HC 1 General framework Flashcards
What’s the importance of getting the whole ICF picture in treating dysphagia?
Because of the great importance for the patient of the unobservable aspects of the dysphagia: the embarrasment, not having fun eating, the effort,…
=> so you need to work on this in therapy as well!
What do we understand in “body functions and structures”? Which team member could be involved here?
- structure of the tongue
- esophagus
- vocal folds
- sucking, biting, chewing, manipulation of food in mouth
- consciousness & attention
- taste & smell function
- …
==> SLP, doctors, phsyical therapist,…
What do we understand in “activity”. Which team member could be involved here?
- eating
- drinking
- meal preparing
- coughing, choking
- consistencies
- reflexes, habits
==> SLP, doctors, dietitian,…
What do we understand in “participation”? Which team member could be involved here?
- family at the dinner table
- going to a restaurant
- have/attend a birthday party
- weddingcake
- …
==> patients associations
What do we understand in “environmental factors”? Which team member could be involved here?
- availability of aids
- food adjustments
- medication
- other treatments
- …
==> SLP, social worker, psychologist, nurse, occupational therapist,…
What do we understand in “personal factors”? Which team member could be involved here?
- patients preferences in food and drinks
- cultural or religious food choices
- …
==> psychologist, social worker, dietitian,…
Why do we use - besides ICF - EBP as a frame of reference?
Because it leads to the
- best assessment
- best treatment
- best advice
for your patient
Explain the 5 steps of EBP
- ASK: convert the need for information into an aswerable clinical question
- ACQUIRE: track down the best evidence for answering your question
- APPRAISE: critically appraise the evidence for validity, impact and applicability
- APPLY: integrate the evidence into your clinical decision making
- AUDIT: evaluatie steps 1-4 and seek ways to improve next time
We set SMART goals and will achieve it by a SMARTER process. Explain
- SMART: specific, measurable, achievable, realistic and time-bound
- SMARTER: shared, monitored, accessible, relevant, transparent, evolving and relationship-centered
What elements are mandatory to talk about dysphagia?
- structures critical for swallowing are involved: abnormalities in the structures or in their movements
- transport/movement is involved: from mouth to stomach
- safety is involved: (risk of) choking, undernutrition or aspiration pneumonia
How can we classify dysphagia?
1. by age:
- pediatric - adults - presbyphagia
2. by stage:
- oropharyngeal dysphagia: preparation phase, transport phase, pharyngeal phase (mouth & throat)
- esophageal dysphagia: esphageal phase (disturbed peristalsis or obstruction)
3. by etiology:
- neurologic (acute, chronic, degenerative)
- structural (pathology [congenital or acquired] or therapy)
- iatrogenic
- presbyphagia (primary or secondary)
- psychogenic
In which groups is there a high prevalence of dysphagia?
- stroke (acute & chronic)
- stroke brainstem
- TBI (= traumatic brain injury)
- progressive diseases
- head-neck carcinoma
- dementia
- elderly
What are the main medical consequences of dysphagia? Why?
- undernutrition: lower energy levels (important to sustain a swallow), negative effect on immune system => infection, sepsis, death
- aspiration pneumonia: treatment is costly, increased lenght of stay in hospital, greater disability, poorer nutritional status
- dehydration: increase mental confusion + organ system failure => negative effect on swallowing (vicious circle)
==> higher morbidity, higher mortality
What does a SLP have to think about when treating dysphagia?
- is it safe? Airway protection
- is it adequate? Nutrition, hydration
- quality of life
What psychosocial consequences come with dysphagia?
- social interactions: limitations
- affects spouses and family too
- stress when preparing special meals
- increased cost for dietary supplements
Which team members could be involved?
- Speech-language pathologist
- Otolaryngologist (ENT)
- Gastroenterologist
- Radiologist
- Neurologist
- Dentist
- Nurse
- Dietitian
- Occupational Therapist
- Pulmonologist and Respiratory Therapist (= Physical therapist)
- Social worker
What is nasal regurgitation?
Bolus goes partially or fully upwards into the nasopharynx because the soft palate is not entirely closed
Wat is odynophagia
painfull swallowing
What is drooling?
involuntary loss of saliva
Explain the penetration-aspirationscale.
- score 1: no entry of materials into the larynx or trachea
- score 2-5: laryngeal penetration: entry of material into the larynx, but it stays above the vocal cords
- score 6-7: aspiration: bolus passes the vocal cords and enters the trachea
- score 8: silent aspiration: no attempt to clear the trachea
What is aspiration pneumonia?
Infection of the lungs due to aspiration
What is residue?
part of the bolus stays in the back of the mouth after the swallow.
What is premature spillage?
Bolus is going too early from mouth to throat, before swallow is in the pharyngeal fase (dangerous, because the airway is not protected yet and esophagus isn’t opened yet)
- either during preparatory or oral phase
- either prior to onset of pharyngeal swallow
