Dysphagia Handout 6.0 - Treatment

evidence based practice

clinical expertise, best available research evidence, and patient/caregiver values and perspectives

steps of evidence based practice

generate a clinical question, search for available scientific evidence, review and evaluate the evidence, and integrate clinical expertise/client's perspective/reviewed evidence

treatment team process

SLP, PT, OT, dietician, dentist, nurse

oral hygiene

poor oral hygiene and dysphagia are both risk factors for aspiration pneumonia

dysphagia management - compensation

short term adjustments to facilitate safe oral intake (posture, food, and patient adjustments)

dysphagia management - rehabilitation

improvement in swallow physiology that permits increased and expanded safe oral intake

dysphagia management - prevention

avoiding or minimizing negative outcomes: food or liquid restriction, nutrition and hydration deficits, infections, and more

compensatory swallowing therapy

strategies which aim to ensure safe swallows without directly improving the physiology of swallowing

compensatory swallowing therapy

should be proven to be effective under instrumental evaluation before recommending to the client

requirements for compensatory strategy therapy

client must have adequate memory and attention to perform strategies consistently or caregivers who can assist (people with severe cognitive impairments/who cannot refuse to follow recommendations are not suitable)

compensatory strategies maneuvers

supraglottic swallow, super-supraglottic swallow, effortful swallow, mendelsohn maneuver, and tongue hold maneuver (mosako)

when to use supraglottic swallow

decreased duration/timing of laryngeal closure, aspiration during or after the swallow

when to use super-supraglottic swallow

decreased closure at entrance of airway, aspiration prior to initiation of swallow, during, and after

when to use effortful swallow

decreased tongue base, decreased/delayed hyolaryngeal excursion, and impaired pharyngeal contraction

when to use Mendelssohn maneuver

decreased hyolaryngeal excursion, decreased pharyngoesophageal segment opening

effortful swallow

produces high pharyngeal pressure and eliminates pharyngeal residue

neuromuscular electrical stimulation (NMES)

stimulate swallow function by applying electric stimulation to the neck area via surface electrodes (treatment)

surface electromyography

this is a measurement using the same tool as NMES, but it gives biofeedback on amount of energy exerted by the muscles during the swallowing process

pharyngeal electrical stimualtion

transoral or transnasal catheter which places electrodes in pharyngeal area

intramuscular stimulation

invasive, is a hooked wire with electrodes inserted into specific muscles

McNeill Dysphagia Therapy Program

exercise based therapy program for adults with dysphagia