The Role of the Speech and Language Therapist Flashcards
Who benefits from SLT input?
Infants: premature babies and infants with specific diagnoses e.g. cleft palate, Down syndrome
Children: children with speech, language and communication difficulties e.g. children with autism, specific language impairment, hearing impairment or stammering
Adults: Adults with communicating or speech difficulties for a variety of reasons
Dysphagia means what?
Swallowing difficulties
What conditions can cause swallowing and/or communication difficulties?
Stroke, Trauma/head injury, Oral lesions (cancers /tumours), frailty, tracheostomy, dementia, TBI/HBI, brain tumours, learning disability, respiratory conditions, spinal injuries/surgery, progressive neurological conditions
How common is dysphagia?
Between 50-75% if nursing home residents
Between 50-60% of head and neck cancer survivors
Between 40-78% of stroke survivors
In 48% of patients undergoing cervical discectomy and fusion
In 33% of the people with multiple sclerosis
In 27% of those with COPD
In 10% of acutely hospitalised older people
Normal swallowing facts
26 pairs of muscles 6 cranial nerves Produce 1-2 litres of saliva per day Swallow around 900 times a day - 3x per hour when asleep - 1 per minute when awake - More when eating/drinking
Normal Swallow
A - Oral Preparatory phase
B - Oral Transit phase
C - Pharyngeal phase
D - Oesophageal phase
What are the signs/symptoms of dysphagia?
Choking when eating, coughing with eating and drinking, food/drink falling out of mouth, food pocketing in mouth, excessive drooling, difficulty chewing, throat clearing when eating and drinking, wet voice with eating and drinking, recurrent chest infections, weight loss, dehydration, nasal regurgitation, taking a long time to eat
What is aspiration pneumonia?
. Aspiration pneumonia occurs when food, saliva, liquids, or vomit is breathed into the lungs or airways leading to the lungs, instead of being swallowed into the oesophagus and stomach.
Impact of Dysphagia
Chest infections (Aspiration pneumonia), Malnutrition, Dehydration, Choking, Increased length of stay, Avoidable hospital admission, Death, Social and emotional implications, Nothing!
Swallow Assessment
Cranial nerve assessment - cranial nerve recap, Oral secretion management, Oral trials of varying consistencies, Palpitation of swallow during trials, Observation for aspiration signs, Instrumental assessment of swallowing if indicated
What is a video fluoroscopy?
A video fluoroscopic swallowing exam (VFSE) looks at your ability to swallow safely and effectively. This noninvasive exam uses fluoroscopy to help identify the thicknesses of liquid and food that you can most safely eat.
What is a Fiberoptic endoscopic evaluation of swallowing? (FEES)
A fiberoptic endoscopic evaluation of swallowing (FEES) test is a procedure used to assess how well you swallow. During the procedure, a speech-language pathologist (SLP) passes a thin, flexible instrument through your nose. Then the SLP views parts of your throat as you swallow.
Fiberoptic endoscopic evaluation of swallowing (FEES) is the preferred test over videofluoroscopy in the evaluation of a swallowing disorder in any of the following conditions:
A more conservative examination than videofluoroscopy is required because of concerns about aspiration of barium, food, and/or liquid; or
Need to assess fatigue or swallowing status over a meal; or
Repeat examination to assess change; to assess effectiveness or need for maneuvers; or
Severe dysphagia with very weak or possibly absent swallow reflex and/or very limited ability to tolerate any aspiration or
Therapeutic examination that requires time to try out several maneuvers, several consistencies, etc or
To visualize the larynx directly for signs of trauma or neurological damage and assess laryngeal competence post-intubation or post-surgery or
When positioning for fluoroscopy is problematic
When there is a suspicion that laryngeal competence may be compromised in a member with a tracheostomy; or
When transportation to fluoroscopy is problematic or
When transportation to the hospital is problematic
Swallowing Recommendations:
Yellow poster - seen by SALT - swallowing difficulty
- Fluid recommendation (E.g. thin fluids - small sips, open cup)
- Diet recommendation (E.g. soft and bite sized diet)
- Medication format recommendation (E.g. tablet)
including equipment and strategies
Do not recommend … drinks without assessment by SLT first!
Do not recommend thickened drinks without assessment by SLT first! It can make swallowing worse
