Chapter 10 Notes
Chapter 10 Notes 1230.0
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This 5 page Class Notes was uploaded by Emily Clark on Friday November 13, 2015. The Class Notes belongs to 1230.0 at Bowling Green State University taught by Lynne Hewitt in Fall 2015. Since its upload, it has received 24 views. For similar materials see INTRODUCTION TO COMMUNICATION DISORDERS in Language at Bowling Green State University.
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Date Created: 11/13/15
Chapter 10 Dysphagia Is a difficulty in swallowing or an inability to swallow When patients have dysphagia they are unable to consume enough food or liquids safely and efficiently When food enters the airway it is called aspiration May occur because the weak or paralyzed pharyngeal and laryngeal muscles cannot control the food Communication and swallowing problems frequently occur together The two activities share some common structures and functions The process of swallowing is viewed in stages Occurs before the food reaches the mouth The senses allow the person the opportunity to prepare to eat Marks the beginning of events that led up to the swallow There are two parts of this stage and both are under voluntary control The preparatory part is when a bolus the chewed food is being readied for a safe swallow Once the food enters the mouth a lip seal is needed to prevent the food from falling out and the nasal airway is open for breathing The second part is called the transport phase begins when the tongue pushes the bolus against the palate to move it back toward the pharynx The oral stage is completed when the bolus passes the anterior faucial arches and enters the pharyngeal area Begins with the triggering of the pharyngeal swallow There are two purposes To protect the airway To direct the bolus toward the stomach The motor pattern is initiated by sensory information sent from the mouth and oropharynx to the brainstem The velum contracts to close off the velopharynx so the food cannot enter the nasal cavity As the larynx elevates and moves forward the epiglottis comes over the larynx to provide additional airway protection When the swallow is triggered the contraction of the muscles of the pharyngeal constrictors transport the bolus through the pharynx toward the esophagus Begins with the lowering and backward movement of the larynx and resumption of breathing The upper esophageal sphincter contracts to prevent food from reentering the pharynx Swallowing requires both cognitive and motor skills A person must be able to recognize the need to eat and decide what to eat When an illness or injury affects either the cognitive or the motor skills there is a high risk for dysphagia Individuals who suffer cerebrovascular accidents CVAs to the left hemisphere of the brain often have an oral stage difficulty resulting from weakened or paralyzed facial musculature Including labial lingual and mandibular function Often have oral stage difficulties resulting from reduction in labial lingual and mandibular strength Often have delayed pharyngeal swallow which can cause aspiration Often have oral stage difficulties resulting from reduced labial lingual and mandibular sensation and strength Delayed or absent pharyngeal swallow Dysphagia symptoms resulting from traumatic brain injury vary according to the location and severity of the injury Problems usually exist at each stage of the swallow Common oral stage problems include reduced tongue control abnormal re exes and difficulty with chewing Pharyngeal swallow may be delayed or absent and pharyngeal peristalsis and aspiration may be reduced Causes cognitive deficits such as reduced attention reasoning judgement and poor orientation skills Significantly affect the initiation of the eating process Food may be held in the mouth for an extended period of time and not recognized as something to be swallowed Some progressive neuromuscular diseases that cause changes in strength rate and efficiency of muscular movement are Multiple sclerosis amyotrophic lateral sclerosis Parkinson s disease myasthenia gravis and muscular dystrophy Can cause several types of swallowing problems Due to surgery the anatomic structures used for swallowing change Radiation can cause tissues such as those in the mouth and throat to become irritated and dry which makes swallowing very uncomfortable The patient and family are a huge part of the dysphagia team A dysphagia assessment is composed of a review of the patient s history a bedside examination and an instrumental examination Upon receiving the referral for a dysphagia evaluation the SLP needs to collect relevant feeding behavioral and medical information The SLP needs to know whether the patient had swallowing problems prior to the illness or accident Additionally the SLP needs to find out what medications the patient had been taking The next step in a dysphagia evaluation is to review the patient s current medical condition The SLP needs to know whether the patient is medically stable the respiratory status which medications have been prescribed and the current level of cognitive functioning The SLP also needs to know how the patient is currently receiving nutrition The SLP meets with the patient and assesses the ability to take food off the plate prepare the bolus and safely swallow in the NICE also called the BCA A safe swallow occurs when the larynx moves upward and forward while opening the upper esophageal sphincter at the top of the esophagus This process cannot be directly observed but the SLP can observe several signs 1 Watching the neck along with placement of two fingers under the chin to determine whether there is upward and forward laryngeal movement 2 Listening for coughing which could mean that the bolus or part of it is going the wrong way 3 Listening for a gurgly sound after swallowing Use to better understand the pharyngeal stage of functioning The most common instrumental procedure is the modified barium swallow MB S A uoroscopic image that is recorded on videotape While the patient is sitting in a chair that is positioned for optimal eating the SLP places bariumcoated food in the patient s mouth A radiologist then takes a moving picture of the patient chewing and swallowing An MBS allows the dysphagia team to understand the cause of the dysphagia to make recommendations for treatment Another common procedure is endoscopy FEES A exible scope is inserted through the nose and positioned just above the epiglottis The patient is given food mixed with dye so that the examiner can observe the pharyngeal structures and functions through the scope The entire dysphagia team reviews the information that has been gathered about the patient and writes a treatment plan to help keep the patient wellnourished and safe The treatment plan has to be able to re ect the changes and improvements that can occur throughout the treatment There are also evolving treatment paradigms that look promising but have not been shown to be consistently effective Neuromuscular electric stimulation can help improve swallowing for individuals with mild to moderate dysphagia but not for patients with severe dysphagia Adult dysphagia deals with the treatment and assessment of swallowing after an injury or the onset of an illness In cases of pediatric dysphagia the SLP treats children who have yet to acquire eating skills Or medical conditions genetic disorders or illness that have been present from birth or shortly after birth can prevent the development of normal swallowing skills The goal of dysphagia assessment and treatment with children is to aid in the development of skills needed to keep the child safe and wellnourished The ability to suck and swallow develops prenatally These re exes also develop during the last 4 to 8 weeks of gestation For this reason a premature baby may not have the ability to suck milk from a nipple Weak facial muscles and underdeveloped lungs can also contribute to this difficulty Children with cerebral palsy have a wide range of feeding problems The type and severity of the feeding problem depend on the degree of motor deficit Cognitive deficits can also result in problems that affect all stages of the swallow Children with cognitive deficits may have inadequate velopharyngeal closure which causes a delay in the pharyngeal swallow The assessment procedures for children are similar to those for adults The SLP reviews part medical history and current medical status Then they perform a NICE and if warranted proceeds to do an instrumental examination An understanding of underlying medical conditions and how these conditions may contribute to current feeding problems is the focus of management in pediatric dysphagia The SLP must gather information about the child s prenatal history birth history early feeding problems preferred positioning preferred textures types of utensils respiratory status use of alternative feeding methods medications seizures and signs of distress during eating The SLP looks for lip tongue and jaw movements along with any changes on respiratory function Any additional behaviors such as nasopharyngeal re ux lethargy coughing choking gagging or arching of back are noted Currently the MBS procedure is used to a much greater degree than endoscopy Based on the information gained from the review of the child s medical and feeding history NICE and MBS the dysphagia team formulates a treatment plan designed to meet two major goals The first goal is a way for the child to meet current nutritional needs while remaining safe The second is focused on techniques or strategies that will improve both oralmotor and pharyngeal stage functioning It is also designed to help normalize the child s eating and swallowing skills