Dysphagia Assessment & Intervention

Mon/Wed

COTA Roles

require direct supervision, must achieve competency, dysphagia evals typically not in scope of practice, and requires continuing ed if interested.

OTR Roles

formal evals often by SLP, obtain PMH/HPI, consider motor/sensory control of head/neck/trunk/UE/LE/oral musculature, and MBS often indicated.

Indications of Swallow Dysfunction (Questionable Aspiration)

coughing or throat clearing, gurgling voice quality, respiratory changes, delayed or absent swallow response, reflux/vomiting after meals, weight loss/decreased oral intake, pneumonia diagnosis, and extended time to complete meal intake.

Deglutition (Normal Process of Swallowing)

oral preparatory phase, oral phase, pharyngeal phase, and esophageal phase.

Oral Preparatory Phase

looking at, reaching for, food to mouth, and chewing begins.

Oral Phase

tongue moves bolus toward back of mouth.

Pharyngeal Phase

bolus passes to pharynx and involuntary swallow is triggered.

Esophageal Phase

bolus enters esophagus.

Treatment Goals

proper positioning, improve motor control, maintain intake for nutrition, prevent aspiration (if signs, terminate feeding session and alert OTR/SLP), and re-establish safest eating level.

Treatment Considerations

perform in seated position ideally, head/neck/trunk/pelvis in alignment, slight chin tuck, and positioning should be clearly stated by OTR/SLP.

Non-Oral Feeding

used for nutritional support when patient can’t swallow, NPO (nothing by mouth), NG tube, and G-tube.

NG Tube

naso-gastric and temporary.

G Tube

gastric/PEG; inserted surgically and for more long term use.

Oral Feeding

progresses in stages when risk for aspiration is low.

Stage 1 Oral Feeding

pureed.

Stage 2 Oral Feeding

mechanical soft.

Stage 3 Oral Feeding

ground/chopped.

Stage 4 Oral Feeding

regular diet.

General Feeding Principles

patient must be alert, ideally looking at and reaching for food, allow patient to perform as much self-feeding as possible, feeding should occur in appropriate/typical context, continually observe for positioning and signs for aspiration.

Swallow Precautions

diet, liquids, and modifications.

Swallow Precautions - Diet

regular, soft, puree, and full liquid.

Swallow Precautions - Liquids

thin (regular), nectar, honey, and none.

Swallow Precautions - Modifications

always elevate to 90 degrees (as upright as possible); small bites, small drinks, alternate liquids/solid, no straw, dry swallow/repeat swallow, chin down, and head turn R/L.

J Tube

bypasses the stomach and goes directly into the small intestine; a slow continuous feed.

Mechanical Soft

can be mushed by the tongue.

Nectar

thick juice.