Week 11 - Speech Pathology and Dysphagia in the acute setting Flashcards
What is dysphagia?
Disorder of swallowing
What age group does dysphagia affect?
All ages, from pre-term infants to very elderly.
True or false, dysphagia can be a life-long condition?
True eg. cerebral palsy, stroke
What is presbyphagia?
Swallowing changes associated with aging.
What 3 stages can Dysphagia occur at?
Oral, pharyngeal and oesophageal
What disorders have a high rate of associated dysphagia?
Parkinson’s, MND, stroke, head and neck cancer
What can dysphagia result in?
Aspiration
Aspiration pneumonia
Choking
Dehydration/Malnutrition
What type of dysphagia does SP treat?
Oral and Pharyngeal
What are the phases of swallowing?
Pre-oral stage
Oral stage
Pharyngeal Stage
Oesophageal stage
What is the pre-oral stage?
Before food enters the oral cavity - using cutlery, smelling and seeing food, putting food to the mouth
What is the oral stage?
eating - using lips to take food off fork, chewing food, tongue cupping bolus
What is the Pharyngeal stage?
Food is pushed into the back of the throat, epiglottis covers airway and wave of pharyngeal contraction.
What is aspiration?
Food/drink/saliva passing below vocal fold and entering the lungs
What is the usual response to aspiration in a healthy person?
Coughing
What is overt aspiration?
Occurs with symptoms such as coughing/throat clearing
What is silent aspiration?
No symptoms noticeable at bedside
What are the biggest predictors for aspiration pneumonia?
Dependence for feeding Dependence for oral care Number of decayed teeth Tube feeding More than 1 medical diagnosis Number of medications Smoking Dysphagia
What are the reasons for referral of SP?
Stroke
Coughing with food or drink
Aspiration pneumonia
Patient or family report swallowing difficulties
What are the 2 types of SP assessments?
Bedside assessments and instrumental assessments
What does a bedside assessment look at?
Case history
Current presentation/results of respiratory observations
Cranial nerve assessment
Swallowing trials for diet and fluids
What are types of instrumental assessment?
Videofluoroscopy
Fibreoptic endoscopic evaluation of swallowing
Which instrumental assessment requires barium?
Videofluoroscopy
What influences dysphagia treatment?
Aetiology
Patient’s medical plan
Patient’s preferences
What are acute treatment options?
Physical/environment modifications
Swallow techniques/modifications
Texture/fluid modifications
How long do rehabilitation exercises take?
weeks to months
What are physical/environmental treatment options?
Positioning
Reducing distractions
Mealtime set-up cues
What do swallowing techniques/modifications involve?
Bolus size and bolus delivery
What happens if someone cannot swallow safely?
Nasogastric tube
PEG
When is a PEG considered?
If someone can’t swallow in the long term (years)
