Presentation on theme: "KEY ITEMS IN DYSPHAGIA PROCESS"— Presentation transcript:
1KEY ITEMS IN DYSPHAGIA PROCESS Recognizing dysphagia features:* education of nurses, doctors, therapists about dysphagia* screening methods
2Speech and Language Therapist´s Examination Assesses: * Motor of speech* Volitional and reflexive function of the muscles in the oral, pharyngeal, larynxgeal, and facial areas* Sensory of the oral, pharyngeal, and laryngeal areasDefines: * The deficit functionDiscerns: * Muscle group that will restore the deficit function* Motor lines that power the muscle group* Sensory pathways to motor line(s)Chooses: Appropriate DPNS-techniquesStimulates: times/ weekProposes: Modified diet, PO/ NPO, VFG-studyDocuments: Systematically on weekly basisInforms: Patient, Family, Multiprofessional Team.
3In Videofluorography study: Radiologist, SLT and NurseSLT and Radiologist assess:Triggering point of swallowPalatal reflex competency rateTongue base retraction reflex competency ratePharyngeal peristalsisEpiglottal range of motionCricopharyngeal reflex competency rateSensory in oral, pharyngeal and laryngeal areasAspiration risk● Nurse:- Prepares the room and the equipment for VFG study.- Helps patient to get ready for VFG study
4Multiprofessional Teamwork Doctor: Responsible for patients health Plan of Care (POC)SLT: Examination and rehabilitation of dysphagiaNurses: Medical care & daily nutrition/hydration intakeRadiologist: VFG-studyDietician: Medical Nutrition assessmentsENT: Medical & Structural assessments as appropriateOT: Hand to Mouth function/coordination for feedingPT: Balance/positioning assessmentsInstitutionalEmployees: All aspects of the patient’s health POCPatient: Compliance with all Plan of Care treatmentsFamily : Educated/trained on Patient’s condition & management techniques
5Information and guidance Patient Education and training for patient, family and multiprofessional team:Dysphagia features/signsUnderstanding the symptomsNutritionRehabilitation Treatment strategies & GoalsAdditional examinations and POC modifications as appropriateOngoing Patient Risk Determinations
6ConclusionsThe model for rehabilitation of dysphagia patients has been in use since 2000The results have been promisingIt has clarified the roles and responsibilities of the teamThe recognition of dysphagia has increasedThe role of SLT has become crucial to the success of the total Rehabilitation TeamThe examination, rehabilitation and documentation are done systematically -> cost effective therapy, short-term treatment schedule, patient satisfaction, and increased patient safety.
7SuggestionsScreening methods and educational protocols for the team have to be establishedSystematic documentation enables information transfer with patient -> subsequent rehab facilitiesThis kind of model for dysphagia rehabilitation could be a basis for national guidelines
8Case Male 56 yrs Large temporoparietal stroke verified in CT-scan AnarthricSevere dysphagiaWeakness in motor lines of CN V, VII, X, XIISensory deficiency in the sensory lines of CN V, VII, IX, X
91. VFG-study Sept. 2002 showed: Poor bolus management in oral cavity Tongue base retraction competency rate 8 %Palatal reflex competency rate 50 %Epiglottal range of movement 25 %Cricopharyngeal reflex competency rate 100 % (table 1)Silent aspiration occurs
11Treatment DPNS-treatment Goals: 1) to restore the motor function of the tongue muscles and the laryngeal musculature, 2) to increase sensory in the oral cavity and pharynx (specific functional goals can be read in the handout)5 times per weekWeekly documentation of progress (daily treatment response form)
132. VFG-study Nov. 2002, after six weeks of treatment Tongue base retraction reflex competency rate 100%Palatal reflex competency rate 100 %Epiglottal range of movement %Cricopharyngeal reflex competency rate 100 %Aspiration on liquids, but sensory was75 %
16ResultsThe therapeutic feeding was started after seven weeks of treatmentPatient was discharged from the hospital after ten weeks of treatment with diet of: pudding consistencies and nectar thick liquidsThe patient was able to communicate with speech characterized as mildly dysarthric