Class #2 Overview Flashcards
What is Dysphagia?
From the Greek root:
A ______, not a disease, with clinical signs
phagein (to ingest)
With the prefix ‘dys-’ meaning a disorder
symptom; disease
Definition of Dysphagia
Simplest and most frequently used definition:
Difficulty moving food from the mouth to the stomach
Expanded by Leopold & Kagel (1996)
Dysphagia is all of the behavioral, sensory, and preliminary motor acts in preparation for the swallow including cognitive awareness of the upcoming eating situation, visual recognition of food, and all of the physiologic responses to the smell and presence of food such as increased salivation.
Text prefers:
Tanner (2006),
“Dysphagia:
[an] impairment of emotional, cognitive, sensory, and/or motor acts involved with transferring a substance from the mouth to the stomach, resulting in failure to maintain hydration , nutrition and posting a risk of choking and aspiration” (p. 152.)
Feeding Disorder vs. Swallowing
Feeding:
Swallowing:
placement of food in the mouth, manipulation of food in the oral cavity prior to the initiation of the swallow including mastication of food and the oral state of the swallow when the bolus is propelled backward by the tongue. Oral prep and oral stages of the swallow
techniques for reducing delay in triggering the pharyngeal swallow, improving pharyngeal transit time and the individual neuromotor actions comprising the pharyngeal stage of the swallow and well as all of the techniques to improve the oral prop and oral stages of the swallow –the entire act of deglutition from placement in the mouth until material enters the stomach.
Textbook on Difference….
Swallowing disorder:
Feeding disorder:
Eating disorder:
the act of swallowing
result of weakness or incoordination I the hand or arm used to move the food from the plate to the mouth
anorexia or bulimia nervosa: poor appetite, changes in dietary selections, problems with oral preparation of the bolus, may have swallowing difficulties.
Who manages dysphagia?
Dysphagia Team Members:
Speech Language Pathologist- often the team leader/coordinator
(additional role of the SLP)
Otolaryngologist: for structural problems
Gastroenterologist: esophageal issues
Radiologist: MBS
Neurologist:often neurological etiologies
Dentist: missing teeth/ denture issues
Nurse: have the most contact with the patient
Dietician: monitor/ educate about special diet
Occupational Therapist: help get the food from the plate to the mouth
Respiratory Therapist
Physical Therapist: hand/ arm strength
Neonatal Development Specialist: development issues
History of SLPs and Dysphagia
History of dysphagia study: Late ____ and early ______
Special interest division formed in 1992 Swallowing and Swallowing Disorders –
Specialization now available:
1970s
1980s
Division 13.
Board-Recognized Specialist in Swallowing and Swallowing Disorders (BRS-S)
Today
Swallowing is one of the __ major areas of _______ now.
The Standards and Implementation for the CCC in SLP (2005) Standard III-C states:
9
required knowledge
specific knowledge in the area of swallowing (i.e. oral, pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myofunction) is required .
ASHA 2002 Omnibus Survey:
__ of SLPs in residential health care work with dysphagia
___ in hospitals
____ in non-residential health care,
___ in schools.
Recent Health Care survey (2002) SLPs in adult health care settings spend ___ of their time in services related to dysphagia
90%
84%
50%
11%
31%
Incidence and Prevalence
Incidence:
Prevalence:
Prevalence and incidence help…
Prevalence of dysphagia is highest among those with ___________
Reported frequency of new occurrences over a period of time (e.g. a year) related to a population
Number of cases in a population during a shorter period, often a specific setting
medical personnel who screen, hospital administrators, third-party payors, groups like ASHA.
neurologic disease
Prevalence
ASHA: about _____to _______ new cases are identified annually.
Acute care= ___ of all patients are dysphagic
Acute Rehab. = ___
Chronic Care = ___
300,000 to 600,000
1/3
42%
60%
Prevalence By Setting
General Community: Among older persons, dysphagia at ______
Acute care intensive care units and skilled nursing facilities– ______ risk for dysphagia,
-Varied reports: as high as ___ nursing home residents at risk.
Acute General Hospitals:
Groher & Bukatman = ____
Acute Rehab. Hospitals: About ___
16-22%
highest; 87%
13%
1/3
Levels of Care
Acute Care Setting: traditional hospital setting
Subacute Care Setting: bridge between acute care and rehab. They need a little more assistance before they can are ready for rehab.
Rehabilitation Setting
Skilled Nursing Facility-SNF
Unit: Not ready to go home yet
Home Health
Signs/Complaints indicating Dysphagia
Coughing
Choking: during or after a meal
Food sticking
Regurgitation
Odynophagia- painful swallowing
Drooling
Unexplained weight loss
Nutritional deficits
By Disorder
Most likely to be due to ________
Stroke: Acute= ____ or more; reduced to 10-28% in a week.
Daniels: ___ of patients had dysphagia, ___ silent aspirators, long-term, ____ returned to oral intake. Not dependent upon whether silent or not.
neurological diseases
50%
65%
2/3
94%
By Disorder (CVA)
Right CVA- _______
Left CVA- _______
Bi-lateral CVA- ______
Brainstem CVA- _________
Pharyngeal phase
Oral phase
overall problems
no swallow reflex
Cancer, TBI, Spinal Cord Injury
Head/Neck Cancer: ____ symptoms of dysphagia
Head injury: Reports range from ______ (due to different severity levels)
59%
4.5%-78%
Traumatic Brain Injury
____ have dysphagia
delayed or absent ____
cognition
laryngeal penetration w/out _____
1/4
reflex
cough
Spinal Cord Injury
a)
b)
Any Tumor involving the _________
-__________
________ changes
a) tongue base
b) laryngeal elevation
alimentary tract
Dementia
Age-related
Disorders, Cont.
Motor Neuron Diseases
- Progressive Neurological Disorders:
2. 3. 4. 5. 6.
Amyotrophic lateral sclerosis Multiple sclerosis Myasthenia gravis Parkinson’s Disease Huntington’s Disease Progressive Supranuclear Palsy Wilson’s disease
- Cerebral Palsy
- Guillain-Barre Syndrome
- Poliomyelitis
- Infectious disorders
- Myopathy
Other Disorders 1. 2. 3. 4. 5. 6. 7.
- Connective tissues/Rheumatoid Disorder
- Polydermatomyositis
- Progressive systemic sclerosis
- Sjogren’s disease
- Scleroderma
- Overlap syndrome
- Acquired Immune Deficiency Syndrome (AIDS Dementia)
Iatrogenic Diagnoses:
Radiation Therapy
Chemotherapy
Intubation or tracheostomy
Post surgical cervical spine fusion
Post surgical coronary artery bypass grafting
Medication related
Other related disorders
- _______ infants
- Severe _________
- ________ conditions
pre-mature
respiratory compromise
psychogenic
Consequences of Dysphagia
Aspiration: material enters airway below the vocal folds
Aspiration Pneumonia: lung infection resulting from aspiration
Dehydration
Immune System Failure (infection, sepsis, death)
Psychosocial Issues
Clinical Case 1-1- pg. 4 of Text
Practice Note 1-2
Delay or misdirection of bolus
Two hallmarks of dysphagia:
- Delay in propulsion from mouth to stomach
2. Misdirection of bolus – enters airway
Stages of the Swallow
- (Anticipatory)- Logemann
- Oral
a) Oral Preparatory
b) Oral Transit - Pharyngeal
- Esophageal
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