Lecture 3 Flashcards
Decisions after CBE
- no EDS issue, discharge from SLT
- onward referral; not SLT scope
- make recommendation for NBM
- make recommendations for diet and fluids +/- conpensatory strategies
- consider candidacy for rehabilitation
- unclear what is happening with swallow
Term for pain when swallowing
Odynophagia
Videofluoroscopic swallow study (VFSS) (objective assessment)
- a dynamic, radiological assessment considers oral, pharyngeal and upper oesophageal phases of swallowing
- identifies aspiration, penetration, structural abnormalities
What to consider for VFSS
- level of consiousness
- ability and/or willingness to follow instructions
- posture, sitting or standing balance
- medical fitness for journey, exam and potential waiting time
Disadvantages of VFSS
- can be expensive
- radiation limits the frequency (for clinician and client)
- need trained SLTs
- availability
Fibreoptic endoscopic evaluation of swallowing (FEES)
- can be used to compliment VF studies with reduced cost and risk
- provides data regarding flow of food and fluid pre swallow and the amount of residue post-swallow
- can be left in place for long period of time and May be more appropriate for patients who cannot tolerate transfer to a radiological suite
- provides accurate information on vocal fold movement
Other assessments that are less commonly used
- high resolution
- ultrasound
- IOPI (The Iowa Oral Performance)
- surface electromyography
Principles of management plans
- base your management on a solid assessment (solid means integrating your data from a range of sources)
- you should always involve MDT collagues
- you should take patient preferences into account when planning and have their agreement
Nasogastric feeding (NG)
- a feeding tube is passed through the nose, down oesphagus and into the stomach
- temporary measure
- a dietician calculates nutritional requirements
Percutaneous endoscopic gastronomy (PEG)
- more permanent but can be removed
- an endoscope with a powerful light source identifies the point of incision. A thread is pulled through the needle at incision, pulled up but the endoscope, attached to the PEG tube and pulled back down
Accommodating dysphagia
- accommodate rather than trying to change dysphagia
- aim to achieve a safe functional, efficient swallow
- not intended to change the swallow
Reasons for postural changes in EDS compensation
- aims to redirect the bolus to compensate for weakness
- can change the sensory input
- Influence pressure changes in the pharynx
Alternate liquids/solids (wash down)
Clears oral cavity
Rate of intake
Eating at a steady pace/pace you can maintain
Bolus placement in oral cavity
3 second prep
Count to 3 before swallow
Cued swallow
Someone else counts and prompts swallow
Double swallow
Clear oral cavity
Effortful swallow
Squeeze muscles, clear as much as possible, can be tiring
Suck swallow
Suck and swallow
Dump and swallow
Place right at back of cavity, likely for someone with tongue removal
