Dental Care Dysphagia Kathleen Funck

Who am I? –Kathleen Funck Where did I graduate? –LSU Health New Orleans 2014 Where do I work? –Veterans Affairs Medical Center What’s my focus? –Degenerative Diseases About me Kathleen Funck, MCD, CCC-SLP

What we will cover today: Agenda Kathleen Funck Welcome Evaluation and Treatment Dysphagia Who is involved? ✓ Surprise

Kathleen Funck United States Department of Veterans Affairs Defines it as - A swallowing disorder National Institute on Deafness and Other Communication Disorders Defines it as -having difficulty swallowing and may even experience pain while swallowing What is it? Dysphagia

Kathleen Funck Etiologies 1 1 Approximately 71 to 73% of patients with a stroke have swallowing disorders Strokes 51% of patients admitted with severe hcad injury showed pharyngeal problems affecting swallowing Head Injuries 44 Approximately 300,000 to 600,000 people each year Progressive Neurologic Diseases No case is the same and no individual should be treated the same. Every case is unique and different. 2 Head and Neck Cancer 3 severity can depend on the tumor size, staging and location, and the type of surgical resection and reconstruction.

entry of secretions, food, or any foreign material into the airway that travels below the level of the true vocal folds. Material breaches vocal folds into trachea and potentially into lungs without any signs refers only to acts associated with bolus transfer and transport from the oral cavity to the stomach the food, liquid, or other material placed in the mouth for ingestion the entry of secretions, food/liquid, or any foreign material into the laryngeal vestibule above the level of the true vocal folds which are then ejected from the airway. This can occur normally and can also occur before, during, or after the pharyngeal swallow. A channel, or depression between the base of the tongue and the epiglottis Kathleen Funck Terminology Aspiration Bolus Degluttion Laryngeal Penetration Vallecula Silent Aspiration

Phases of a Swallow Kathleen Funck Velopharyngeal port closes Hyoid bone and larynx begin ascent Epiglottis folds down Tongue to the posterior pharyngeal wall Pharyngeal constrictors Cricopharyngeus muscle UES. Pharyngeal Phase 1 1 Oral Phase UES opens and food is propelled down through the esophagus LES opens and food goes into stomach Esophageal Phase Oral Preparatory: reducing food to a bolus and position it for transport. Oral Transport: bolus is prepared for transport from the anterior to posterior oral cavity 33 22

Kathleen Funck Everyone Who is involved? Family and Friends Dietians, Dental Care Speech, Physical, Occupational Therapy Doctors and the Nursing Staff

Your Logo Multi-disciplinary Approach Speech Language Pathologist The goal is to maximize the safety and efficiency of eating. -Feeding evaluations and treatments 84% in hospitals 90% in residential health care Dental Care The goal is to provide daily dental and denture hygiene

Kathleen Funck Symptoms Hesitation to swallow Painful swallow Constant feeling of a lump in the throat Food sticking in the throat Regurgitation Hoarse voice Repetitive swallowing Coughing during or after swallow The feeling having to “wash down” foods Unexpected weight loss

Kathleen Funck It includes a structural and functional evaluation of the muscles and structures used in swallowing, functional evaluation of actual swallowing ability, and judgments of adequacy of airway protection and coordination of respiration and swallowing Videofluorscopic swallowing evaluation (VFSS) Fberoptic endoscopic evaluation of swallowing (FEES ) Evaluations 22 Standardized Testing Instrumental Evaluation Bedside Evaluation Swallowing Ability and Function Evaluation (SAFE) Mann Assessment of Swallowing Ability (MASA)

Kathleen Funck Bedside Evaluation Past medical history Current medical status and medications Nutrition/Hydration Respiratory status Cognitive/Communicative history Posture and Movement Alertness and Awareness Auditory and Visual Acuity Oral Motor Exam Laryngeal Function Respiratory Status Trial Swallows

Kathleen Funck Videofluoroscopic Swallow Study Bolus Size Texture Position of Patient Radiographic focus of the structures More Accurate

VFSS Videofluoroscopic Swallow Study

VFSS Videofluoroscopic Swallow Study

Treatment Your own footerYour Logo 33 Head Down Head Back Head Turn Head Tilt and turn Postures Take a breath Hold it while swallowing Then cough after the swallow Supraglottic Swallow 1 1 same procedure as with the supraglottic swallow, but bear down while holding breath Supersupraglottic Swallow 2 Turn head to weak side and tilt head to strong side learns to use muscles to keep the larynx elevated for several seconds after the swallow. Mendelsohn Maneuver 4 4 Tapping or rubbing of the faucial pillars using frozen q-tips, or lemon ice Presenting a warm or cold bolus strong tastes or textures Pressing the spoon on the tongue when food is presented Thermal and Tactile Stimulation 5

Kathleen Funck Diets Level 2: Mechanical Altered Level 1: Pureed This is placeholder text. Level 3: Advanced Level 4: Regular

Kathleen Funck Liquids Thick Thin This is placeholder text.

Material aspirated is heavily colonized with bacteria. Rapid development of extensive bacterial colonies around the teeth will lead to colonization by respiratory pathogens. The risk becomes increasingly prevalent the longer a dependent patient resides in a health care environment. All of these patients are at elevated risk for aspiration- related pneumonia if not provided good dental hygiene. Kathleen Funck Important? Patient Professiona l Staff Better quality of life

Test your knowledge Kathleen Funck TrueFalse OR

Stroke is the leading cause of neurologic dysphagia? Kathleen Funck TrueFalse OR

More than 60,000 people die annually from complications related to dysphagia, making it the sixth leading cause of death in the United States? Kathleen Funck TrueFalse OR

Videofluoroscopic examination is essential and the same assessment techniques may be used with all patients with dysphagia? Kathleen Funck TrueFalse OR

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