Tagged "swallowing disorder"


Dysphagia Patients: Holiday Survival Tips

Posted by Casey Roy on

The holidays are a wonderful time of year, and conjure up memories of past gatherings with family and friends. Images of warmly lit homes, crackling fires, laughter, songs and the aromas that swirl about can trigger such feelings of good will. It’s a time to come together and eat.

But, what if eating is a struggle, a battle, or even not in the picture at all?

If a family member, whether adult or child has experienced dysphagia or is on a special diet, some considerations and preparations may need to be made in advance. There is no reason for the individual experiencing a feeding difficulty or dysphagia be excluded of the joy of holiday food gatherings along with everyone else!

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Dysphagia: Who. What. Why.

Posted by Casey Roy on

Who. What. Why.

When You Don’t Know, What You Don’t Know

by Colette Ellis, M.Ed., CCC-SLP, BCS-S

Who needs a Dysphagia Education Course?

  • Clinicians who evaluate and treat dysphagia, regardless of location 
  • Physicians, phoniatrists, physician assistants, nursing staff interested in a patient-centered team approach
  • Parents, educators wanting knowledge and skill for care planning and follow-through

 

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Deciphering Dysphagia

Posted by Deborah Grauzam on

by Colette Ellis M.Ed., CCC-SLP, BCS-S

Dysphagia, or having difficulty swallowing, can affect upwards of 15 million adults in the United States alone. Research has demonstrated that as many as 1 in 25 individuals will experience some form of dysphagia in their lifetime, including 22% of those 50 years of age and older (ASHA 2018; Bhattacharyya, 2014). In the elderly, these percentage may be as high as 30% receiving inpatient medical treatment (Lane, Losinski, Zenner, & Amet, 1989). 68% of residents in long-term care setting may experience dysphagia according to the National Institute on Deafness and Other Communication Disorders (NIDCD, n.d.; Steele, Greenwood, Ens, Robertson, & Seidman-Carlson, 1997). In the "healthy elderly," dysphagia may occur between 13-38% among those living independently.

Dysphagia does not discriminate, rich or poor, young or old. If a swallowing problem occurs in the teen population, it is typically a continuation of a feeding/swallowing problem which was present as a younger child, such as the growing child with cerebral palsy.  New onset dysphagia in teens or younger children may be related to specific choking episodes or a sudden onset such as a traumatic brain injury (TBI) (Swigert, NFOSD, 2015). Second only to children 0-4 years of age, teenagers and young adults ages 15-24 experience the most TBI injuries, which can also present with dysphagia (http://www.cdc.gov/traumaticbraininjury/data/). Dysphagia has been estimated to occur in 13% of those individuals suffering a TBI, with gunshot wounds that cause TBI, producing dysphagia upwards of 37% of the time.

This medical condition can often be neglected or misdiagnosed, despite the significand prevalence across all ages. Education and timely referrals are potential keys to successful recovery or management of dysphagia. Including the above, dysphagia can be a consequence of stroke, head and neck cancer, neurological disease onset, Alzheimer’s dementia and other dementias, Parkinson’s disease, and congenital onset conditions. Speech-language pathologists are highly trained in head and neck anatomy/physiology, and can, with collaboration with the patient’s physician, evaluate and treat many forms of swallowing disorders or dysphagia.

But what does all this mean? What are the consequences of dysphagia? In children, dysphagia can lead to failure to meet nutritional and hydration needs, including failure to thrive in infants (Vivanti, Cambell, Suiter, Hannen-Jones, Hulcomb, 2009; Hays & Roberts, 2006). Severe consequences of dysphagia can include asphyxiation and death across all ages (Berzlanovich, et al, 2005), depression and isolation with negative impact on social well-being (Ekberg, et. al, 2002), as well as potential delayed or disordered development of oral and communication skills (Barbosa, Vasquez, Parada, Carlos, Gonzalez, Jackson, 2009; Morris & Klein, 2000). Another obvious, or maybe not so obvious consequence of dysphagia is pneumonia.

In order to evaluate and treat dysphagia, the speech-language pathologist must know how, when and why the symptoms are occurring. After a thorough case history is reviewed, a clinical swallow examination would be in order; in other words, watch the infant, child or adult eat and drink, regardless of their physical setting. If choking or coughing symptoms are noted, along with other risk factors such as recent hospitalizations, poor weight gain, change in current function, pneumonia onset, dehydration with urinary tract infection (UTI), a swallow instrumentation study may be necessary. These studies (the modified barium swallow study MBSS or the fiberoptic endoscopic examination of swallowing, FEES) would identify the anatomy and physiology of that individual’s current status and swallow, while enabling the skilled SLP to trial maneuvers, compensation or exercise while the swallow is "in view," and aid in treatment planning.

If you or someone you care about has been experiencing swallowing problems, encourage them to relay this to their physician and seek an evaluation from a speech-language pathologist skilled in evaluating and treating swallowing disorders. Eating and drinking have many social significances and being deprived of this basic pleasure would be detrimental. Think of this the next time you take that big drink of cool, refreshing water.

***

Here are a few resources to get more information:

References

ASHA, (2002). Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders, Position Statement

ASHA, End-of-Life Issues in Speech-Language Pathology, https://www.asha.org/slp/clinical/endoflife/

Barbosa,C., Vasquez, S., Parada, M.A., Carlos, Gonzalez, J.C., Jackson, C., Yanez, N.D., Gelaye, B., Fitzpatrick, A.L.(2009). The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers. BioMed Central Pediatrics, Oct 21;9:66. doi: 10.1186/1471-2431-9-66.

Berzlanovich, A.M., Fazeny-Dorner, B., Waldhoer, T., Fasching, P., Keil, W. (2005). Foreign body asphyxia: a preventable cause of death in the elderly, American Journal of Preventative Medicine, Jan;28(1):65-9.

Bhattacharyya, N. (2014). The prevalence of dysphagia among adults in the United States. Otolaryngology-Head and Neck Surgery, 151, 765-769.

Vivanti, Cambell, Suiter, Hannen-Jones, Hulcomb. (2009). Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalized patients with dysphagia. Journal of Human Nutritional Diet, Apr 22 (2)148-155.

Layne, K., Losinski, D., Zenner, P., & Ament, J. (1989). Using the Fleming Index of Dysphagia to establish prevalence. Dysphagia, 2, 216-219.

Morrison, et al., (2004). Palliative Care, NEJM, 350:2582-2590

Steele, C., Greenwood, C., Ens, I., Robertson, C., & Seidman-Carlson, R. (1997). Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia, 12, 43-50.

Swallowing Disorders Foundation: http://swallowingdisorderfoundation.com/dysphagia-in-teens-adults/ published 03-29-2015.

http://www.cdc.gov/traumaticbraininjury/data/

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Performing a VFSS that Communicates Positive Results: Adult and Pediatric Patients

Posted by Deborah Grauzam on

We are delighted to share with you a description of TalkTools® Instructor Jennifer Jones's four-hour presentation at the annual MSHA Convention, March 3, 2016.

"Performing a VFSS that Communicates Positive Results: Adult and Pediatric Patients"

By Jennifer Jones, Ph.D., CCC-SLP, BCS-S, C/NDT

ABSTRACT

The VFSS is the standard for instrumental evaluation of swallowing disorders, but if clinicians don't communicate the appropriate results then the receiving therapist cannot properly treat the patient. Participants will watch many VFSS and identify abnormal and normal physiology utilizing interactive technology, discuss positive attributes of a disordered swallow and plan treatment.

OBJECTIVES

  1. Identify 2 disorders each that could occur before, during and after the swallow.
  2. List 3 normal and appropriate physiologic attributes of the VFSS viewed.
  3. Discuss positive attributes of disordered swallows and plan appropriate treatment.

As Clinicians, we are taught to find the things that are “wrong” with our patients. When we write a language and/or swallowing report we document all of the things that our patient cannot do.  We are trained to see what is disordered or abnormal and we document those findings. However, there are positive attributes that should be reported as well. We need to see the positives that our patients have to offer, either through language or swallowing.

This course is created based on research that shows the normal aging process with swallowing, which is coined Presbyphagia. Are our patients being diagnosed with moderate and severe dysphagia based on normal aging changes to the swallowing anatomy and physiology? Are there patients who are on limited diets based on normal aging difficulties with swallowing? This course will teach attendees about the normal aging process and how to discern normal from abnormal physiology in the aging population.

The Videofluoroscopic Swallow Study is a means to discover what our patients can eat and drink safely with minimal risk and minimal invasion to their quality of life.  In order to achieve this goal, we must be able to discern the positive aspects of a patient’s swallow so that we can build on it. A swallow study should not be considered complete until there is some consistency that a patient can eat or drink safely with minimal invasion.  If a therapist can focus more on the positive aspects of the swallow then designing a treatment plan utilizing those aspects would be less invasive.

This course involves utilizing an audience response system so that participants can be interactive with the speaker. The speaker will present greater than 15 VFSS (the # depends on allotted time) for interpretation.  The VFSS will be discussed and participants will be presented with a question and multiple answers.  The participants will be required to answer these questions using the audience response system, which will require them to commit to an answer.  When we perform the VFSS we commit to answers rather quickly, which is what changes our on-line modifications during the VFSS. The participants will be required to answer questions related to normal and abnormal physiology, positive attributes and planning treatment. Upon completion of this course, participants will have reviewed multiple swallow studies and observed that positive attributes should be utilized to plan treatment.

If you missed it, meet Jennifer Jones June 24-25 in San Juan, PR for her live workshop: "Pediatric Dysphagia: Interpreting the MBSS and Planning Treatment."

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Effects of TalkTools Assessment and Treatment of the Jaw on Feeding in Children with Feeding and/or Swallowing Disorders

Posted by Deborah Grauzam on

This poster was peer reviewed and accepted at the 2014 European Society for Swallowing Disorders (ESSD) Congress in Brussels, Belgium.

Author: Karin van der Walt, Department of Clinical Speech and Language Studies, Trinity College (Dublin, Ireland).

"Effects of TalkTools Assessment and Treatment of the Jaw on Feeding in Children with Feeding and/or Swallowing Disorders"

Effects of TalkTools Assessment and Treatment of the Jaw on Feeding in Children with Feeding and/or Swallowing Disorders

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