT, ENT –Neurologist –Gastroenterologist –Pharmacist

Copyright © 2008 Delmar. All rights reserved. 5 Four Phases of the Normal Swallow Oral preparatory phase Oral phase Pharyngeal phase Esophageal phase

Copyright © 2008 Delmar. All rights reserved. 6 Oral Preparatory Phase Thinking about food/liquid and how to get it to the mouth Chewing the food in our mouth

Copyright © 2008 Delmar. All rights reserved. 7 Oral Phase Begins when chewing stops Tongue pulls the food to the back of the mouth Takes one second

Copyright © 2008 Delmar. All rights reserved. 8 Pharyngeal Phase Bolus contacts anterior faucial pillars and initiates the swallow response Soft palate rises Peristalsis moves the bolus down Vocal folds close tightly Esophageal sphincter pulled open

Copyright © 2008 Delmar. All rights reserved. 9 Esophageal Phase Bolus carried to lower esophageal sphincter to enter stomach

Copyright © 2008 Delmar. All rights reserved. 10 Oral Preparatory Phase Problems Decreased awareness of food Difficulty holding food in mouth Pocketing food in cheeks Premature spillage of food into airway

Copyright © 2008 Delmar. All rights reserved. 11 Oral Phase Problems Anterior spillage Premature spillage into airway Difficulty moving bolus back towards pharynx

Copyright © 2008 Delmar. All rights reserved. 12 Pharyngeal Phase Problems Delayed swallow response Impaired coordination of oral and pharyngeal structures Weak elevation of velum Inadequate closure of vocal folds

Copyright © 2008 Delmar. All rights reserved. 13 Esophageal Phase Problems Upper esophageal sphincter does not open Slow or absent esophageal peristalsis

Copyright © 2008 Delmar. All rights reserved. 14 Penetration and Aspiration Penetration –Material enters larynx and remains above the vocal folds Aspiration –Material goes below level of the vocal folds

Copyright © 2008 Delmar. All rights reserved. 15 Aspiration Pneumonia Acute inflammation caused by material entering the lungs through the airway Symptoms include spiked temperatures, myalgia, and productive cough

Copyright © 2008 Delmar. All rights reserved. Chapter 41 Diagnosis of Dysphagia

Copyright © 2008 Delmar. All rights reserved. 17 Evaluation of Adults Review medical chart Screen patient –Behavioral observations –Interview –Check for protective cough

Copyright © 2008 Delmar. All rights reserved. 18 Bedside Evaluation Evaluate all speech systems Patient drinks and eats selected consistencies of liquids and food Monitor for signs of aspiration –Coughing, wet voice quality

Copyright © 2008 Delmar. All rights reserved. 19 Modified Barium Swallow Study “Gold standard” of instrumental assessment A dynamic imagining of the bolus from entering the mouth to entering the stomach

Copyright © 2008 Delmar. All rights reserved. 20 Fiberoptic Endoscopic Evaluation of Swallowing (FEES) Provides information about pharyngeal phase Endoscope is passed through nose into nasopharynx Laryngopharynx can be viewed while patient eats

Copyright © 2008 Delmar. All rights reserved. 21 Ultrasound Imaging Noninvasive imaging that uses sound waves to view the oral and laryngeal structures

Copyright © 2008 Delmar. All rights reserved. 22 Evaluating Infants and Children Review medical chart Assess postural control and muscle tone Note respiratory function/endurance Evaluate oral structures Complete feeding/swallowing evaluation Instrumental assessment

Copyright © 2008 Delmar. All rights reserved. Chapter 42 Treatment of Dysphagia

Copyright © 2008 Delmar. All rights reserved. 24 Feeding Environment Environment for eating will affect the experience with meals SLPs can be limited in modifying many aspects of the hospital environment and its distractions

Copyright © 2008 Delmar. All rights reserved. 25 Textures and Consistencies of Food and Liquid Foods Regular Dysphagia - advanced Dysphagia - mechanical soft Dysphagia pureed Liquid Thin Nectar-like Honey-like Spoon-thick

Copyright © 2008 Delmar. All rights reserved. 26 Postural Techniques Chin-tuck (down) Head rotation Head tilt

Copyright © 2008 Delmar. All rights reserved. 27 Oral-Motor Exercises Can help increase muscle tone and strength

Copyright © 2008 Delmar. All rights reserved. 28 Swallow Maneuvers Used for the pharyngeal phase: –Double or dry swallow –Effortful or hard swallow –Supraglottic swallow –Mendelsohn maneuver –Thermal/tactile stimulation

Copyright © 2008 Delmar. All rights reserved. 29 NPO – Nothing by Mouth Patients who cannot eat orally receive nutrition through entereal feeding: –Nasogastric (NG) tube –Gastrostomy tube (G-tube) –Percutaneous endoscopic gastrostomy (PEG) tube

Copyright © 2008 Delmar. All rights reserved. 30 Goals of Treating Infants and Children Promote adequate nutrition and hydration Develop age-appropriate feeding skills

Copyright © 2008 Delmar. All rights reserved. 31 General Areas of Management for Children Establish optimal feeding readiness Organize oral feeding Establish nonnutritive suck Establish external pacing Establish optimal position

Copyright © 2008 Delmar. All rights reserved. 32 General Areas of Management for Children Develop oral stimulation program Reduce oral aversion Alter consistency, taste, temperature Develop chewing skills Choose feeding utensils

Copyright © 2008 Delmar. All rights reserved. Chapter 43 Emotional and Social Effects of Dysphagia

Copyright © 2008 Delmar. All rights reserved. 34 Emotional and Social Effects Eating is a a social event Diet modifications can reduce enjoyment of eating and affect quality of life

Copyright © 2008 Delmar. All rights reserved. 35 Emotional and Social Effects Anxiety Depression Grief Embarrassment Sense of loss