As with the postural adjustments, these maneuvers provide an ‘immediate but only transient approach to the underlying physiologic deficit.’ [81] The supraglottic swallow functions to close the vocal folds before and during the swallow [43] and clear bolus residue from the airway post-swallow [82]. These will be discussed, along with potential future directions and emerging treatment options. For example, Winstein [6] reported that 94 % of dysphagic patients progressed to full oral feeding within 5 months post-injury. Videofluoroscopic swallow studies (VFSS) assesses the speed and coordination of movements during chewing and swallowing in the oral cavity, tongue base, pharynx, hyoid, larynx, and cricopharyngeal region [43]. More studies specifically examining dysphagia and its management in the TBI population are required to ensure the future efficacy and accuracy of treatment. going well, they can usually see for themselves, and then they ask what the options DYSPHAGIA: A COMPARISON OF TREATMENT EFFECTIVENESS by Larenda Henshaw A.A., Southeastern Illinois College, 2008 B.S., Southern Illinois University Carbondale, 2010 A … In my charting, I say, Disordered sensory perception in some patients may result in difficulty registering that food/fluid remains in their mouth [40]. Ward EC, Green K, Morton A-L. [4] found that global injury severity indicators [Glasgow Coma Score (GCS), RLA, Functional Independence Measure and Functional Oral Intake Scale scores] were all predictors of time to achieving functional oral intake. O’Suilleabhain P, Dewey RB. Training has been suggested to obtain consistent and effective performance: [82] a factor meaning they may be unsuitable for some patients with TBI, particularly as the supraglottic swallow was shown to be difficult for neurological patients to learn and perform [84]. Giving small amounts of food or one utensil at a time [8, 9] at a time, cueing to reduce the amount and rate of food intake and to put utensils and cups down between mouthfuls are strategies that may reduce impulsive grabbing and ‘shoveling’ of food. 2008;63:499–508. Thus, without an accurate identification of the nature of the problem use of oral motor exercises as a form of treatment is not prudent. Classification of traumatic brain injury for targeted therapies. improvement of the patient’s status. - 85.214.89.103. It is intended as a saliva swallowing exercise (i.e., no bolus) to strengthen pharyngeal muscles [77, 98]. for pulmonary issues, so they’ll begin to see that perspective as well. However, the authors commented that tracheostomy and longer ventilation were potentially not causative factors for dysphagia, but were indicative of a greater severity of brain injury [42]. Download DYSPHAGIA … Chest. Recent research into the effects of dysphagia therapy for patients undergoing head and neck cancer treatment have provided new insights into the importance of proactive swallowing therapy. of example, I will sometimes point out that aspiration isn’t really bothering a given Ludlow CL. This assesses the oral structures and their functions (e.g., symmetry, sensation), the cranial nerves involved in swallowing, oral hygiene, dentition and, if appropriate, an oral food and/or fluid trial of varying consistencies [62, 63]. Long-term tracheostomies can cause physical injuries such as tracheostenosis, tracheomalacia, and/or granuloma [49–52]. Am J Med. Dysphagia. These factors help identify patients at risk of dysphagia [12]. Agitated patients, and those with verbal and/or physical outbursts, are at risk of choking or aspirating if outbursts occur during mealtimes [8, 9, 40]. 2008;25:719–38. This examination involves passing a flexible scope through the nose to the level of the soft palate [43] to view the hypopharynx, larynx and proximal trachea [66] during swallowing. meal an unhappy experience, they’ll “get” the issue. Ann Otol Rhinol Laryngol. 2004;19:192–206. Barquist E, Brown M, Cohn S, Lundy D, Jackowski J. Postextubation fiberoptic endoscopic evaluation of swallowing after prolonged endotracheal intubation: a randomised, prospective trial. Participant: I sometimes feel that I have more difficulty when educating other SLPs than MDs concerning Second, population demographics are different, with CVA more common in older patients with degenerative co-morbidities. Available in English and Español. Here are some factors that may be related to Impaired Swallowing: Neuromuscular: 1. In patients where oral feeding is contraindicated due to low responsiveness, sensory stimulation (tactile, olfactory, gustatory, auditory and visual) to has been suggested to improve patient responsivity [8, 9]. Huckabee ML, Cannito MP. Electrical stimulation and dysphagia: what we do and don’t know. J Speech Lang Hear Res. Stauffer J, Olson D, Pelta T. Complications and consequences for endotracheal intubation and tracheostomy: a prospective study of 150 critically ill adult patients. It is there that we have the freedom to use what we know with our patients—but our DON [director of nursing] and medical director ahead of time on what evidence possibilities as our rehab patients. Identifying exactly why (at a neurological level) oropharyngeal movements are impaired can be difficult. If the dysphagia manifests in pharyngeal and/or laryngeal deficits, further instrumental assessments may be undertaken [62, 63]. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Arch Phys Med Rehabil. 2007;22:251–65. a clinician, in my view. The argument against electrical stimulation for dysphagia. Conversely, in dysphagia following CVA [47] the tongue control deficits were less severe and reduced pharyngeal peristalsis was more frequent [32]. [76] Irrespective of this, supportive evidence for these management strategies is limited and has not necessarily provided recommendations on how best to prescribe and apply them [77]. It’s not really something that I feel I can accomplish and things you are learning at conferences like this would be the best way to proceed. Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patients. 2nd ed. Morgan A, Ward E, Murdoch B, Gilmore G, Bilbie K. A study of the resolution of paediatric dysphagia following traumatic brain injury: practical implications for clinicians. 1996;109:167–72. Patients with diffuse TBIs present heterogeneous pathoanatomical injury features and pathophysiological mechanisms behind their neurological symptoms [99]. Logemann JA. This can also be a useful strategy for patients with limited attention spans [40]. An effortful breath hold with the super-supraglottic swallow aims to close the airway before and during the swallow [43]. PubMed  1981;70:70–6. Brenda Arend: The main thing I’d want you to take away is the shift in focus from “rehab” to “palliative” 1989;3(1):19–26. 2000;110:641–4. doctor about it. J Head Trauma Rehabil. 2003;44(Suppl 10):2–10. Curr Phys Med Rehabil Rep. 2013;1:216–22. Variants include nil by mouth ( NBM ), nihil / non / nulla per os, or complete bowel rest. If a patient is tracheotomised, blue dye tests may also be used to screen for aspiration. 1999;14(5):497–504. 1994;37:1041–9. J Speech Hear Res. In most cases, ice chips were viewed as a … At 1 year follow-up, none were silent aspirators and some had recovered their cough reflex. only take milk-based products (and not no-fat but low- fat)? challenged by the idea of laying out options for our patients. 1987;68:79–84. Swallowing dysfunction after tracheostomy. J Speech Lang Hear Res. Sharma OP, Oswanski MF, Singer DS, Buckley B, Courtright B, Raj SS, et al. goals are very important. Have a monthly meeting Tracheostomytube 6. 2012;27:521–7. Antunes EB, Lunet N. Effects of the head lift exercise on the swallow function: a systematic review. Dysphagia is a common morbidity and cause of mortality following traumatic brain injury (TBI). Typically, subjects with dysphagia following TBI are placed into non-specific ‘neurogenic’ dysphagia subject groups, which include subjects with degenerative neurological diseases, neurological cancers, and cerebrovascular accident. However, dysphagia following TBI has a multifactorial presentation, with causative and contributory factors including cognitive-communication, behavioral, neurological, and mechanical issues. 2008;117(4):279–87. Arch Otolaryngol Head Neck Surg. Logemann JA, Rademaker AW, Pauloski BR, et al. Facial paralysis (cranial nervesVII, IX, X, XII) 4. Arch Phys Med Rehabil. Both techniques are effective tools for assessing dysphagia, detecting aspiration and trialing management strategies in patients with TBI [35]. Arch Phys Med Rehabil. Disorders of nutrition and swallowing: intervention strategies in the trauma centre. Participant: If a participant were to remember or put into practice only one idea from your session, what would that one key takeaway be? Much of the research regarding the management and treatment of dysphagia in general is in its infancy: larger and more rigorous studies are required to demonstrate treatment efficacy. 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