dysphagia3 trombly feeding evaluation+ Flashcards
After completing the prefeeding assessment what must be decided?
if a feeding evaluation can be safely done or if a vidofluoroscopic evaluation is indicated
in general:
-if total oral then?
-if nonoral then?
-if modified diets, are partial oral feeders, or have had previous _______ ______ should be?
ultimately the decision at this point is guided by what?
-total oral - should undergo a feeding evaluation
-nonoral - should have videofluoroscopic evaluation before taking food by mouth
- videofluoroscopic eval - evaluated on an individual basis
-guided by the institutional policy and procedures
During the feeding assessment the evaluation will observe (3)
postural control, respiratory function, and alterations in cognition or behaviour as relate to feeding process
When determining swallowing capabilities NB to include:
various consistencies, variety of methods of intake, and different bolus sizes
If decreased oral control or delayed initiation of swallow response use what type of foods?
these require very little what?
and provide what information to the person?
prevents what from happening?
purees and thickened liquids
very little bolus formation
sensory info to the tongue about taste and texture,
and viscosity prevents premature loss into the pharynx
If upper esophageal sphincter dysfunction or decreased pharyngeal constrictor activity is suspected use what type of foods?
thin liquids and thinned purees because of fluid state
Bolus size depends on
if no signs of dysfunction with small bolus then …… until what point?
patients performance with various textures and small bolus size(1/4-1/2 tsp)
-then bolus size can be increased until symptoms occur or a normal bolus is swallowed w/o difficulty
self feeding will depend on
patient cognitive ability and motor
To observe anticipatory phase observe:(3)
patient’s hand to mouth patterning if self feeding, awareness of the feeding process, and anticipatory mouth opening in response to the food.
to observe preparatory phase record: (4)
ability to remove food from the utensil, prevent anterior spillage of material, thoroughly masticate food, and swallow bolus w/o leaving residue in cheek or on tongue
are clinical observations of feeding definitive in detecting asperation?
no
videofluoroscopy defined
able to visualize the:
allows for _____ ______ of the nature and extent of swallow dysfunction, including if _____ is occuring, and the patients _________ to asperation.
Also what strategies can be observed and effectiveness determined?
-highly specialized testing uses radiographic equipment to view swallowing function dynamically
-preparatory, oral, pharyngeal, and esophageal stages of swallow
- accurate identification, asperation, response.
-compensatory strategies
Before treatment begins, and before talking with family
the team has to discuss the findings of evaluation and recommendations.
feeding eval complete, 3 things needed for treatment team
summarized info obtained, identify problems, and make recommendations to team
Summarized info obtained should include:
ex?
-key info from history, prefeeding, and feeding components of eval
-“weight loss, decreased cog, multiple stage swallow impairment, following recommendations are being made”
recommendation section of report should include: (10)
feeding status
diet and liquid levels
medication form and method of intake
body position during and following feeding
feeding strategies
compensatory strategies
therapeutic exercises
recommended consults
need for videofluoroscopic eval and reevaluation
and long term therapeutic goals.
Team review
multiple issues can be involved: (5)
risk of complications if nonoral feeding source recommended
patient and family refusal
time required to feed safely - burden to caregiver
can nutritional adequacy be achieved on proposed diet
do recommendations take into account disease progression
Family and patient education
timing
benefits
receive info and have input as decisions are made
the more info they have about the patients dysphagia the more likely they are to follow guidelines, support and encourage patient
Treatment
4 areas
diet modification
equipment
compensatory strategies to maximize safety
remediation and direct treatament
why Diet modifications
they can exist with?
work closely with what professional to identify diet level
-attempt to allow for safe oral intake and adequate nutrition and hydration
-multiple levels of food and liquid
-clinical nutritionist
progression from nonoral to oral feeding has a typical progression (6)
nonoral - patient recovers swallowing abilities / compensation tech ( increased ability to handle secretions & change in videofloro test) - therapeutic feedings by allied health (intake increases safe feeding behav noted) - eat under supervision of health provider or trained family identified as partial oral feeder - if continue to improve to drink enough fluid and take medication and nonoral feeding source removed - diet consistency upgraded as skills develop w/ goal of returning to normal diet
Equipment to assist patient needs what 2 educations with family and patient
how to use
cleaning
In addition to treatment, what can be done to stimulate oral cavity and reinforce _____ _____
oral hygiene and prefeeding and feeding activities
normal patterning
therapeutic intervention focusing on (4) things will enhance dysphagia interventions
postural and limb control
cognitive, behavioral, and perceptual remediation
Progression of treatment should be made based on?
individual performance with appropriate grading to ensure safety
effectiveness of intervention?
treatment vs nontreatement was effective in decreasing occurance of aspiration pneumonia in dysphagia
problem: Impulsivity
Treatment:
compensatory:
supervise feeding
require placement of utensil on table after each bit4e
present one food item at a time
problem: poor judgement
Treatment:
Compensatory:
use small-bowled utensils to decrease bolus size
for liquids use of covered cup with small opening or pinch straw to limit amount
problem: poor attending
Treatment:
Compensatory:
feed in a quiet distraction-free environment
Problem: facial weakness
Compensatory:
Diet consists of - purees, ground foods with sauce, and thickened liquids for easy control
Place food: toward back of mouth, on stronger side of mouth,
Tilt head: toward stronger side
Therapist places finger around lips to assist with closure
Remediational:
Tactile stim of face: tapping or quick stretch
facial exercises using mirror for feedback
sucking or blowing activities with increasing resistance
Problem: poor lingual control
Compensatory:
Diet consists of - food requiring little oral manipulation
Place food: toward the back of mouth
Tilt head: towards the stronger side, forward and backward head mvmt to assist with bolus propulsion
oral inspection after mealtime to check for residue
Remediational:
Tongue: range of motion exercises, resistive exercises, gauze or gum in gauze exercise
(place in patients mouth with tail sticking out, ask to move right to left or foward and back and observe oral manip by watching tail)
encourage precise articulation
Problem: Swallow Delay
Compensatory:
Diet excludes thin liquids
Chin tucked to chest to max airway protection
head rotation to weaker side
Remediational:
Thermal stim
(sterile #00 laryngeal mirror dipped in ice water 10 sec, stroke faucial arch 5 - 10 times, and a swallow is requested, alternate between R and L sides, treatment stops after 5 min or fatigue occurs by increased time before initiation or coughing / choking)
