TREATMENT OF DYSPHAGIA IN PATIENTS AFTER STROKE IN ESTONIA

Transcription

1 TREATMENT OF DYSPHAGIA IN PATIENTS AFTER STROKE IN ESTONIA ANNE URIKO SPORTS MEDICINE AND REHABILITATION CLINIG OF TARTU UNIVERSITY HOSPITAL

2 DYSPHAGIA DIFFICULTY MOVING FOOD FROM MOUTH TO STOMACH DYSFUNCTION OF BEHAVIORAL, SENSORY AND PRELIMINARY MOTOR ACTS IN PREPARATION FOR THE SWALLOW OCCURES IN ALL AGE GROUPS RESULT OF CONGENITAL ABNORMALITIES, STRUCTURAL DAMAGE AND/OR MEDICAL CONDITIONS OF STROKE PATIENTS 51-57% MAY HAVE SWALLOWING PROBLEMS

3 DYSPHAGIA CARE INCLUDES: SCREENING PROCEDURES - ENDOSCOPY, SCINCTIGRAPHY,CERVICAL AUSCULTATION, SPEED OF SWALLOW TEST DIAGNOSTIC PROCEDURES VIDEOFLUOROSCOPY, ULTRASOUND, MANOMETRY THERAPY SCREENING = IDENTIFYING PATIENTS AT HIGH RISK FOR DYSPHAGIA DIAGNOSIS = DEFINES ANATOMIC/PHYSIOLOGIC ABNORMALITIES AND ASSESSES TREATMENT

4 VIDEOFLUOROSCOPY = MODIFIED BARIUM SWALLOW (MBS) DEFINES THE EXACT NATURE OF THE DISORDERED ANATOMY/ PHYSIOLOGY OF PATIENT S OROPHARYNGEAL SWALLOW ALLOWS INTERVENTION EFFECTS TO BE EVALUATED *EXAMINES ORAL, PHARYNGEAL AND ESOPHAGEAL FUNCTION : - TIMING OF BOLUS MOVEMENT; - TIMING AND EXTENT OF STRUCTURAL MOVEMENT *IDENTIFIES ETIOLOGY OF ASPIRATION *IDENTIFIES EFFICIENCY OF SWALLOW *EXAMINES EFFECTIVNESS OF REHABILITATION STRATEGIES: compensations, Therapy strategies/maneuvers; diet modifications

5 MBS PROTOCOL (X-RAY READING): PATIENT SEATED AND VIEWED LATERALLY AND ANTERIORLY - DOES THE PATIENT HAVE ORAL /PHARYNGEAL RESIDUE? - ARE THERE ABNORMALITIES IN MOVEMENT OF STRUCTURES IN THE PHARYNX? - WHY DOES THE PATIENT ASPIRATE? WHICH DISORDER CAUSES ASPIRATION? THE VIDOEFLUOROGRAPHIC REPORT SHOULD INCLUDE THE SYMPTOM AND THE DISORDER IT REPRESENTS

6 WHY TO PREFER VIDEO TO STATIC X-RAY? KRISTINA 40 YRS DIAGNOSIS: DYSPHAGIA OF UNKNOWN ETIOLOGY PATIENT SWALLOWS ONLY BLENDERIZED FOOD MBS STUDY WITH NORMAL SPEED DOES NOT SHOW ANY ABNORMALITY MBS WITH SLOW SPEED SHOWS DIVERTICLE A POSSIBLE CAUSE OF DYSPHAGIA

7 KRISTINA VIDEO WITH NORMAL SPEED

8 KRISTINA VIDEO WITH SLOW SPEED

9 EXAMPLE OF A VIDEOFLUOROSCOPIC STUDY IRINA 41: DIAGNOSIS :Chronic inflammatory demyelinating polyneuropathy (CIDP). - WEIGHT LOSS 20 KG - BULBAR AND FACIAL NERVE PALSY, FLACCID TETRAPARESIS, DYSPHAGIA - SWALLOWS PUDDING, EACH MEAL LASTS 40 MINUTES, VERY RARE AND UNPRODUCTIVE COUGHING INFORMATION AFTER MBS : - REDUCED RANGE OF MOTION OF THE ORAL TONGUE, TONGUE BASE AND LARYNX - DELAYED PHARYNGEAL SWALLOW - SILENT ASPIRATION (WITHOUT COUGHING)

10 IRINA

11 IRINA

12 DECISION MAKING: NONORAL FEEDING! GASTROSTOMY (BLENDERIZED TABLE FOOD THROUGH THE TUBE) SWALLOWING THERAPY: - COMPLEX OF EXERCISES TO IMPROVE TONGUE MOVEMENT - HEIGHTEN SENSORY INPUT (THERMAL-TACTILE STIMULATION)

13 MANAGEMENT OF THE PATIENT WITH OROPHARYNGEAL SWALLOWING DISORDER WHAT TYPE OF NUTRITIONAL MANAGEMENT IS NECESSARY (ORAL, NASOGASTRIC FEEDING, GASTROSTOMY)? SHOULD THERAPY BE INITIATED AND WHAT TYPE: - COMPENSATORY (DIET, POSTURE) OR EXERCISES; - DIRECT (WITH FOOD) OR INDIRECT (WITHOUT FOOD)? WHAT SPECIFIC THERAPY STRATEGIES SHOULD BE USED: - SUPRAGLOTTIC SWALLOW - SUPER-SUPRAGLOTTIC SWALLOW - EFFORTFUL SWALLOW - MENDELSOHN MANEUVER GOAL OF ANY TREATMENT PROGRAM IS THE REESTABLISHMENT OF ORAL FEEDING

14 VitalStim ELECTROTHERAPY SYSTEM (CHATANOOGA GROUP, USA) A 4-CHANNEL ELECTROTHERAPY SYSTEM USED IN TREATING PATIENTS WITH ORAL-PHARYNGEAL DYSFUNCTIONS AND DISORDERS OF THE NECK AND HEAD SPECIALIZED FORM OF NEUROMUSCULAR ELECTRICAL STIMULATION DESIGNED TO TREAT DYSPHAGIA THROUGH MUSCLE RE-EDUCATION THE CURRENT STIMULATES MOTOR NERVES IN THE THROAT WHILE THE PATIENT PRACTICES SWALLOWING EXERCISES THAT CAUSE THE SWALLOWING MUSCLES TO CONTRACT SURFACE ELECTROMYOGRAPHY FUNCTION READS AND RECORDS MUSCLE ACTIVATION

15 VitalStim THERAPY

16 DYSPHAGIA IS UNDERDIAGNOSED! SCREENING TECHNIQUES, DIAGNOSTIC TECHNOLOGIES AND TREATMENT STRATEGIES FOR OROPHARYNGEAL DYSPHAGIA HAVE INCREASED, BUT: UNDERSTANDING OF THE OPTIMAL APPLICATION OF DIAGNOSTIC AND TREATMENT PROCEDURES TO VARIOUS POPULATIONS REQUIRES A GREAT DEAL MORE RESEARCH MANY MAJOR QUESTIONS REMAIN TO BE ANSWERED IN ALL ASPECTS OF NORMAL AND ABNORMAL PHYSIOLOGY OF THE SWALLOWING MECHANISM AND ITS RELATIONSHIP TO CONTROL RESPIRATION AND SPEECH PRODUCTION SALIVATION IS ALSO SWALLOWING DISORDER! COUGHING WITHOUT PNEUMONIA DURING/AFTER EVERY MEAL- IT IS A SWALLOWING PROBLEM!

17 THANK YOU!