Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. Blow, M, Olsson, R, Ekberg, O (2002) Supraglottic swallow, effortful swallow, and chin tuck did not alter hypopharyngeal intrabolus pressure in patients with pharyngeal dysfunction. Improved Pharyngoesophageal Segment Opening. Intraoral appliances (e.g., palatal plates) are removable devices with small knobs that provide tactile stimulation inside the mouth to encourage lip closure and appropriate lip and tongue position for improved swallow function. Effortful swallow. ACP and sEMG: Synchrony for Dysphagia - Dysphagia Ramblings Keep your shoulders flat. Ayman, A. R., Khoury, T., Cohen, J., Chen S., Yaari, S., Daher, S., Benson, A. 13%38% among elderly individuals who are living independently (Kawashima et al., 2004; Serra-Prat et al., 2011). 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 support adequate nutrition and hydration and return to oral intake (including incorporating the patients dietary preferences and consulting with family members/caregivers to ensure that the patients daily living activities are being considered); determine the optimum supports (e.g., posture, or assistance) to reduce patient and caregiver burden while maximizing the patients quality of life; and. 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. http://europepmc.org/abstract/MED/20645565, Ruoppolo, G., Schettino, I., Frasca, V., Giacomelli, E., Prosperini, L., Cambieri, C., Roma, R., Greco, A., Mancini, P., De Vincentiis, M., Silani, V., & Inghilleri, M. (2013). https://doi.org/10.1007/s12603-019-1191-0, Balzer, K. (2000). Archives of Physical Medicine and Rehabilitation, 74(7), 736739. Treatment options should be selected on a case-by-case basis as there are many etiologies of dysphagia. Upon completion of the comprehensive assessment, the clinician uses the acquired data to identify which treatment options would be most beneficial. First, the possibility of vocal hyperfunction is a concern due to the effortful phonation produced with the EPG. SLPs should maintain competency of skills through reading current research and engaging in continuing education. Super-supraglottic swallow in irradiated head and neck cancer patients. Provider refers to the person providing the assessment or treatment (e.g., SLP, trained volunteer, caregiver). Masako Maneuver: Stick your tongue out of your mouth between your front teeth and gently bite down to hold it in place. Thieme. https://doi.org/10.1007/s00455-015-9657-7. Dysphagia, 29(5), 603609. 2. (2009) found that dysphagia occurs in over one third of patients admitted to stroke rehabilitation units. https://doi.org/10.1097/MCG.0000000000000624, Bahat, G., Yilmaz, O., Durmazoglu, S., Kilic, C., Tascioglu, C., & Karan, M. A. Increased risk of dehydration and associated conditions (e.g., renal failure, gastroparesis, constipation, urinary tract infections, confusion/delirium, and poor recovery from illness (Cichero & Lam, 2014; Leibovitz et al., 2007; Murray et al., 2016, Wheelan, 2001). multiple sclerosis (De Pauw et al., 2002); amyotrophic lateral sclerosis (ALS, Lou Gehrigs disease; e.g., Ruoppolo et al., 2013); muscular dystrophy (e.g., Tabor et al., 2018); developmental disabilities in an adult population (e.g., intellectual disability; Chadwick & Jolliffe, 2009); post-polio syndrome (e.g., Sonies & Dalakas, 1991); myasthenia gravis (e.g., Llabrs et al., 2005; Romo Gonzlez et al., 2010); and. Effects of age and bolus volume on velocity of hyolaryngeal excursion in healthy adults. (2017). Identifying the prevalence of dysphagia among patients diagnosed with unilateral vocal fold immobility. Dysphagia, 30(5), 558564. Pharmacotherapy, 19(8), 974978. ), Normal and abnormal swallowing (pp. Ultrasound imaging and swallowing. 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. 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). typical and atypical parameters of structures and functions affecting swallowing; effects of swallowing impairments on the individuals capacity for, performance in, and participation in activities; and. Lick three times and then do an effortful swallow with your lips firmly pressed together. Plonk, W. M. (2005). intake. For example, the super-supraglottic swallow is a rehabilitative technique that increases closure at the entrance to the airway and may also serve as a compensation to protect the airway (McCabe et al., 2009). See the Dysphagia Evidence Map for summaries of the available research on this topic. OtolaryngologyHead and Neck Surgery, 151(5), 765769. https://doi.org/10.1007/BF02414429, Langmore, S. E., & Pisegna, J. M. (2015). Members: 800-498-2071
8, AHCPR Publication No. Please enable it in order to use the full functionality of our website. PDF Efficacy of exercises to rehabilitate dysphagia: A critique of the https://doi.org/10.1097/CCM.0b013e31829caf33, Madanick, R. D. (2013). Retrieved month, day, year, from www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/. Current Physical Medicine and Rehabilitation Reports, 2(4), 197206. The effortful swallow achieves overload through high effort. (2012). Aghaz, A., Alidad, A., Hemmati, E., Jadidi, H., & Ghelichi, L. (2018). 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). Timing refers to the timing of rehabilitation relative to the onset of dysphagia. Understanding emotional and psychological issues related to death is essential to treating patients with swallowing problems at the end of life. Study with Quizlet and memorize flashcards containing terms like Effortful swallow - targets, Effortful swallow - contraindications, Effortful swallow - dosage and more. Dysphagia may increase caregiver costs and burden and may require significant lifestyle alterations for the patient and the patients family. Gender difference in masticatory performance in dentate adults. Overheard: Using Respiratory Muscle Strength Training in Dysphagia - @ASHA combines voluntary airway protection with strength building of effortful swallow (tilts aryteoinds anteriorly, closes the true and false VF) voice quality check. 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. https://doi.org/10.1016/j.jmu.2013.10.008, Huckabee, M. L., & Steele, C. M. (2006). https://doi.org/10.1007/s00455-017-9863-6. Dysphagia as the sole manifestation of myasthenia gravis. (2016). Aspiration pneumonia: A review of modern trends. trials including consistencies typically consumed by the patient in their natural environment, the SLP may assess, The clinical examination may inform recommendations for the management of dysphagia (Garand et al., 2020), including. Stroke, 30, 744748. Management of GERD-related chronic cough. Bedside diagnosis of dysphagia: A systematic review. (2007). Surface electromyographic biofeedback and the effortful swallow exercise for stroke-related dysphagia and in healthy ageing. Dysphagia and its consequences in the elderly. British Journal of Anaesthesia. Abstract. https://doi.org/10.1016/0003-9993(93)90035-9, Shiga, H., Kobayashi, Y., Katsuyama, H., Yokoyama, M., & Arakawa, I. The presence of the two abnormalities indicated that this young patient had cricopharyngeal hypertonicity. Krekeler, B. N., Broadfoot, C. K., Johnson, S., Connor, N. P., & Rogus-Pulia, N. (2018). Effect of cold water on esophageal motility in patients with achalasia and non-obstructive dysphagia: A high-resolution manometry study. A 5-year longitudinal study. Archives of OtolaryngologyHead & Neck Surgery, 130(2), 208210. The Effortful Swallow Exercise | National Foundation of Swallowing PDF Mendelsohn Maneuver Roden, D. F., & Altman, K. W. (2013). https://doi.org/10.1044/2016_AJSLP-15-0041, Hsiao, M. Y., Wahyuni, L. K., & Wang, T.-G. (2013). SLPs interpret and apply the results of imaging to dysphagia treatment plans and make recommendations and referrals as appropriate. Preferred practice patterns for the profession of speech-language pathology [Preferred practice patterns]. British Medical Journal, 295(6595), 411414. Clinical ethics. (2012). A Systematic Review of the Physiological Effects of the Effortful (2013). Swallowing Midterm Flashcards | Quizlet (2012). Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. https://doi.org/10.1016/j.apmr.2006.11.002. The Synchrony Dysphagia Solutions by ACP combines sEMG with a virtual environment to engage patients in fun, interactive swallowing and speech exercises. B. PURPOSE To increase tongue base retraction and pressure during the pharyngeal phase of the swallow and reduce the amount of food residue in the valleculae of the throat. A., Rademaker, A. W., Pauloski, B. R., & Kahrilas, P. J. The patient is not medically stable enough to participate in the procedure. If the individuals swallowing does not support nutrition and hydration via oral intake, the swallowing and feeding team may recommend alternative avenues of intake (e.g., nasogastric [NG] tube, gastrostomy). Practical Gastroenterology, 29(7), 1631. Impact of texture modifications on medications (e.g., some medications may not be available in liquid form, and crushing others may change their effectiveness; Cichero, 2013; Steadman et al., 2022). ICU-acquired swallowing disorders. https://doi.org/10.1001/archinte.159.17.2058. Journal of Communication Disorders, 46(3), 238248. Dysphagia: Clinical management in adults and children. https://doi.org/10.1016/j.otc.2013.08.008, Romo Gonzlez, R. J., Chaves, E., & Copello, H. (2010). effortful swallow contraindications Dosage primarily refers to the amount of treatment provided (e.g., the frequency, intensity, and duration of service). INSTRUCTIONS Journal of Physical Therapy Science, 27(12), 36313634. Dysphagia management in acute and sub-acute stroke. https://doi.org/10.1007/s00455-004-0013-6, Kim, H. D., Choi, J. A., Kahrilas, P. J., Kobara, M., & Vakil, N. B. Current Opinion in Otolaryngology & Head and Neck Surgery, 26(6), 382391. Dysphagia, 33(3), 380388. The medical team may make temporary recommendations (e.g., no oral intake, stipulation of specific dietary precautions) while the patient is awaiting further assessment. Patient/caregiver report or observation of difficulty with per os (P.O.) 1997- American Speech-Language-Hearing Association. Using ethnographic interviewing strategies during the assessment process is an excellent way to gather information about an individuals specific needs (Westby et al., 2003). The physician is ultimately responsible for selecting which type of tube is used, but a brief description of several options is provided below. A descriptive investigation of dysphagia in adults with intellectual disabilities. https://doi.org/10.1177/0194599814549156, Bloem, B., Lagaay, A., van Beek, W., Haan, J., Roos, R., & Wintzen, A. Oropharyngeal function may be potentially affected in some patients with esophageal motility issues. cises, swallowing and non-swallowing exercises. American Journal of Speech-Language Pathology, 20(2), 124130. Additional systematic reviews and studies have reported varied estimates of dysphagia prevalence in the following: drooling and poor oral management of secretions and/or bolus; ineffective chewing, in consideration of the individual variability in mastication cycles and time (Shiga et al., 2012); food or liquid remaining in the oral cavity after the swallow (oral residue); inability to maintain lip closure, leading to food and/or liquids leaking from the oral cavity (anterior loss of bolus); food and/or liquids leaking from the nasal cavity (nasopharyngeal regurgitation); complaints of food sticking or complaints of a fullness in the neck (globus sensation); complaints of pain when swallowing (odynophagia); changes in vocal quality (e.g., wet or gurgly sounding voice) during or after eating or drinking; coughing or throat clearing during or after eating or drinking; difficulty coordinating breathing and swallowing; acute or recurring aspiration pneumonia/respiratory infection and/or fever (Bock et al., 2017; DiBardino & Wunderink, 2015; Marik, 2010); changes in eating habits, for example, avoidance of certain foods/drinks (Sura et al., 2012); weight loss, malnutrition, or dehydration from not being able to eat enough (Saito et al., 2017; Via & Mechanick, 2013); and, complaints of discomfort related to suspected esophageal dysphagia (e.g., globus sensation, regurgitation). The ability of the 10-item Eating Assessment Tool (EAT-10) to predict aspiration risk in persons with dysphagia. 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. To Chin Tuck, or Not to Chin Tuck? That is the Question. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740808/, Mann, G., Hankey, G., & Cameron, D. (1999). Effects of cuff deflation and one way speaking valve placement on swallow physiology. During any screening process, the members of the patient care team may note proper posture and positioning for eating, as well as any potential sensory deficits that may affect swallowing. Otolaryngologic Clinics of North America, 46(6), 10591071. 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). Effects of transcutaneous neuromuscular electrical stimulation on swallowing disorders: A systematic review and meta-analysis. Kaneoka, A., Pisegna, J. M., Saito, H., Lo, M., Felling, K., Haga, N., LaValley, M. P., & Langmore, S. E. (2017). Journal of Rehabilitation Research & Development, 46(2), 205214. Journal of Medical Ultrasound, 21(4), 181188. HARD / EFFORTFUL SWALLOW . As indicated in the ASHA Code of Ethics (American Speech-Language-Hearing Association [ASHA], 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so. Bend your head forward so that your chin tucks. Specialty certification is a voluntary program and is not required by ASHA to practice in any disorder area. Determine the presence, cause, and severity of dysphagia by visualizing bolus control, the flow and timing of the bolus, and the individuals response to bolus misdirection and residue. 119138). Impact of the modified consistency/viscosity on the individuals swallowing physiology. World Health Organization. Instrumental assessments may be recommended and completed regardless of setting (e.g., hospital, skilled nursing facility) in which the services are delivered. https://doi.org/10.1007/s00455-013-9471-z, Fukuoka, T., Ono, T., Hori, K., Tamine, K., Nozaki, S., Shimada, K., Yamamoto, N., Fukuda, Y., & Domen, K. (2013). Recovery from dysphagia symptoms after oral endotracheal intubation in acute respiratory distress syndrome survivors. https://doi.org/10.1044/1092-4388(2005/089), Meux, M., & Wall, S. (2003). The benefit of head rotation on pharyngoesophageal dysphagia. https://doi.org/10.7224/1537-2073-2.1.40, Barczi, S. R., Sullivan, P. A., & Robbins, J. APPLICABILITY . https://doi.org/10.1007/s00455-013-9488-3, Sun, Y., Chen, X., Qiao, J., Song, G., Xu, Y., Zhang, Y., Xu, D., Gao, W., Li, Y., & Xu, C. (2020). Parkinsonism & Related Disorders, 18(4), 311315. Using an effortful swallow increases sensory input to the swallowing mechanism. Journal of Speech, Language, and Hearing Research, 48(6), 12801293. https://doi.org/10.1111/j.1365-2788.2008.01115.x, Chadwick, D. D., Jolliffe, J., Goldbart, J., & Burton, M. H. (2006). Archer, S. K., Smith, C. H., & Newham, D. J. 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. Journal of Intellectual Disability Research, 53(1), 2943. Stroke, 36(12), 27562763. Effortful swallow enhances vertical hyolaryngeal movement and - PubMed understand issues relative to radiation equipment, equipment maintenance, and safety. Swallowing screening is a procedure to identify individuals who require a comprehensive assessment of swallowing function or a referral for other professional and/or medical services (ASHA, 2004). Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. SLPs work collaboratively with other professionals, individuals, families, and caregivers. Acta Gastroenterologica Latinoamericana, 40(2), 156158. 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). (2023). Conflict may occur when medical recommendations do not match patient preferences. Code of ethics [Ethics]. (2000). Kalf, J. G., de Swart, B. J. M., Bloem, B. R., & Munneke, M. (2012). Archives of Physical Medicine and Rehabilitation, 70(10), 767771. The ASHA Leader, 8(8), 417. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. 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. Management of individuals with dysphagia should be based on results of comprehensive assessment, including both instrumental and non-instrumental assessments as applicable. Aspiration syndromes: Aspiration pneumonia and pneumonitis. The non-instrumental assessment of swallowing is insufficient to infer specific information about laryngeal, pharyngeal, or upper esophageal anatomy and physiology required to develop effective treatment options and prevent consequences of dysphagia, such as dehydration, malnutrition, pneumonia, and death (Garand et al., 2020). BMJ, 300(6726), 721722. With this support, swallowing efficiency and function may be improved. https://doi.org/10.1682/JRRD.2008.08.0092, McCullough, G., Rosenbek, J., Wertz, R., McCoy, S., Mann, G., & McCullough, K. (2005). Various pressure measures can be calculated and compared to normative data (Omari & Schar, 2018). Effects of neuromuscular electrical stimulation in patients with ment is the effortful swallow. An inspection of the oral mechanism, cranial nerve assessment, and other observations such as. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. A patient with decision-making capacity, the patients family, or other established decision-maker has the right to accept or refuse such recommendations (Krekeler et al., 2018). Malnutrition, dehydration, and ancillary feeding options in dysphagia patients. Please see ASHAs resource on the Videofluroscopic Swallowing Study for further information on the VFSS. The effortful swallow was designed as a compensatory strategy to improve BOT retraction and thereby decrease vallecular residue [13, 76], . Patients who are tactically defensive may need approaches that reduce the level of sensory input initially, with incremental increases as tolerance improves. Or hold this position for 1 minute, and then lower your head and . Barriers to caregiver compliance with eating and drinking recommendations for adults with intellectual disabilities and dysphagia. (2001). Springer. Therefore future studies are needed to examine these factors. Robbins, J., Gensler, G., Hind, J., Logemann, J. The prevalence of dysphagia among adults in the United States. (1992). Extend your lower jaw above your upper jaw (like a bull dog). SLPs collaborate with other team members in identifying and implementing use of adaptive equipment. Relative contraindications for PEG are aspiration pneumonia due to gastroesophageal reflux, significant ascites, and morbid obesity. Chest, 137(3), 665673. vocal . International Journal of Otolaryngology, 2012, Article 157630. https://doi.org/10.1155/2012/157630. The role of the SLP in treating individuals with progressive neurological disorders is designed to maximize current function, compensate for irreversible loss of function, assess and reassess changes in status, and educate and counsel patients regarding the progression of the disorder and potential options, including non-oral means of nutrition. International Archives of Otorhinolaryngology, 20(1), 1317. Only saliva swallow Food/Liquid swallow . World Journal of Gastroenterology, 18(23), 29732978. The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. To PEG or not to PEG. Journal of the American Geriatrics Society, 59(1), 186187. Full article: Effect of effortful swallow on pharyngeal pressures Other studies suggest that dysphagia occurs in 29%64% of stroke patients (Barer, 1989; Flowers et al., 2013; Gordon et al., 1987; Mann et al., 1999). The VFSS is also known as the modified barium swallow study (MBSS) and is a radiographic procedure used to gain further information regarding dysphagia. (1997). A Systematic Review of the Physiological Effects of the Effortful A report by the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) estimates that approximately one third of patients with dysphagia develop pneumonia and that 60,000 individuals die each year from such complications (Agency for Health Care Policy and Research, 1999). (2005). 2200 Research Blvd., Rockville, MD 20850
Does a water protocol improve the hydration and health status of individuals with thin liquid aspiration following stroke? 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). The Role of Pharyngeal and Upper Esophageal Manometry in Swallowing Directions 1. A., Pauloski, B. R., Rademaker, A. W., & Colangelo, L. A. American Journal of Speech-Language Pathology, 25(4), 453469. Dysphagia in the elderly: Management and nutritional considerations. Physiology & Behavior, 174, 155161. Setting refers to the location of treatment (e.g., home-based, community-based). Board Certified Specialists in Swallowing and Swallowing Disorders are individuals who hold ASHA certification and have demonstrated advanced knowledge and clinical expertise in diagnosing and treating individuals with swallowing disorders. Determine the presence and cause(s) of laryngeal penetration and/or aspiration. https://doi.org/10.1044/leader.FTR3.08082003.4. Consideration of the underlying neurophysiological impairment is necessary for understanding swallow function and deficits. Neurogastroenterology & Motility, 21(4), 361369. Children may also experience cyanosis, which . Dysphagia, 2(4), 216219. However, other parties (e.g., state regulatory agencies) may require a radiologist to be present during the VFSS. Journal of Gastroenterology and Hepatology Research, 3(5), 10731079. Journal of Oral Rehabilitation, 44(1), 5964. The SLP frequently serves as a coordinator for the team management of dysphagia. SLPs also recognize causes and signs/symptoms of esophageal dysphagia and make appropriate referrals for its diagnosis and management. https://doi.org/10.1007/s00455-017-9855-6, Serra-Prat, M., Hinojosa, G., Lpez, D., Juan, M., Fabr, E., Voss, D. S., Calvo, M., Marta, V., Rib, L., Palomera, E., Arreola, V., & Clav, P. (2011).
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