1. Hospital mealtime volunteers workshop
Julie Quinn Speech and Language Therapist (x2712)
21/12/12

2. By the end of the training you will have a better understanding of the:
Prerequisites for safe eating and drinking
Process of normal swallowing
Warning signs of a swallowing problem (dysphagia)
Types of patients who may experience a swallowing problem
Practical strategies to support eating and drinking
Actions to take if there is a problem identified

3. What do you need to do in order to eat and drink safely?

4. The stages of the normal swallow
Write responses on a flipchart

5. Normal swallowing process
Eating and drinking central to our life
Complex and rapid process involving more than 50 muscles
Voluntary and involuntary control
4 stages of swallowing
Frequency 2x times per minute

6. What do we do when we eat and drink?
What position is your head in, in relation to your body?
What do your lips do before and after each mouthful?
What is your tongue doing?
Are you breathing? Do you stop at any point?
Are you able to talk? What happens to your voice box?
How is drinking different from eating?

7. Stages of normal swallowing Stage 1: Anticipatory phase
Environment
Sight, smell, touch
Hand to mouth
Saliva
Access
Health

8. Stage 2 – Oral phase (mouth)
Putting food in mouth
Chewing
Mixing food with saliva
Lips keep the food in the mouth
Tongue moves the food around

9. Stage 3 – Pharyngeal phase (throat)
Involuntary phase
Airway shuts to stop food / drink going wrong way
Muscles of throat push food down towards oesophagus (gullet)

10. Stage 4 – Oesophageal phase (gullet)
Top of oesophagus (gullet) opens
Food pushed down by rhythmical movement
Sphincter opens at bottom of oesophagus – food enters stomach

11. The normal swallow animation

12. What can go wrong when eating and drinking?

13. Signs of a swallowing problem
Poor lip closure – food / liquid leaking out of mouth, dribbling
Difficulty biting and chewing
Difficulty getting the food into a soft ball in the mouth and moving it backwards
Food pocketing in mouth / sticking to teeth
Food / drink coming down nose

14. Signs of a swallowing problem
Coughing or choking on food and drink
Wet gurgly voice
Increased breathing rate / shortness of breath
Slow to swallow / swallow not triggering
Avoiding certain food textures
Food sticking in the throat
Fear of eating
Recurrent chest infections

15. What are the main causes of swallowing problems (dysphagia)?

16. Potential Causes of swallowing problems
Neurological changes - stroke, parkinson’s disease, MS, head injury
Dementia (in end stages)
Structural changes – cancer of the mouth / throat, surgery or trauma, laryngectomy
Severe confusion / deliruim
Reduced levels of consciousness

17. Potential consequences of a swallowing problem
Chest infection / pneumonia
Malnutrition / dehydration / weight loss
Longer stays in hospital
Slower physical recovery
Anxiety / distress / embarrassment
Reduced quality of life

19. What do you do if you think that someone has a swallowing problem?
Stop! Report to the nurse immediately

20. Vulnerable patients – Issues for discussion
Involving mealtime volunteers with patients who:-
have swallowing problems???
are challenging because of their behaviour??
Need to be fed??

21. Thank you for listening
Any comments, questions?