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DYSPHAGIA MANAGEMENT DYSPHAGIA MANAGEMENT

DYSPHAGIA MANAGEMENT - PowerPoint Presentation

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Uploaded On 2016-09-12

DYSPHAGIA MANAGEMENT - PPT Presentation

A Collaborative Plan for Successful Interventions Joseph L Garcia MSCCCSLP STAGE ONE THE ORAL PREP STAGE Begins as soon as food or liquid reaches the lips Labial and lingual structures existing dentition and intraoral musculature are ID: 464849

pharyngeal oral dysfunction patient oral pharyngeal patient dysfunction stage swallow esophageal training food solids liquids dietitian nutritionist bolus weight

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Slide1

DYSPHAGIA MANAGEMENT

A Collaborative Plan for Successful Interventions

Joseph L. Garcia, MS-CCC/SLPSlide2

STAGE ONE

THE ORAL PREP STAGE

Begins as soon as food or liquid reaches the lips.Labial and lingual structures, existing dentition, and intraoral musculature are all working in unison to have a bolus prepared for a safe and timely swallow.Timely oral preparation of solids and liquids maintains the oral bolus from leaking out of the oral structure and allows it to remain intraorally until it is ready for a safe esophageal transfer.Slide3

Signs and Symptoms of Oral Preparatory Dysfunction:

Perseverative mastication

Heightened or diminished pace of self feeding

Expectoration of solids/liquidsCoughing and chokingTexture avoidance

Protein malnutrition and failure to thrive

Weight lossDrooling with or without meal itemsXerostomiaOral stuffing or oral hoardingSlide4

WHAT CAN BE DONE FOR ORAL PREP DYSFUNCTION:

Texture modifications and analysis of temperatures

Environmental modifications: seating arrangements with talkative eaters

Functional endurance lingual training throughout the dayLabial, lingual, and oral musculature strengthening and resistance trainingCompensatory eating and feeding strategies: lingual or finger sweeps; chin tuck

Alternate liquids with solids to improve bolus breakdown & residual clearance

Energy conservation strategies: small frequent meals; positioning; O2; etc.Staff and family training for improved successReferrals: Speech and Occupational Therapies; Dentist; Dietitian/NutritionistSlide5

STAGE

TWO

–THE PHARYNGEAL STAGE

Occurs immediately after a bolus leaves the mouth by passing over the base of the tongue and through the pharynx. Multiple muscle groups must work strongly, succinctly and simultaneously for a safe pharyngeal phase.Weakened or untimely swallow triggers will significantly increase the potential for aspirants to enter the trachea and/or into the lungs. Pharyngeal dysfunction can occur with both solids and with liquids.Slide6

Signs and Symptoms of

Pharyngeal Dysfunction:

Coughing/choking can be immediate or delayed

GaggingExcessive throat clearing during or after mealsNasal emission of meal itemsLaryngeal bobbing

Absent swallow triggers

Oral holding of meal itemsDehydration and/or weight lossGrimacing and/or turning the head when swallowingComplaints of food or pills that stick in the throatRecurrent pneumonia; URIs; FUOs; tracheal congestionSlide7

WHAT CAN BE DONE FOR

PHARYNGEAL DYSFUNCTION:

Texture

and consistency modifications and analysisElectro-Musculature StimulationPharyngeal strengthening exercises

Palatal lift exercises or prosthetics

Compensatory eating/feeding strategies: chin tuck; double or hard swallow; head turnAlternate liquids with solids for improved pharyngeal cleansingEnergy conservation strategies via small frequent meals; O2Staff and family training for improved successVideofluoroscopic Swallow Study

Referrals: Speech and Occupational Therapies; Dietitian/NutritionistSlide8

STAGE

THREE

–THE ESOPHAGEAL STAGE

The final swallowing stage where a bolus is passed into the esophagus. Peristaltic action pushes food and liquids to the stomach.Upper and lower esophageal sphincters and peristaltic action must work in unison to be effective.UE and LE sphincters are chemically aggravated by highly acidic food and drink causing reflux.Newborns, preemies, diabetics, PEG/NG patients, and those with degenerative neurological disease are at high risk.Slide9

Signs and Symptoms of

Esophageal

Dysfunction

:BelchingEarly satietyWeight loss/failure to thriveDehydrationFoul or sour breath despite good oral

hygeine

Upper GI bleedsReferred globus – the feeling of food getting stuck in the esophagusOdynophagia: pain with swallowingRegurgitation during or soon after mealsRecurrent pneumonia; URIs; FUO’s; delayed tracheal congestionSlide10

WHAT CAN BE DONE FOR

ESOPHAGEAL

DYSFUNCTION

:Physician referral for upper GI testing; gastric dumping; etc.Esophageal dilationPharmaceutical management for lowering acid or for improved peristaltic controlX-ray to determine possible obstruction

Hiatal hernia surgery (not typical)

Leaning away from an obstruction with each swallowAvoidance of tomato and citrus-based productsAvoidance of carbonated drinks and of caffeineLosing weightHead elevation during slumber; never lay flat or on the bellySmaller, lighter mealsGelatin or applesauce chasersReferral to: Speech Therapy; PCP; Dietitian/NutritionistSlide11

COLLABORATIVE DYSPHAGIA MODEL: Developing an Interdisciplinary Team (IDT)

1) First, develop the IDT

Patient and Family (grandparents?)

Speech and Occupational TherapiesPhysicians and NursingTeachers/AidesDietitian/Nutritionist2) Then, develop a plan:Swallowing Eval with POT by the SLPFeeding Eval

with POT by the OT

Dietitian referral for options/replacementsReferrals to specialists as neededTraining resident and POA prior to discharge with dysphagia mgt; meal prep; weight monitoring and with F/U care.Slide12

ONGOING PATIENT DEVELOPMENT FOR EFFECTIVE CARRYOVER

SLP and/or OT treat the patient with the development of goals and their proposed outcomes. Regular screens for ALL

dysphagic

patients.Increased frequency of weight monitoring and I&Os with all patients receiving modified textures or consistencies.Teachers/Aides/Nursing support feeding techniques and strategies for continuous, cross-contextual skills training.Dietitian/Nutritionist develops a focused plan specific to each dysphagic patient to avoid dehydration or nutritional deficiencies.Discharge education from all disciplines.Slide13

BARRIERS

Things we can control:

Siloed

departmentsTerritorial departmentsTime constraintsLack of patient advocacyPerception of food vs. nutritionThings out of our control:Cultural departuresDegenerative disease and wastingExisting comorbidities

Patient non-compliance

Patient/family follow-throughSlide14

QUESTIONS AND ANSWERS:

Joseph L. Garcia, MS-CCC/SLP

joegee_1@yahoo.com

garciaj@mennohaven.org