Transcript DYSPHAGIA

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


aspiration pneumonia rates highly correlated with morbidity
rates (40%)
(Aviv, 2001)
Malnutrition

47% of patients with dysphagia experience

Dehydration

Strokes

45% prevalence
(Elmstahl, Bulow, Ekberg et al., 1999)
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
Speech and Language Therapy
Whitchurch Community Hospital
FOOD & DRINK CONSISTENCIES
Name:
Mrs Sophia Lauren
WHAT:-
Puree Diet
Thickened Fluids
HOW:- Sitting Upright and Alert
√
X
Specific Information:
1.
2.
3.
4.
Needs verbal prompting to open her mouth.
Give small mouthful at a time.
Encourage to swallow x2 to completely clear.
No chocolate button, at risk of choking.
Stop if
Excessive Coughing, Voice sounds wet/gurgly, Patient tries to
throat clear a lot. Chest deteriorate, Tiredness occurs,
Should you notice any of the above signs contact the Speech therapist for advice?
Please send with patient on transfer or discharge )
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
Stage 2
Yoghurt like
Stage 3
Thick custard
THICKENING DRINKS
Use beaker
Cup 200ml
Use level scoop
from tub
stir in
with fork
Texture
Description
Naturally Thick
Leaves a coating on an
empty glass
Like tomato juice
1½
Stage 1
Semi thick
Runs off spoon slowly
syrup-like
2½
Stage 2
Thickened
Drops off spoon rather
yogurt-like
3
Stage 3
Very thick
Comes off spoon in one
lump (holds its own shape)
like thick custard
4
Example
Allow 1minute
standing time
How much (scoops)
than pours
Treatment by SLT





Exercises
Diet Modifications
Sensory Stimulation
Electrical Stimulation
Compensatory
Strategies/Postural
Techniques
Ertekin, Keskin, Kiylioglu et al
2001

Swallow Maneuvers

Alternative Feedings

Patient & Family
Education
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.
Questions