feeding & swallowing study guide #1

dysphagia

difficulty swallowing

difficulty moving food from the mouth to the stomach

a swallowing disorder

feeding and swallowing includes

behavioral, sensory, and motor acts of ringing food into the mouth, the preparatory phase of swallowing, the oral and pharyngeal swallow, and the esophageal swallow

why is there a growing number of children and adults with feeding and swallowing disorders

Premature infants surviving at younger gestational ages

Children & adults are living longer with complex medical conditions

People are living longer, and swallow function changes with age

Increasing knowledge about feeding and swallowing disorders

Increasing understanding of the impact of feeding and swallowing disorders on individuals,

caretakers, and families

Increased awareness of the risks associated with dysphagia & the need for intervention

New definition of Pediatric Feeding Disorder which expands our ability to diagnose and

treat it

Research continues to determine consensus on clinical decision making in the disease

trajectory of oropharyngeal dysphagia in adults

signs an symptoms of dysphagia

Pain with swallowing (odynophagia)

Inability to control food or saliva in the mouth

Coughing before, during, or after a swallow

Frequent coughing at the end of a meal

Recurring pneumonia

Weight loss and dehydration

Gurgly vocal quality

Patient complaints of swallowing difficulty

Inability to recognize food (food agnosia)

Limited food preferences

Fear of swallowing

odynophagia

pain with swallowing

aspiration

entry of material into the airway below the level of the true vocal cords

• increases risk of pneumonia and pulmonary disease

laryngeal penetration

material enters the upper airway but remains above vocal cords

chocking: different. the airway is 100% blocked

dysphagia complications

Pneumonia

Malnutrition (skin breakdown, weakness, fatigue)

Dehydration

Increased length of hospitalization

Disability/decreased functional status

Increased likelihood of discharge to institutionalized care

Increased risk of morbidity & mortality

Increased cost of care

Caregiver stress/distress

impact of dysphagia

Reduced quality of life

Stressful mealtimes

Increased caregiver burden

Limited participation in social functions, religious ceremonies, family

traditions, etc. (Limits activity and participation per the WHO framework)

why are services limited for dysphagia

Services not always offered or available

Not enough trained SLPs

Limited insurance coverage

Lack of follow up/continuity upon discharge from acute hospitalization

Feeding therapy not typically available in schools

the interprofessional team

Person with dysphagia and caregivers

Speech-Language Pathologist

Physician, Nurse Practitioner/Physician Assistant

Gastroenterologist, Neurologist, Otolaryngologist

Nurse & patient care technicians

Dietitian

Radiologist

Pulmonologist & Respiratory Therapist

Physical & Occupational Therapists

incidence and prevalence of dysphagia in the US

An estimated 9.5 million (1 in 25) adults in the US have dysphagia

An estimated 569,000 children ages 3-17 have swallowing problems

An estimated 116,000 newborns are discharged from the hospital with feeding

disorders

Prevalence depends on population

Overall between 2.3-16% of population

Higher prevalence in geriatrics and premature infants

Varies by diagnosis: Up to 42% in stroke, 50.9% in cerebral palsy, 72.4% in

dementia

role of SLP in dysphagia care

• Assess swallow function

• Determine plan to maximize safety and oral intake of food/liquids

• Determine if plan meets the needs of the patient

• Communicate back to team whether or not the findings are consistent with the medical diagnosis

• Work with team members to implement plan for nutrition and intervention for swallowing dysfunction

Functions of the SLP in Dysphagia Care

• Clinical Swallow Evaluation (CSE), also known as Bedside Swallow Evaluation (BSE)

• Instrumental assessment if needed (MBSS, FEES, etc)

• Identify normal vs abnormal swallow A & P

• Identify s/s of disorders in the aerodigestive tract and make appropriate referrals to medical team

• Make decisions about management of dysphagia

• Develop and implement treatment plan along with client & caregivers

• Educate, counsel, advocate

• Participate in research

Dysphagia trajectories

• Acute, recovery expected

  • Stroke, TBI, Spinal surgery

• Acute, will only improve with compensatory strategies

  • Head, neck cancer surgery, SCI with total nerve paralysis

• Progressive, expected decline

  • Dementia, Degenerative neurological disorders (ALS)

• Progressive, treatment may improve function

  • MS/PD

• Congenital/Developmental

  • Child born with a condition that impacts feeding and swallowing

Acute, recovery expected

Stroke, TBI, Spinal surgery

Acute, will only improve with compensatory strategies

Head, neck cancer surgery, SCI with total nerve paralysis

progressive, expect decline

Dementia, Degenerative neurological disorders (ALS)

Progressive, treatment may improve function

MS/PD

Congenital/Developmental

Child born with a condition that impacts feeding and swallowing