Adult & Pediatric Swallowing

Question 1

Swallowing/Deglutition

Answer 1

All processes, functions, acts associated w/ intro. of food/material to be swallowed, including preparing, transferring & transportation to stomach

Question 2

Dysphagia

Answer 2

• 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

Question 3

Feeding Disorder

Answer 3

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

Question 4

_______: 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

Answer 4

Aspiration

Penetration

Question 5

What occurs first: Penetration or Aspiration?

Can one occur without the other?

Answer 5

Penetration occurs before Aspiration.

Penetration can occur without aspiration; aspiration cannot occur without penetration.

Question 6

_____%: 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.

Answer 6

47%

91%

Question 7

Adults with diagnosis of what may be affected by dysphagia?

Answer 7

stroke, head injury, progressive neurological diseases, alzheimers, head/neck cancers, tracheostomy, VF dysfunction.

Question 8

Children with diagnosis of what may be affected by dysphagia?

Answer 8

premie, low BW, CP, craniofacial anomalies, failure to thrive, undernutrition, developmental disability

Question 9

How much more likely are 85+ year olds more likely to have a diagnosis of dysphagia than those under 25?

Answer 9

18 times more likely

Question 10

As SLP’s why do we care about dysphagia?

Answer 10

It can lead to aspiration, malnutrition, or dehydration.

Question 11

How many times a day does an adult typically swallow?

Answer 11

580 swallows/day in normal adults –> affects social life

Question 12

What are are 2 main priorities and concerns of SLP’s when working w/ patients w/ dysphagia?

Answer 12

• adequate nutrition

- safety of patients during oral feeding

Question 13

Clinical swallowing and feeding assessments include?

Answer 13

oral mech exam and “bedside” swallow/feeding eval

Question 14

Instrumental assesment (as appropriate)

Answer 14

• videofluroscopy/MBS/VFS/VFSS

- endoscopy/FEES

Question 15

SLP’s role in swallowing/feeding disorders (apart from exams)

Answer 15

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.

Question 16

Acute: _______ :: subacute: _________

Answer 16

hospital

short term care (rehab/intensive care) or long term care (SNF)

Question 17

What are the 3 levels of care?

Answer 17

acute
subacute
home health

Question 18

Acute care setting

Answer 18

• 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

Question 19

Subacute setting

Answer 19

• 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

Question 20

acute/intensive rehab setting aka “inpatient clinic”

Answer 20

• 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

Question 21

“outpatient” rehab setting

Answer 21

• not common for dysphagia therapy
• PTs must be living @ home and visit clinic for therapy
• no nursing services
• must find own transport

Question 22

Long term care

Answer 22

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

Question 23

Home Health

Answer 23

• 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

Question 24

NICU

Answer 24

• premies need stay in hospital for extended period of time
• specialized interventions are required
• integrated developmental care
• cluster care

Question 25

What is the ultimate goal for dysphagia therapy?

Answer 25

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.”