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Evaluation and Management of Dysphagia a Team Approach

Evaluation and Management of Dysphagia a Team Approach. Rebecca L. Gould, MSC, CCC-SLP rebec26050@aol.com (561) 833-2090 www.med-speech.com. “More than 15 million Americans have some degree of dysphagia, and with regular treatment 83% recover or significantly improve”.

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Evaluation and Management of Dysphagia a Team Approach

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  1. Evaluation and Management of Dysphagia a Team Approach Rebecca L. Gould, MSC, CCC-SLP rebec26050@aol.com (561) 833-2090 www.med-speech.com

  2. “More than 15 million Americans have some degree of dysphagia, and with regular treatment 83% recover or significantly improve”. Bello, J. (1994) compiled by Communication Facts. ASHA Research Division RLG

  3. Pneumonia occurs in 38% of all stroke victims and is the most common respiratory complication. Pneumonia contributes to about 34% of all stroke deaths and represents the third cause of mortality in the first month following stroke. Stepphens & Addington, 1999 RLG

  4. “IS IT SAFE TO FEED THIS PATIENT?” RLG

  5. EVALUATION • Clinical “bedside” swallow evaluation. • Videofluoroscopic Swallowing Study (VFSS) • Fiberoptic Endoscopic Evaluation of Swallowing (FEES) • (Reflexive cough test) RLG

  6. MBSS? or FEES? RLG

  7. Two Goals of Swallowing Evaluation: • Determine the Safest and Least Restrictive Level of P.O. • Determine the physiologic breakdown of the swallow so it can be rehabilitated in treatment. RLG

  8. FEES (Fiberoptic Endoscopic Evaluation of Swallowing) RLG

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  12. RESIDUAL Leftover material in the oral pharynx after swallow has occurred. RLG

  13. PENETRATION Entry of material into the laryngeal vestibule to the level of the vocal folds. RLG

  14. ASPIRATION Entry of material below the level of true vocal folds. RLG

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  23. Assess secretions RLG

  24. Leder, Sasaki, Burrell (1998) • FEES/Fluoro Comparison, n = 56 • 96% Agreement: • 1 silently aspirated during MBS but coughed during FEES • 1 did not aspirate during MBSS but did during FEES RLG

  25. Will Test ALL Types of Food/Liquid • Thin liquid • Thick liquid (Nectar) • Puree • Solid • Mixed Consistency • Pills • Challenging food (i.e. nuts, peanuts, etc.) RLG

  26. Will give MULTIPLE trials of each consistency • CPG can break down • Large bolus size • Consistency • Fatigue • Lack of coordination (COPD) RLG

  27. Protocol • Saliva – Secretion rating • Anatomy screen • Laryngeal physiology assessment • Swallowing physiology assessment • Functional – Patient self-administer bolus • Diet recommendations • Recommendations for swallowing therapy/follow-up RLG

  28. Typically use green food coloring

  29. FEES Interpretation 4 Main Parameters: • Delay in Swallow Initiation • Penetration • Aspiration • Residue RLG

  30. RLG

  31. Swallow Initiation • Bolus spills to valleculae or pyriform sinuses for greater than one second before the swallow (white-out). RLG

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  35. Penetration/Aspiration

  36. RLG

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  38. Timing of Penetration/Aspiration • Before the Swallow • During the Swallow • After the Swallow RLG

  39. Issues With Residue • Residue in Vallecula? • Residue in Pyriform Sinuses? • Diffuse Pharyngeal Residue? RLG

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  46. Zenker’s Diverticulum

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  49. Cervical Osteophytes

  50. Cervical Osteophytes RLG

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