Garand, K. L., McCullough, G., Crary, M., Arvedson, J. C., & Dodrill, P. (2020). All screening procedures include communication of results and recommendations to the team responsible for the individuals care and to the patient and caregivers. The manometric examination revealed a markedly elevated resting peak UES pressure and greatly elevated pharyngeal pressures (approximately 250 mmHg). Swallow while squeezing your throat as hard as you can (pretend that you're swallowing a whole grape) Repeat to fatigue (or in sets of 5-10 swallows, as appropriate) You can also prompt patients to press their tongue hard against their palate . https://doi.org/10.1007/s00455-015-9637-y, Bchet, S., Hill, F., Gilheaney, ., & Walshe, M. (2016). Dysphagia, 19(4), 266271. Dysphagia, 6(4), 187192. SLPs also have expertise in communication disorders that may affect the diagnosis and management of swallowing disorders. Journal of Oral Rehabilitation, 44(1), 5964. Impact of the modified consistency/viscosity on the individuals swallowing physiology. Intensive training can improve swallowing function and reduce the risk of aspiration. 109(4):578-83. Pharmacotherapy, 19(8), 974978. Non-Member: 800-638-8255, Site Help | AZ Topic Index | Privacy Statement | Terms of Use Dysphagia in Parkinsons disease. radiation treatment protocols in head and neck cancer; psychosocial, environmental, and behavioral factors. Directions 1. How To Do The Effortful Swallow. Please see ASHAs resource on Flexible Endoscopic Evaluation of Swallowing for further information on the FEES. American Journal of Speech-Language Pathology, 29(2S), 919933. Instrumental assessments may be recommended and completed regardless of setting (e.g., hospital, skilled nursing facility) in which the services are delivered. (1992). cises, swallowing and non-swallowing exercises. facilitating communication between team members, actively consulting with team members, and. Screening identifies the need for further assessment and may be completed prior to a comprehensive evaluation. It is important to consider signs and symptoms of dysphagia in the context of other clinical indicators such as the etiology of the dysphagia and the overall health of the patient, rather than relying on a single sign or symptom. Neck Exercises Neck Stretch: Extend your chin up towards the ceiling. However, clinicians were not concerned about the possible effects of this rehabilitation protocol on cardiac events. https://doi.org/10.1044/sasd11.1.9, Fujiu-Kurachi, M., Fujiwara, S., Tamine, K., Kondo, J., Minagi, Y., Maeda, Y., Hori, K., & Ono, T. (2014). Effortful Swallow . https://doi.org/10.1177/0003489414558107. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: Observational prospective study. https://doi.org/10.1056/NEJM199104253241703, Spechler, S. (1999). Goal The goal of this activity is to keep food or fluid from getting stuck in your pharynx, or throat, by improving the force and timing of your swallow. Swallow while keeping your tongue gently between your teeth. A., Michou, E., MacRae, P. R., & Crujido, L. (2012). It is not contraindicated for patients with cardiovascular disease or stroke. SLPs may also make recommendations regarding continuing per os (P.O.) (2010). Dosage primarily refers to the amount of treatment provided (e.g., the frequency, intensity, and duration of service). Steele, C., Greenwood, C., Ens, I., Robertson, C., & Seidman-Carlson, R. (1997). SLPs may make recommendations for modifications of texture and viscosity and discuss their implications with other team members (e.g., dietary team, the patient). Archives of OtolaryngologyHead & Neck Surgery, 133(6), 564571. Dysphagia may develop secondary to damage to the central nervous system (CNS) and/or cranial nerves, and to unilateral or bilateral cortical and subcortical lesions, such as, Dysphagia may also occur from problems affecting the head and neck, including, Dysphagia may be associated with other factors, such as. Clinicians should be aware that research into the overall efficacy of dysphagia treatment is ongoing; therefore, treatment options may evolve. Molfenter, S. M., Hsu, C.-Y., Lu, Y., & Lazarus, C. L. (2018). (Practice Portal). Prevalence of dysphagia in multiple sclerosis and its related factors: Systematic review and meta-analysis. Swallow hard. Preferred practice patterns for the profession of speech-language pathology [Preferred practice patterns]. Hold this posture for 3-5 seconds. Economic and survival burden of dysphagia among inpatients in the United States. With this support, swallowing efficiency and function may be improved. . (1992). Decision making must take into account many factors about each individuals overall status and prognosis. https://doi.org/10.1007/BF02493524, Llabrs, M., Molina-Martinez, F. J., & Miralles, F. (2005). Contraindications of Effortful Swallowing. (2018). SLPs use instrumental techniques to evaluate oral, pharyngeal, laryngeal, upper esophageal, and respiratory function as they apply to normal and abnormal swallowing. The SLP educates involved parties on possible health consequences and documents all communication with the patient and caretakers (Horner et al., 2016). SLPs should discuss any dietary texture/consistency-related changes with the patient and caregivers who prepare food. Disfagia como nica manifestacin de miastenia gravis [Dysphagia as the sole manifestation of myasthenia gravis]. Effortful swallowing was also associated with significantly greater maximum velocities of the hyoid and larynx during swallowing. Archives of OtolaryngologyHead & Neck Surgery, 130(2), 208210. side effects of some medications (e.g., Balzer, 2000); metabolic disturbances (e.g., hyperthyroidism); infectious diseases (e.g., COVID-19, sepsis, acquired immune deficiency syndrome [AIDS]); Meux & Wall, 2003); pulmonary diseases (e.g., chronic obstructive pulmonary disease [COPD]); identifying signs and symptoms of dysphagia; identifying normal and abnormal swallowing anatomy and physiology supported by imaging; identifying indications and contraindications specific to each patient for various assessment procedures; identifying signs of potential disorders in the upper aerodigestive and/or digestive tracts and making referrals to appropriate medical personnel; assessing swallow function as well as analyzing and integrating information from such assessments collaboratively with medical professionals, as appropriate; providing treatment for swallowing disorders, documenting progress, adapting and adjusting treatment plans based on patient performance, and determining appropriate discharge criteria; identifying and using appropriate functional outcome measures; understanding a variety of medical diagnoses and their potential impact(s) on swallowing; recognizing possible contraindications to clinical decisions and/or treatment; being aware of typical age-related changes in swallow function; providing education and counseling to individuals and caregivers; incorporating the clients/patients 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; educating and consulting with other professionals on the needs of individuals with swallowing and feeding disorders and the SLPs role in the diagnosis and management of swallowing and feeding disorders; advocating for services for individuals with swallowing and feeding disorders; performing research to advance the clinical knowledge base; and. Utility of clinical swallowing examination measures for detecting aspiration post-stroke. combines voluntary airway protection with strength building of effortful swallow (tilts aryteoinds anteriorly, closes the true and false VF) voice quality check. Patient adherence to dysphagia recommendations: A systematic review [published correction appears in Dysphagia, May 4, 2018]. Various pressure measures can be calculated and compared to normative data (Omari & Schar, 2018). The VFSS is also known as the modified barium swallow study (MBSS) and is a radiographic procedure used to gain further information regarding dysphagia. ), Normal and abnormal swallowing (pp. Dehydration among long-term care elderly patients with oropharyngeal dysphagia. Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia. Using ethnographic interviewing strategies during the assessment process is an excellent way to gather information about an individuals specific needs (Westby et al., 2003). SLPs have knowledge of the anatomy, physiology, and functional aspects of the upper aerodigestive tract as they relate to swallowing and speech. as low as 3% in U.S. inpatients aged 45 years or older to as high as 22% in adults over 50 years of age (Lindgren & Janzon, 1991; National Foundation of Swallowing Disorders, n.d.; Patel et al., 2018; Tibbling & Gustafsson, 1991); as high as 30% in elderly populations receiving inpatient medical treatment (Layne et al., 1989); up to 68% for residents in long-term care settings (National Institute on Deafness and Other Communication Disorders, n.d.; Steele et al., 1997); and. Indications for rehabilitative exercises -appropriate etiology of the dysphagic physiology -cognitively able -motivation to perform exercises independently -good support systems Oral rehab exercises: hypertonicity -slow, progressive stretching exercises to relieve spasms or hyperfunction As with any treatment, if it is powerful . Otolaryngologic Clinics of North America, 46(6), 965987. The effortful swallowing used in our protocol aims to increase muscle strength, improve coordination, and reduce the posterior movement of the tongue base [ 9 ]. This system is a specialized form of neuromuscular electrical stimulation (NMES) administered through uniquely designed external skin electrodes. A review of medical/clinical records, including the potential impact of medications and treatment of other medical diagnoses such as. the Yale Swallow Protocol (Suiter et al., 2014). Causes of dysphagia among different age groups: A systematic review of the literature. International Journal of Speech-Language Pathology, 17(3), 222229. Qualified SLPs may also screen for esophageal motility and gastroesophageal reflux disease (GERD) to identify the need for appropriate referral. Springer. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 69A(3), 330337. ), Normal and abnormal swallowing (pp. Effect of cold water on esophageal motility in patients with achalasia and non-obstructive dysphagia: A high-resolution manometry study. Ask the client to: 1. Patients who exhibit residue in the valleculae after the swallow. Clinical Nutrition, 26(6), 710717. The primary goals of dysphagia intervention are to. Other studies have such findings as follows: Not all signs and symptoms are seen in all types of dysphagia, and the evidence supporting the predictive value of these signs and symptoms is mixed. contextual factors that serve as barriers to or facilitators of successful swallowing and participation for individuals with swallowing impairments. Journal of Intellectual Disability Research, 53(1), 2943. The effortful swallow achieves overload through high effort. The benefit of head rotation on pharyngoesophageal dysphagia. https://doi.org/10.1016/j.otc.2013.08.008, Romo Gonzlez, R. J., Chaves, E., & Copello, H. (2010). understand issues relative to radiation equipment, equipment maintenance, and safety. Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. Individuals of all ages are screened as needed, requested, or mandated or when presenting medical conditions (e.g., neurological or structural deficits) suggest that they are at risk for dysphagia. Journal of Critical Care, 30(1), 4048. After being educated about the risks and benefits of a particular recommendation (e.g., oral vs. non-oral means of nutrition, diet level, rehabilitative technique), if a patient (or their decision-maker) chooses an alternate course of action, the SLP makes recommendations and offers treatment as appropriate. Patients may also require further assessment or reassessment depending on changes in functional or medical status. Dysphagia, 4(1), 3942. The FEES is a portable procedure that may be completed in outpatient clinic space or at bedside by passing an endoscope transnasally (Langmore et al., 1988). Chin tuck for prevention of aspiration: Effectiveness and appropriate posture. Bedside diagnosis of dysphagia: A systematic review. Roden, D. F., & Altman, K. W. (2013). OtolaryngologyHead and Neck Surgery, 160(6), 955964. Setting refers to the location of treatment (e.g., home-based, community-based). The SLP may then decide to discontinue speech-language pathology services to the patient but should avail themselves to additional consultation or communication with the parties involved, as appropriate. The patient is not medically stable enough to participate in the procedure. The effortful swallow is designed to improve posterior tongue-base movement, in that way improving clearance of the bolus from the valleculae. Oropharyngeal dysphagia after stroke: Incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. (2016). Preferences of the person with dysphagia and their care partners, related cultural and/or religious considerations and the impact on the patients overall quality of life. Mosby. World Health Organization. (2004). Please see ASHAs Practice Portal pages on. The SLP frequently serves as a coordinator for the team management of dysphagia. American Journal of Speech-Language Pathology, 20(2), 124130. (2020). Squeezing hard with their tongue and throat Administration of an interview or a questionnaire that addresses the patients perception of and/or concern with swallowing function (e.g., the 10-item Eating Assessment Tool [EAT-10]; Cheney, 2015). Using the Fleming index of dysphagia to establish prevalence. masako, shaker, lingual isometric exercises, laryngeal elevation, oral motor exercises, base of tongue exercises . Tongue Exercises Masako: Gently hold the tip of your tongue between your front teeth. Examples of maneuvers include the following: Swallowing exercises include exercises of the lips, jaw, tongue, soft palate, pharynx, larynx, and/or respiratory muscles to improve function. https://doi.org/10.1034/j.1600-0404.2002.10062.x, Calvo, I., Sunday, K. L., Macrae, P., & Humbert, I. Archives of Physical Medicine and Rehabilitation, 74(7), 736739. High-resolution manometry is a technique used to measure pressures generated in the pharynx and esophagus. Electrical stimulation uses an electrical current in order to stimulate the peripheral nerve. Archives of OtolaryngologyHead & Neck Surgery, 131(9), 762770. The patient is severely agitated, unable to remain alert, or unable to follow simple commands. The SLP should consider and integrate the patients wishes and advocate on behalf of the patient to the health care team, the family, and other relevant individuals. Incidence refers to the number of new cases of dysphagia identified in a specified time period. SLPs should consider how culture influences activities of daily living (Riquelme, 2004). Effortful swallow Aims to make the muscles of swallowing stronger and therefore help food and drink to move to the stomach more safely. concerns regarding the safety and efficiency of swallow function, contribution of dysphagia to nutritional compromise, contribution of dysphagia to pulmonary compromise, contribution of dysphagia to concerns for airway safety (e.g., choking), the need to identify disordered swallowing physiology to guide management and treatment, the need to assist in the determination of a differential medical diagnosis related to the presence of dysphagia, the presence of a medical condition or diagnosis associated with a high risk of dysphagia, previously identified dysphagia with a suspected change in swallow function; and, the presence of a chronic degenerative condition with a known progression or the recovery from a condition that may require further information for the management of oropharyngeal function. Maintenance and/or maximization of an individuals health status is a primary concern. Head & Neck, 19(6), 535540. Biofeedback incorporates the patients ability to sense changes and aids in the treatment of feeding or swallowing disorders. Evolution of tracheal aspiration in severe traumatic brain injury-related oropharyngeal dysphagia: 1-year longitudinal follow-up study. https://doi.org/10.1177/0194599818815885. Verification of aspiration and thorough assessment of impairments in swallowing physiology or laryngeal/pharyngeal/upper esophageal anatomy require instrumental assessment. A. Kaneoka, A., Pisegna, J. M., Saito, H., Lo, M., Felling, K., Haga, N., LaValley, M. P., & Langmore, S. E. (2017). (n.d.). Bend your head forward so that your chin tucks. Some of these interventions can also incorporate sensory stimulation. Journal of Neurogastroenterology and Motility, 20(1), 7986. Alternative feeding does not preclude the need for rehabilitative techniques to facilitate sensory and motor capabilities necessary for oral feeding. https://www.swallowingdisorderfoundation.com/about/swallowing-disorder-basics/, National Institute on Deafness and Other Communication Disorders. Many facilities have an ethics consultation service that can help clinicians, patients, and families address challenges when an ethical issue arises. Dysphagia, 18:284-292. Aspiration pneumonia: A review of modern trends. Or hold this position for 1 minute, and then lower your head and . Special considerations may need to be made regarding PPE for COVID-19. Management of individuals with dysphagia should be based on results of comprehensive assessment, including both instrumental and non-instrumental assessments as applicable. https://doi.org/10.1044/1058-0360(2011/10-0067), Donzelli, J., & Brady, S. (2004). Ultrasound imaging and swallowing. (2023). Examples of postural techniques include the following: Postures and maneuvers may be combined, taking care to minimize patient effort/burden when possible. The New England Journal of Medicine, 324(17), 11621167. Try to see your toes. Surface electromyographic biofeedback and the effortful swallow exercise for stroke-related dysphagia and in healthy ageing. Consulting with the interprofessional team, including a dietician and pharmacist, when altering a diet can help ensure that the patients nutritional and medication needs continue to be met. https://doi.org/10.1016/j.jmu.2013.10.008, Huckabee, M. L., & Steele, C. M. (2006). https://doi.org/10.1002/(SICI)1097-0347(199709)19:6<535::AID-HED11>3.0.CO;2-4, Macht, M., Wimbish, T., Bodine, C., & Moss, M. (2013). Validation of the Yale Swallow Protocol: A prospective double-blinded videofluoroscopic study. SLPs examine the influence of diet texture modifications on swallowing physiology, including airway protection, during a comprehensive assessment of an individuals swallowing status prior to recommending these changes as part of treatment. Keep your shoulders flat. nasal congestion. (2019). Acta Gastroenterologica Latinoamericana, 40(2), 156158. Journal of Prosthodontic Research, 56(3), 166169. Comparison of 2 interventions for liquid aspiration on pneumonia incidence: A random-ized trial. Instrumental techniques are usually conducted either independently by the SLP or by the SLP in conjunction with other members of the interprofessional team (e.g., radiologist, radiologic technologist, physiatrist, otolaryngologist). A systematic review by Martino et al. This includes external scientific research as well as data gathered on a specific person. This, in part, is due to the concomitant medical conditions being reported and the timing and type of diagnostic procedures being used to identify swallowing disorders across neurological populations. (2012). Determine with specificity the relative safety and efficiency of various bolus consistencies and volumes. Dysphagia, 2(4), 216219. Seminars in Speech and Language, 21(4), 347364. Different management approaches may be necessary for individuals with dysphagia that has resulted from an acute event, a chronic/stable condition, or a progressive neurological disorder. https://doi.org/10.1044/leader.FTR3.08082003.4. https://www.asha.org/policy/. Squeeze their muscles with their chin tucked down 2. https://doi.org/10.1016/j.pmr.2008.07.001, Gordon, C., Hewer, R. L., & Wade, D. T. (1987). https://doi.org/10.1097/MCG.0000000000000624, Bahat, G., Yilmaz, O., Durmazoglu, S., Kilic, C., Tascioglu, C., & Karan, M. A. Dysphagia, 30(5), 558564. https://doi.org/10.1007/s00455-013-9464-y. For further information on the modified Evans blue dye test, please see the, recommendations for additional assessment to determine whether, and the degree to which, swallowing anatomy and/or physiology may be impaired; and. Iranian Journal of Neurology, 17(4), 180188. The Journal of Nutrition, Health & Aging, 23(6), 571577. The Journal of Nutrition, Health & Aging, 22(8), 10031009. Dysphagia: Clinical management in adults and children. Please see ASHAs Dysphagia Evidence Map. volitional airway protection strategy (compensatory) . https://doi.org/10.1378/chest.09-1823, Solazzo, A. slowly touch and count each one of your teeth. 243259). A., Rademaker, A. W., Pauloski, B. R., & Kahrilas, P. J. polymyositis and dermatomyositis (Gonzlez-Fernndez & Daniels, 2008). Diagnostic accuracy of the modified Evans blue dye test in detecting aspiration in patients with tracheostomy: A systematic review of the evidence. (1989). Additional assessment of voice, motor speech patterns, cognition, and communication, as warranted. SLPs with appropriate training and competence in performing electrical stimulation may provide the intervention.

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