Management of the Patient with Dysphagia Flashcards
Clinical Questions To Think Of Prior to Therapy
- What type of nutritional management is necessary?
- Should Tx be initiate and what type?: Compensatory, Exercises, Direct, Indirect
Clinical Questions to Think of During Therapy
Does the patient require a maintenance program to maintain the gains in therapy or slow deterioration?
Main Goal for any dysphagia treatment plan
Re-establishment of oral feeding while constantly maintaining proper hydration, nutrition, and safe swallowing
Diagnosis- Primary factor in deciding whether to initiate therapy
Knowledge of the speed and potential of the patient’s swallowing disorder
Diagnosis- Therapy Considerations
- Compensatory strategies may only be necessary if a patient is likely to recover quickly (i.e., stroke without other medical complications – recovery may be within 1-2 weeks)
- Effortful swallows and active exercise may be inappropriate for patients that have motor neuron disease secondary to fatigue (i.e., Myasthenia Gravis- clients fatigue over time because of constant muscle activity)
- Dementia patients may not be a candidate for therapy as they are unable to follow directions
Prognosis- Sudden onset neurological damage
- stroke
- head injury
- spinal cord injury
- structural damage (surgical, radiation therapy from head and neck cancer, gun shot wound, other trauma)
Tx is appropriate as there is potential for partial or full recovery of PO intake
Prognosis- Progressive degenerative disease
- Parkinson’s
- Motor neuron disease
- Myasthenia Gravis
- Multiple sclerosis
- Various types of muscular dystrophy
- Alzheimer’s disease
Tx may not be appropriate because of eventual loss of motor control or cognitive abilities to ensure safe swallowing via compensatory strategies or active treatment
Compensatory Strategies
If compensatory strategies alone are successful in eliminating the symptoms of dysphagia (aspiration, residual material): swallowing therapy may not be warranted
Severity of Dysphagia
If compensatory strategies alone are unsuccessful: swallowing therapy may warrant a variety of exercises to improve the range and coordination of the oral and oropharyngeal movements necessary without giving solid/liquid (pre-feeding therapy)
Following directions
- Determine if Pt can follow simple and complex directions
- Swallowing maneuvers are complex
- Compensatory strategies rely more on caregiver
Respiratory function
-Normal swallowing requirements:
0.3 to 0.6 seconds for sip of liquids
3 to 5 seconds for continuous cup drinking
- Supraglottic and Super-Supraglottic swallows require modification of airway closure duration
- Effortful swallow and Mendelsohn maneuver affect duration of airway closure
- If respiratory function is severely affected Tx may be postponed until proper functioning is restored
Caregiver Support
Necessary for some to ensure:
- regular Tx practice
- compensatory strategy reminders
- proper feeding
Compensatory Treatment Procedures
Usually introduced during Dx procedure
- Control the flow of food and eliminate the patient’s symptoms (aspiration)
- Don’t always change the swallow physiology
- Largely under the control of the caregiver or clinician and can be used with patients of all ages and cognitive levels
- Less muscle effort or work for the patient
- Do not fatigue the patient as quickly as swallowing exercises
Compensatory Treatment- Postural Techniques
- Chin-Down (chin tuck)
- Chin-Up
- Chin-Down and head rotation
- Head Tilt
- Lying Down
- To improve sensory awareness: thermal-tactile, exaggerated suck-swallow,
- Modifying volume and speed of food presentation
- Diet changes (food consistencies)
- Intra-oral prosthetics
Chin-Down (chin-tuck)
- Touch chin to neck
- Pushes anterior pharyngeal wall posteriorly
- Tongue base and epiglottis pushed close to pharyngeal wall
- Narrows airway entrance
Used for:
- Delayed triggering of pharyngeal swallow
- Reduced tongue base retraction
- Reduced airway closure
