Tour of facility CogLanguage Screening MoCA andor SLUMS Observe patients during mealtime Observe Patient consuming alternate diet Oral Motor Exam When will we go You will go for 2 hours 1x this term ID: 784828
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Slide1
Medical Practicum
Goals/Objectives of First Visit
Tour of facility
Cog/Language Screening
MoCA
and/or SLUMS
Observe patients during mealtime
Observe Patient consuming alternate diet
Oral Motor Exam
Slide2When will we go?
You will go for 2 hours, 1x this term
It is nice to go during mealtime, therefore;
Fridays 11-1
Monday or Tuesday 4-6
Slide3How do I sign up?
Via SIGN UP genius
DO’s – Please carpool if possible
email me with questions or concerns
elisep@uoregon.edu
PLEASE DON’T- email me via sign up genius
Slide4Liquid & Texture Modification in Patients with Dysphagia
Spring
2017
Slide5Swallowing Screening
Have you ever watched people at mealtime?
Dentition
Managing secretions
Pacing ( fast or slow)
Feeding themselves?
Coughing or choking
Slide6GOAL
Primary goal in dysphagia therapy is to meet nutrition and hydration needs by mouth – while minimizing the risk of aspiration
Slide7Approaches to
Treatment of Dysphagia
Compensatory strategies
Compensate for lost function
Do
not target change in swallowing
physiology
Strategies include posture modification,
diet texture modification
etc.
U
sed
during meals
Facilitation strategies
Intended to
change selected aspects of
swallow physiology
No food needed to teach maneuvers
Other
Slide8Compensatory Strategies
Posture modification
Modification of bolus volume
Modification of
liquid and food
consistencies
Modification of how food is presented to
patient
Enhancing
sensory input
Special eating utensils
Slide9Facilitation strategies
Swallowing
maneuvers - examples
Effortful swallow
Supraglottic
/Super-
supraglottic swallowMendelsohn maneuverPhysical Exercises - examplesHead-lift exercisesOral-motor exercises to increase vertical
, lateral ROM of lingual movements
in cancer patients
Slide10Other considerations
Reducing distractions during meals
Assistance during feeding
Support with oral hygiene
Slide11Study – thickened liquids
D
iet texture modification and thickening liquids should be used as a last resort
(
Logeman
, 1998)
Large-scale study with stroke, PD, and dementia patients - compared chin-tuck and thickened liquids
(
Logeman
et al., 2008; Robbins & Hind, 2008)
Part I (N=742) - Eliminating aspiration
49% aspirated on all 3 interventions
Honey-thick liquid < nectar-thick liquid < chin tuck
Part II (N=515) - Preventing pneumonia
Pneumonia within 3 months occurred in 52 participants (11%)
Lower incidence of pneumonia in patients randomized to nectar-thick than those on honey-thick
Slide12Using thickened liquids
Factors to consider
(Garcia et al., 2005; Mills, 2008)
Absorption of water by the digestive system
Patient acceptance of thickened fluid
Mixing characteristics
Starch-based thickener – unstable, thickens over long period of time, varies across liquid types
Xanthan-gum thickener – more stable over time & across liquid types & different temperatures
Slide13Diet Texture Modification
National Dysphagia Diet
NDD Level 1
:
Dysphagia-Pureed (homogenous, very cohesive, pudding-like, requiring very little chewing ability).
NDD Level 2
:
Dysphagia-Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing).
NDD Level 3
:
Dysphagia-Advanced (soft foods that require more chewing ability).
Regular
(all foods allowed).
Slide14COMING SOON
http://
iddsi.org/wp-content/uploads/2013/07/IDDSI-Print-Post-Poster-1-What-is-IDDSI.pdf
Slide15References
Garcia, J. ,Chambers, E., &
Molander
, M. (2005). Thickened liquids: Practice patterns of speech-language pathologists.
American Journal of Speech-Language Pathology
,
14(1), 4-13. Logemann, J. A., Gensler, G., Robbins, J. A., Lindblad,
A.S
., Brandt, D. K., Hind, J. A.
et al
. (2008). A randomized study of
three
interventions for aspiration of thin liquids
in patients
with dementia
or
Parkinson's disease.
Journal
of Speech, Language,
and
Hearing Research,
51, 173
-183
.
Mills, R. H. (2008, October 14). Dysphagia Management: Using Thickened Liquids.
The ASHA Leader
.
Robbins, J., & Hind, J. (2008). Overview of Results From the Largest Clinical Trial for Dysphagia Treatment Efficacy.
Perspectives on Swallowing and Swallowing Disorders (Dysphagia)
,
17
(2), 59–66.
Sharpe, K., Ward, L.
Cichero
, J.,
Sopade
, P., & Halley, P. (2007). Thickened fluids and water absorption in rats and humans.
Dysphagia, 22
, 193-203.