Communication and Swallowing Dysfunction Flashcards
What are the domains to treat communication and swallowing problems?
Speech sounds
Language
Literacy
Social communication
Voice
Fluency
Cognitive communication
Feeding and swallowing
Define speech disorders
occur when a person has difficulty producing speech sounds correctly or fluently (e.g., stuttering is a form of disfluency) or has problems with his or her voice or resonance.
Define Language disorders
occur when a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings (expressive language).
Language disorders may be spoken or written and may involve the form, content, and/or use of language in functional and socially appropriate ways
Define social communication disorders
occur when a person has trouble with the social use of verbal and nonverbal communication.
These disorders may include problems
- communicating for social purposes (e.g., greeting, commenting, asking questions)
- talking in different ways to suit the listener and setting
- following rules for conversation and story telling.
Define cognitive-communication disorders
include problems organizing thoughts, paying attention, remembering, executive functions, and/or verbal problem solving.
These disorders usually happen as a result of (but not limited to) a stroke, traumatic brain injury, or dementia, as well as, related to congenital disorders.
Define swallowing disorders
(dysphagia) are feeding and swallowing difficulties, which may follow an illness, surgery, stroke, or injury.
Why is effective communication important and necessary? (bottom line)
When individuals communicate effectively, they are able to express their needs, wants, feelings, and preferences that others can understand.
What are some communication deficits?
Aphasia
Cognitive Communication Disorders
Dysarthria
Apraxia
Voice Disorders
Fluency Disorders
Deaf/HOH
Social Communication
What is aphasia and how would a pt present?
Language Disorder:
Damage to left hemisphere
Deficit areas:
Understanding
Speaking
Reading
Writing
What are the types of aphasia?
Fluent: Receptive aphasia (wernicke)
Non fluent: Expressive aphasia (broca)
Mixed
Anomic (word finding problems)
Transcortical
How can we help a pt with fluent vs non-fluent aphasia?
Fluent Aphasia:
Decrease complexity and take breaks between ideas
Decrease length by limit filler words
Use visuals and keep a whiteboard close
STOP their fluency - They will keep talking if you let them
Modeling
Non fluent aphasia:
Ask yes/no questions
Starter phrase or phonemic cue
Ask them to show you: write, draw, gesture
Modeling
What are some general guidelines for treating a pt with aphasia?
Look at the person - watch body language and gestures
Use a quiet place and normal volume
Use simple, ADULT language
Repeat KEY words
Slow down and give them time to respond/speak
Allow mistakes/encourage accuracy
Let them ask for help/intervene before frustration
Routine/write out expectations for the session
Demonstrate positive and patient body language
Talk naturally and deliberately
Do not limit your education or explanations
What are some common right hemisphere damage cognitive-communication deficits and what are their impacts?
Alzheimer’s disease
Brain tumors
Strokes
TBI
What are some common impacts for right hemisphere damage cognitive-communication deficits?
Reduced awareness and ability to initiate and effectively communicate needs
Reduced memory, judgment, and ability to initiate and effectively exchange routine information
Reduced ability to anticipate potential consequences, with reasonable judgment and problem solving
When do we refer?
Basic communication deficits noted
Limited eye contact or abnormal social behaviors
Poor organization
Decreased flexibility
Poor executive functions
Misunderstanding humor
Initiating or terminating a thought
Difficulty managing multiple Responsibilities simultaneously
Describe the two motor speech disorders?
Dysarthria: Refers to a group of neurogenic speech disorders affecting most aspects of speech production
Abnormalities are due to one or more sensorimotor problems weakness or paralysis, incoordination, involuntary movements or excessive, reduced or variable muscle tone
Apraxia: Reduced volitional planning and production of articulatory movements
Difficulty with repetition
Can go by other names
What are some strategies to work with pts who have dysarthria?
Maintain eye contact
Be an active listener
Use specific questions to ask for clarification (you said you want to go where? or repeat that last word)
Give feedback and encouragement
Reduce background noise
Good lighting
Face to face seating and decrease proximity
Ask them to spell out the word and repeat back the letters
Encourage use of a loud voice
Encourage shorter message
Use other communication modalities
What are some strategies to work with pts who have apraxia?
Limit requesting repetitions as multiple attempts can result in multiple errors and increased frustration
Encourage them to speak slower
Patience is key
What are some strategies for patients who have fluency voice disorder?
Encourage them to use a slow rate of speech
Encourage relaxed posture of speech muscles
Respiratory support = better posture
Encourage use of easy onset
Do not interrupt
Allow them to work at their pace
Breathe out when tension noted
What is social communication disorder and what could you see patients struggle with?
Difficulties with the use of verbal and
nonverbal language for social purposes.
You may see difficulty with the following:
Communicate appropriately for the specific social context
Modify their communication to match context
Follow rules of conversation and storytelling
Understand non literate or ambiguous language
Ability to inference
What are some deficits that are specific to TBI and/pr CVAs?
Verbosity (going on and on)
Initiating and maintaining topic
Turn taking
Inhibiting inappropriate language or behavior
Impaired ability to use nonverbal communication effectively
Decreased ability to regulate, express or perceive emotions
Difficulty with perspective and modifying language
Poor monitoring of others nonverbal communication
Tangential
What are some strategies for pts who are Deaf or HOH?
Work in a well lit room
Check batteries in hearing aid
If they can lip read, talk at a normal rate
Keep a whiteboard handy
Use text to speech apps
Pre made directive cards
Use of vibration on device
What is dysphasia and what are the signs?
Swallowing difficulty:
drinking, chewing, eating, controlling saliva, taking medications
Signs:
Coughing
Gagging
Choking
Increased mouth wiping or drooling
What are some risk factors or consequences if pt has dysphasia?
Malnutrition
Dehydration
Aspiration pneumonia
Compromised general health
Chronic lung disease
Choking
Death
What is aspiration and what is aspiration pneumonia?
Aspiration: When foreign material enters the airway (below the level of the vocal cords) or distal lung
Aspiration Pneumonia: Lung infection caused by inhaled oral or gastric contents
Chest x rays used to differentiate
sy/sx: fever, fatigue, cough, SOB, difficultly swallowing, chest pain, profuse sweating, and blueish skin color
What are some complications from aspiration pneumonia?
Parapneumonic effusion
Empyema
Lung abscess
Supra infection
Bronchopleural fistula
Respiratory failure
Death
What are some risk factors for aspiration pneumonia?
poor oral hygiene
compromised immune system
prolonged hospitalization or mechanical respiration
damaged lung tissue
antipsychotic drugs
gastrointestinal motility disorders
radiation therapy to head and neck
alcoholism or substance abuse
malnutrition
hiatal hernia
diabetes
What are some assessments for dysphagia?
Should include an instrumental
assessment: VFSS vs FEES and prior studies
Assessment of oral mechanism and cranial nerves
Medical records, medications, radiation
status
What are some considerations of TBI when assessing for dysphagia?
Extent of BI
Vent, intubation and/or trash Impairments in positioning or motor control
Physical damage to structures
Sensory disorders
Movement disorders
Cognitive impairment
What are the goals of intervention?
Support adequate hydration and nutrition and return to oral intake
Determine optimum supports while maintaining QOL and supporting caregiver
Improve the safety and efficiency of the swallow
What are strategies to improve the diet of pts with dysphagia?
Preparing solids (purees, minced, etc)
Thickening liquids
Diet cards
Positioning (chin down, head tilt, etc)
Pacing (single sips, controlled amounts)
Sequencing (swallow, reswallow, cough, etc)
Adaptive équipement (nosey or weighted cup)
