Role of Speech-Language Pathologists in Dysphagia Management

Screening of dysphagia is done to determine the need for comprehensive assessment and make necessary ________.

Examples of swallowing screening include the 3-oz water swallow test, the Yale Swallow Protocol, and Gugging Swallowing Screen (______).

Comprehensive swallowing assessment consists of non-instrumental examination and ________ examination.

In non-instrumental assessment, medical history, chart review, and medications affecting swallowing are important to consider along with physical, social, behavioral, cognitive, and ________ status.

Oral-motor examination is part of the non-instrumental assessment to determine the presence or absence of signs and symptoms of ________.

Physiological status and vital signs, including heart rate and oxygen saturation, are assessed during the non-instrumental examination to evaluate the individual's ________.

A clinician may visualize the initiation of pharyngeal structural movements through the pharyngeal ______, superior movement, and/or epiglottis inversion.

“White-out”—passage of the bolus and movement of the pharyngeal structures cannot be observed during the swallow because of reflected light from pharyngeal and laryngeal tissues into the ______.

Risks associated with endoscopy: - Discomfort and ______.

Risks associated with endoscopy: - Nasal ______.

Risks associated with endoscopy: - Laryngospasm - ______.

Based on the assessment findings, SLP can give recommendations for dysphagia ______.

Assessing swallow function as well as analyzing and integrating information from such assessment collaboratively with medical professional as appropriate. Understanding a variety of medical diagnoses and their potential impacts on ______.

Being aware of typical age-related changes in swallow function. Provide education and counseling to patients and their family. Date 4. The role of SLP in dysphagia incorporating the client’s/patient’s dietary preferences and personal/cultural practices as they relate to food choices during evaluation and treatment services; respecting issues related to quality of life for individuals and/or caregivers; practicing interprofessional collaboration; determining the effectiveness and possible impact of current diet on overall health (e.g., positioning, feeding dependency, environment, diet modification, compensations). Date 5. Normal swallowing process Swallowing involves 4 stages: 1. Oral preparatory phase ( voluntary) 2. Oral transit phase ( voluntary) 3. Pharyngeal phase ( involuntary) 4. ______ phase ( involuntary).

Date 6. Normal swallowing process Swallowing involves 4 stages: 1. Oral preparatory phase 2. Oral transit phase 3. Pharyngeal phase 4. ______ phase.

Date 7. Normal vs. ______.

Write 6 'fill in the blank' statements using the content above. Provide the missing word as the answer.

The role of SLP in dysphagia incorporating the client’s/patient’s dietary preferences and personal/cultural practices as they relate to food choices during evaluation and treatment services; respecting issues related to quality of life for individuals and/or caregivers; practicing interprofessional collaboration; determining the effectiveness and possible impact of current diet on overall health (e.g., positioning, feeding dependency, environment, diet modification, compensations). Date 5. Normal swallowing process Swallowing involves 4 stages: 1. Oral preparatory phase ( voluntary) 2. Oral transit phase ( voluntary) 3. Pharyngeal phase ( involuntary) 4. Esophageal phase ( involuntary) Date 6. Normal swallowing process Swallowing involves 4 stages: 1. Oral preparatory phase 2. Oral transit phase 3. Pharyngeal phase 4. Esophageal phase. Date 7. Normal vs. ______.

Date Positioning may not be optimal. 20 Assessment of dysphagia 2.Flexible endoscopic evaluation of swallowing () Procedure: The laryngoscope is passed through the nose to a point just above the epiglottis to observe hypopharynx and larynx while the patient is taking food. The procedure is video recorded for later analysis. - It’s a portable device and can be performed at bedside. Some considerations: The pt. must be able to follow simple commands. A small amount of anesthesia can be used if the pt. is sensitive to the scope. Use dye (green/blue) with the food to track the bolus and any residues. Date 21 Assessment of dysphagia 2.Flexible endoscopic evaluation of swallowing () Three main problems can be detected by : 1- inability to initiate the swallow in a timely and coordinated manner 2- inadequate airway protection or VP (velopharyngeal) closure during the swallow 3-incomplete bolus clearance The problems that can be observed Spillage before the swallow Residue after swallow Laryngeal penetration Aspiration Date 22 Assessment of dysphagia 2.Flexible endoscopic evaluation of swallowing () Date 23 Assessment of dysphagia 2.Flexible endoscopic evaluation of swallowing (______) Limitations of ______: Inability to visualize the oral or the esophageal phase of swallowing. Limited ability to visualize the pharyngeal phase.

The laryngoscope is passed through the ______ to a point just above the epiglottis to observe hypopharynx and larynx while the patient is taking food.

The pt. must be able to follow simple ______.

Use dye (green/blue) with the food to track the bolus and any ______.

Three main problems can be detected by ______: 1- inability to initiate the swallow in a timely and coordinated manner 2- inadequate airway protection or VP (velopharyngeal) closure during the swallow 3-incomplete bolus clearance.

The problems that can be observed: Spillage before the swallow Residue after swallow Laryngeal penetration ______.

Limitations of ______: Inability to visualize the oral or the esophageal phase of swallowing. Limited ability to visualize the pharyngeal phase.

Examples of the recommendations : Oral feeding without diet modification Oral feeding with diet modification ( e.g., puree only, no think liquid) and /or using compensatory strategies during swallowing ( e.g., chin down, head rotated to the weakness side) Alternative forms of nutrition and hydration (ANH) - ______ tube (NGT) - Gastrostomy tube (G-tube, e.g., PEG-tube)

Swallowing therapy ( indirect or direct) ______ Management of dysphagia Examples of alternative forms of nutrition and hydration (ANH) : 1.______ tube (NGT) 2.Gastrostomy tube (G-tube, e.g., PEG-tube)—inserted through the abdomen to provide non-oral nutrition

The decision on selecting the appropriate tube for the patient is the physician responsibility considerations of using alternative means of nutrition: ______ Medical diagnosis and nature of the disease ( progressive, non-progressive Severe dysphagia Cognitive/behavioral status Nutritional status 33 Management of dysphagia Swallowing therapy: 1.Indirect swallowing therapy ( doing swallowing exercises without food)

Alternative forms of nutrition and hydration (ANH) - Nasogastric tube (NGT) - ______ tube (G-tube, e.g., PEG-tube) Swallowing therapy ( indirect or direct) Date Management of dysphagia Examples of alternative forms of nutrition and hydration (ANH) : 1.Nasogastric tube (NGT) 2.Gastrostomy tube (G-tube, e.g., PEG-tube)—inserted through the abdomen to provide non-oral nutrition

The decision on selecting the appropriate tube for the patient is the physician responsibility considerations of using alternative means of nutrition: Date Medical diagnosis and nature of the disease ( progressive, non-progressive Severe dysphagia ______ status Nutritional status 33 Management of dysphagia Swallowing therapy: 1.Indirect swallowing therapy ( doing swallowing exercises without food)

The decision on selecting the appropriate tube for the patient is the physician responsibility considerations of using alternative means of nutrition: Date Medical diagnosis and nature of the disease ( progressive, non-progressive Severe dysphagia Cognitive/behavioral status ______ status 33 Management of dysphagia Swallowing therapy: 1.Indirect swallowing therapy ( doing swallowing exercises without food)