6 Normal Swallow Sequence In the mouth:lips, teeth and tongue help prepare bolus (food mass) for further stages of swallowing.LipsTeethTongueBolus
7 Normal Swallow Sequence Access between the nasal cavity and mouth closes as bolus moves into pharynx (throat).Nasal CavityPharynxBolus
8 Normal Swallow Sequence Bolus is propelled esophagusAs esophagus entrance opens: Epiglottis helps guard against access to the lungs.EpiglottisVocal CordsTrachea/Airway to the LungsEsophagus Entrance
9 Normal Swallow Sequence The airway reopens and the esophagus entrance closes as muscle contractions move bolus toward stomach.To the Stomach
19 What to Do? Immediate remedies: If coughing/choking, never inhibit coughHeimlich ManeuverStack breathingPortable suctionCoughAssist device [www.respironics.com]CoughAssist™ Mechanical In-Exsufflator
20 Safe Swallowing Strategies Swallowing techniquesDon’t talk with mouth fullRepeat swallowsAlternate solids and liquidsOne sip at a timeSip ‘n’ tip strawsSmaller bitesSlowed rateSupervision and cueingSmaller, more frequent meals per day
22 Safe Swallowing Strategies [cont.] PositioningChin tuckBehavioral changesReduce distractionsEat more calories early in the day or when there is less fatigue
23 Safe Swallowing Strategies [cont.] Pill managementTake with applesauce, yogurt, pudding, ice cream, or any other slippery mediumCool Whip!Long-necked bottlesCarbonated beveragesCrush with pharmacist’s consent
25 Feeding TubesG-tube goes into stomach through an opening in skin
26 Feeding Tubes [cont.] What it does: Provides nutrition via an alternate routeAllows one to receive required nutrition and hydration when no diet texture can be swallowed safely or when oral feeding is not meeting nutritional / hydration needsAllows for the combination of oral eating for pleasure and tube feeding for fluids and calories
28 Speech“Normal” sounding speech requires perfect coordination of the following systems:Articulatory system (e.g., lips, tongue, etc.)Resonatory system (e.g., velum/soft palate)Phonatory system (e.g., vocal cords)Respiratory system (e.g., lungs)
29 Random Speech Facts…Approx. 14 different sounds produced every second when we verbalize.Over 100 different muscles coordinate during speech.
30 “Its Greek to Me”Ataxia comes from:Greek word for “lack of order”
31 Ataxic DysarthriaDisorder of sensorimotor control for speech production that results from damage to cerebellum or to its input and output pathways
33 Effects of Ataxia on Speech Articulation: disruption of the timing, force, range, and direction of movements.Imprecise consonant articulationDistorted vowelsBreakdown is most evident during longer strings of speech
34 Effects of Ataxia on Speech [cont.] Resonance:HypernasalityHyponasalityMay occur due to timing errors between the muscles of the velum and the other muscles of articulation.Soft Palate / Velum
35 Effects of Ataxia on Speech [cont.] Phonation: the sound of the voiceHarsh vocal qualitydue to decreased muscle toneVocal tremor
36 Effects of Ataxia on Speech [cont.] Respiration:Uncoordinated movements of the respiratory musclesExaggerated movementsExcessive loudnessParadoxical movements (different muscle groups work against each other)Talking too quicklyDecreased vocal volumeTrying to talk on residual air
37 Most Common Speech Changes Imprecise consonantsExcess and equal stressArticulatory breakdownDistorted vowelsHarsh vocal qualityMono pitch/Mono loudnessSlowed speech rate
39 What to do about it… 1. Evaluation by a Speech-Language Pathologist 2. TreatmentExercises will target the affected system(s)Improve breath support and coordination of breathing and speakingRate control techniques (e.g., finger/hand tapping to set the pace of appropriate syllable production)Increase articulatory accuracy: over-articulateDevelop stress and intonation skills to regulate pitch and loudness
40 Compensatory Strategies For the Speaker...Energy conservationMinimize environmental noise/distractionsEstablish context of messageAlter your rate of speech…SLOW it down.Exaggerate articulation of final consonants in wordsUse gestures/point to propsBoil down the messagedecrease “filler” wordsKeep important/key words
41 Compensatory Strategies For the Communication Partner…Ascertain patients preferred strategy when not intelligibleDecrease the need for repetition fatigue and frustrationAsk yes/no questionsKnow the topicMaintain eye contactGive undivided attentionDon’t interrupt or finish sentencesLet the speaker know the parts of the message you did not understand so s/he will not have to repeat the entire message.Patience
42 Augmentative/Alternative Communication (AAC) Low techCommunication boardAlphabet boardPhrase boardHigh techSpeech generating devicesAn SLP can help explore your optionsOtherVoice amplificationChattervox OR SoniVox
43 Take Home MessageWith regard to speech or swallowing, there is always a way to keep you functioning at the highest level possible.
44 Anne G. Lefton, M.A. / CCC-SLP Nancy Sedat & Associates 2011 Annual Membership MeetingTHANK YOU!Anne G. Lefton, M.A. / CCC-SLPNancy Sedat & Associates
45 ReferencesFreed, D. (2000). Motor speech disorders diagnosis and treatment. San Diego, CA: Singular Thomson Learning, 2000.Puntil-Sheltman, J. (1997). Follow the swallow. Seal Beach, CA: Sheltman Publishing,Rangamani, G.N., J. (2006). Managing speech and swallowing problems: A guidebook for people with ataxia. National Ataxia Foundation, 1-60.Yorkston, K.M., Beukelman, D.R., & Bell, K. (1988). Clinical management of dysarthric speakers. San Diego, CA: College-Hill Press.
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