1. KEY ITEMS IN DYSPHAGIA PROCESS
Recognizing dysphagia features:
* education of nurses, doctors, therapists about dysphagia
* screening methods

2. Speech 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 areas
Defines: * The deficit function
Discerns: * Muscle group that will restore the deficit function
* Motor lines that power the muscle group
* Sensory pathways to motor line(s)
Chooses: Appropriate DPNS-techniques
Stimulates: times/ week
Proposes: Modified diet, PO/ NPO, VFG-study
Documents: Systematically on weekly basis
Informs: Patient, Family, Multiprofessional Team.

3. In Videofluorography study:
Radiologist, SLT and Nurse
SLT and Radiologist assess:
Triggering point of swallow
Palatal reflex competency rate
Tongue base retraction reflex competency rate
Pharyngeal peristalsis
Epiglottal range of motion
Cricopharyngeal reflex competency rate
Sensory in oral, pharyngeal and laryngeal areas
Aspiration risk
● Nurse:
- Prepares the room and the equipment for VFG study.
- Helps patient to get ready for VFG study

4. Multiprofessional Teamwork
Doctor: Responsible for patients health Plan of Care (POC)
SLT: Examination and rehabilitation of dysphagia
Nurses: Medical care & daily nutrition/hydration intake
Radiologist: VFG-study
Dietician: Medical Nutrition assessments
ENT: Medical & Structural assessments as appropriate
OT: Hand to Mouth function/coordination for feeding
PT: Balance/positioning assessments
Institutional
Employees: All aspects of the patient’s health POC
Patient: Compliance with all Plan of Care treatments
Family : Educated/trained on Patient’s condition & management techniques

5. Information and guidance
Patient Education and training for patient, family and multiprofessional team:
Dysphagia features/signs
Understanding the symptoms
Nutrition
Rehabilitation Treatment strategies & Goals
Additional examinations and POC modifications as appropriate
Ongoing Patient Risk Determinations

6. Conclusions
The model for rehabilitation of dysphagia patients has been in use since 2000
The results have been promising
It has clarified the roles and responsibilities of the team
The recognition of dysphagia has increased
The role of SLT has become crucial to the success of the total Rehabilitation Team
The examination, rehabilitation and documentation are done systematically -> cost effective therapy, short-term treatment schedule, patient satisfaction, and increased patient safety.

7. Suggestions
Screening methods and educational protocols for the team have to be established
Systematic documentation enables information transfer with patient -> subsequent rehab facilities
This kind of model for dysphagia rehabilitation could be a basis for national guidelines

8. Case Male 56 yrs Large temporoparietal stroke verified in CT-scan
Anarthric
Severe dysphagia
Weakness in motor lines of CN V, VII, X, XII
Sensory deficiency in the sensory lines of CN V, VII, IX, X

9. 1. 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

10. 1st Videofluorosgraphy evaluation

11. Treatment 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 week
Weekly documentation of progress (daily treatment response form)

12. REHABILITATION (1st week)

13. 2. 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 %

14. 3rd Videofluorography evaluation

15. REHABILITATION (7th week)

16. Results
The therapeutic feeding was started after seven weeks of treatment
Patient was discharged from the hospital after ten weeks of treatment with diet of: pudding consistencies and nectar thick liquids
The patient was able to communicate with speech characterized as mildly dysarthric