Adult & Pediatric Swallowing Flashcards
Swallowing/Deglutition
All processes, functions, acts associated w/ intro. of food/material to be swallowed, including preparing, transferring & transportation to stomach
Dysphagia
- result of PHYSIOLOGIC CHANGE in the muscles needed for swallowing; a swallowing disorder that may involve signs and symptoms of mouth, pharynx, larynx, or esophagus.
- -> delay
- -> misdirection
Feeding Disorder
impairment in the process of food transport outside the alimentary system; disordered placement of food in mouth such as weakness or incoordination in hands/arms or children failing to develop/demonstrate dev. appropriate eating/drinking
_______: entry of secretions, food or any foreign objects into airway below the level of the true VFs :: ______: entry of bolus into laryngeal vestibule above the level of the true VFs, which are then ejected from the airway
Aspiration
Penetration
What occurs first: Penetration or Aspiration?
Can one occur without the other?
Penetration occurs before Aspiration.
Penetration can occur without aspiration; aspiration cannot occur without penetration.
_____%: of ALL SLP’s report regular service to dysphagic patients :: ____% : of SLP’s working in hospitals/residential health care settings report service to dysphagic patients.
47%
91%
Adults with diagnosis of what may be affected by dysphagia?
stroke, head injury, progressive neurological diseases, alzheimers, head/neck cancers, tracheostomy, VF dysfunction.
Children with diagnosis of what may be affected by dysphagia?
premie, low BW, CP, craniofacial anomalies, failure to thrive, undernutrition, developmental disability
How much more likely are 85+ year olds more likely to have a diagnosis of dysphagia than those under 25?
18 times more likely
As SLP’s why do we care about dysphagia?
It can lead to aspiration, malnutrition, or dehydration.
How many times a day does an adult typically swallow?
580 swallows/day in normal adults –> affects social life
What are are 2 main priorities and concerns of SLP’s when working w/ patients w/ dysphagia?
- adequate nutrition
- safety of patients during oral feeding
Clinical swallowing and feeding assessments include?
oral mech exam and “bedside” swallow/feeding eval
Instrumental assesment (as appropriate)
- videofluroscopy/MBS/VFS/VFSS
- endoscopy/FEES
SLP’s role in swallowing/feeding disorders (apart from exams)
to:
- identify normal/abnormal swallowing anatomy/physiology
- identify signs of possible/potential disorders in oral/pharyngeal stages
- make decisions about management
- develop treatment plan
- provide treatment
- document progress
- determine appropriate dismissal criteria
- teach/counsel patients/family,
- educate other professionals
- serve as part of a team
- advocate.
Acute: _______ :: subacute: _________
hospital
short term care (rehab/intensive care) or long term care (SNF)
What are the 3 levels of care?
acute
subacute
home health
Acute care setting
- prevalence of swallowing-related disorders is 13% (neurology/neurosurgery)
- due to short stay, swallowing issue must be addressed fast –> may not be enough time or pt cooperation due to mental status
Subacute setting
- PTs not ready for strenuous rehab program
- may require additional medical monitoring
- 5-28 long day stay; 1-2 hr therapy/day
- if swallowing tx goal was formulated in the hospital, the action plan to achieve that goal is implemented here
- after –> may be discharged home, rehab, or SNF
acute/intensive rehab setting aka “inpatient clinic”
- PTs are usually judged to have physical stamina for a full day of tasks
- @ least 3 hrs of therapy/day; 6 days/week
- 1:1 or group; based on therapy needs
“outpatient” rehab setting
- not common for dysphagia therapy
- PTs must be living @ home and visit clinic for therapy
- no nursing services
- must find own transport
Long term care
SNF
- Patients have not responded to attempts @ rehab/not candidates/too ill/chronical medical conditions
- 60% or higher prevalence of disorders are here
- work closely w/ team
Home Health
- Px has left hospital or rehab setting
- Px w/ inability to swallow show receive reglar reevaluations for attempts @ oral feeding
- SLP is responsible for managing swallowing disorder
- consult w/family & patient is important
NICU
- premies need stay in hospital for extended period of time
- specialized interventions are required
- integrated developmental care
- cluster care
What is the ultimate goal for dysphagia therapy?
SLP to maintain their skills, improve swallowing function/safety re-eval for resume oral intake or previous diet
*for some oral intake will not be possible
“Px will tolerate the least restrictive diet to maintain the max/adequate nutrition & hydration w/out overt signs of aspiration.”
