Communication and Swallowing Dysfunction

Question 1

What are the domains to treat communication and swallowing problems?

Answer 1

Speech sounds
Language
Literacy
Social communication
Voice
Fluency
Cognitive communication
Feeding and swallowing

Question 2

Define speech disorders

Answer 2

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.

Question 3

Define Language disorders

Answer 3

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

Question 4

Define social communication disorders

Answer 4

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.

Question 5

Define cognitive-communication disorders

Answer 5

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.

Question 6

Define swallowing disorders

Answer 6

(dysphagia) are feeding and swallowing difficulties, which may follow an illness, surgery, stroke, or injury.

Question 7

Why is effective communication important and necessary? (bottom line)

Answer 7

When individuals communicate effectively, they are able to express their needs, wants, feelings, and preferences that others can understand.

Question 8

What are some communication deficits?

Answer 8

Aphasia
Cognitive Communication Disorders
Dysarthria
Apraxia
Voice Disorders
Fluency Disorders
Deaf/HOH
Social Communication

Question 9

What is aphasia and how would a pt present?

Answer 9

Language Disorder:
Damage to left hemisphere

Deficit areas:
Understanding
Speaking
Reading
Writing

Question 10

What are the types of aphasia?

Answer 10

Fluent: Receptive aphasia (wernicke)
Non fluent: Expressive aphasia (broca)
Mixed
Anomic (word finding problems)
Transcortical

Question 11

How can we help a pt with fluent vs non-fluent aphasia?

Answer 11

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

Question 12

What are some general guidelines for treating a pt with aphasia?

Answer 12

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

Question 13

What are some common right hemisphere damage cognitive-communication deficits and what are their impacts?

Answer 13

Alzheimer’s disease
Brain tumors
Strokes
TBI

Question 14

What are some common impacts for right hemisphere damage cognitive-communication deficits?

Answer 14

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

Question 15

When do we refer?

Answer 15

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

Question 16

Describe the two motor speech disorders?

Answer 16

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

Question 17

What are some strategies to work with pts who have dysarthria?

Answer 17

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

Question 18

What are some strategies to work with pts who have apraxia?

Answer 18

Limit requesting repetitions as multiple attempts can result in multiple errors and increased frustration
Encourage them to speak slower
Patience is key

Question 19

What are some strategies for patients who have fluency voice disorder?

Answer 19

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

Question 20

What is social communication disorder and what could you see patients struggle with?

Answer 20

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

Question 21

What are some deficits that are specific to TBI and/pr CVAs?

Answer 21

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

Question 22

What are some strategies for pts who are Deaf or HOH?

Answer 22

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

Question 23

What is dysphasia and what are the signs?

Answer 23

Swallowing difficulty:
drinking, chewing, eating, controlling saliva, taking medications

Signs:
Coughing
Gagging
Choking
Increased mouth wiping or drooling

Question 24

What are some risk factors or consequences if pt has dysphasia?

Answer 24

Malnutrition
Dehydration
Aspiration pneumonia
Compromised general health
Chronic lung disease
Choking
Death

Question 25

What is aspiration and what is aspiration pneumonia?

Answer 25

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

Question 26

What are some complications from aspiration pneumonia?

Answer 26

Parapneumonic effusion
Empyema
Lung abscess
Supra infection
Bronchopleural fistula
Respiratory failure
Death

Question 27

What are some risk factors for aspiration pneumonia?

Answer 27

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

Question 28

What are some assessments for dysphagia?

Answer 28

Should include an instrumental
assessment: VFSS vs FEES and prior studies
Assessment of oral mechanism and cranial nerves
Medical records, medications, radiation
status

Question 29

What are some considerations of TBI when assessing for dysphagia?

Answer 29

Extent of BI
Vent, intubation and/or trash Impairments in positioning or motor control
Physical damage to structures
Sensory disorders
Movement disorders
Cognitive impairment

Question 30

What are the goals of intervention?

Answer 30

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

Question 31

What are strategies to improve the diet of pts with dysphagia?

Answer 31

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)