Medical Practicum Goals/Objectives of First Visit - PowerPoint Presentation

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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

When 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

How 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

Liquid & Texture Modification in Patients with Dysphagia

Spring

2017

Swallowing Screening

Have you ever watched people at mealtime?

Dentition

Managing secretions

Pacing ( fast or slow)

Feeding themselves?

Coughing or choking

GOAL

Primary goal in dysphagia therapy is to meet nutrition and hydration needs by mouth – while minimizing the risk of aspiration

Approaches 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

Compensatory 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

Facilitation 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

Other considerations

Reducing distractions during meals

Assistance during feeding

Support with oral hygiene

Study – 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

Using 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

Diet 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).

COMING SOON

http://

iddsi.org/wp-content/uploads/2013/07/IDDSI-Print-Post-Poster-1-What-is-IDDSI.pdf

References

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.