Dysphagia Identification and Management

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1 Dysphagia Identification and Management Presented By Speech-Language Pathologist Developmental Disabilities Administration DC Department on Disability Services

2 Training Objectives After this training session participants will: Understand swallowing disorders, screening, evaluation, and management Identify common food and liquid textures and consistencies

3 Understand swallowing disorder causes and interventions Training Objectives After this training session participants will: Recognize signs and symptoms of dysphagia and aspiration

4 Training Objectives After this training session participants will: Identify mealtime guidelines and safe swallowing strategies Explain referral protocol for clinical and instrumental SLP swallowing evaluations

5 What is dysphagia? People with dysphagia have difficulty swallowing and may also experience pain while swallowing. Some people may be completely unable to swallow or may have trouble swallowing liquids, foods, or saliva. Eating then becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body.

6 Dysphagia Warning Signs Chronic coughing and/or choking during or after eating or drinking Wet/gurgly vocal quality after eating Food feels like it sticks in the throat Frequent throat clearing Feeling of food coming back up Vomiting after eating Unexplained weight loss Appetite changes Food coming through the nose Self restriction of selected foods

7 Possible Causes of Feeding and Swallowing Issues Structural/Anatomical Abnormalities Neurological/Physiological Problems Sensory Issues Behavioral Issues

8 Assessing Swallowing Disorders Bedside Clinical Swallowing Examination Bedside swallow includes: water/liquid test, food test (varying consistencies and textures) Observes for coughing after swallowing Observes for voice change after swallowing

9 Assessing Swallowing Disorders Rule out any medical condition which may contribute to feeding/swallowing difficulties and weight gain/loss issues Assess oral motor function Assess food sensitivities and allergies Note medication and side effects on eating Include profile of the diet

10 Referral Protocol Individuals who display signs/symptoms of dysphagia should be observed by nurse and referred to a speech-language pathologist for screening. After screening and clinical bedside swallow evaluation, speech-language pathologist should determine if individual warrants a Modified Barium Swallow Study/Videofluroscopy of Swallow. Recommendations documented in Modified Barium Swallow Study report completed at hospital must he carried out by healthcare providers and caregivers.

11 Management of Dysphagia Surgery or Medication Muscle exercises to strengthen weak oral/facial muscles used to eat Postural Positioning Tube feeding Modified Diet Neuromuscular Electrical Stimulation Thermal Stimulation

12 Mealtime Protocol Example Mealtime/Feeding Guidelines: Food and Liquid Texture/Consistency Pureed food (food is prepared in food processor or blender. Food texture is smooth and creamy like pudding.) Regular thin liquids with spouted mug/sippy cup Nutritional/Diet Info 1500 caloric diet, low fat, no added salt, measured portions, no caffeine, extra fiber

13 Mealtime Protocol Safe Swallowing Strategies/Techniques Positioning: Seated upright at 90 degrees Give small amounts of food and small sips of drink Alternate between food and liquid Check mouth after meal is complete for pocketing of food Remain upright for at least 30 minutes after eating Report incidents of excessive coughing, choking, or other signs/symptoms of aspiration or distress

14 National Dysphagia Diet Food Terminology Guidelines Dysphagia Pureed - smooth, cohesive, no lumps; Pureed, homogenous, cohesive, pudding-like foods. Dysphagia Mechanically Altered - moist, soft textured foods with some cohesion; Meats are ground or chopped no larger than one quarter (1/4) inch pieces & are easily formed into a bolus. Dysphagia Advanced - nearly a regular texture with the exception of very hard, crunchy, or sticky foods (ex., bitesized ) Regular Diet - Unaltered

15 Food Texture Description Regular Food is served with no alteration in texture. Pureed Food is prepared in a food processor or blender. Food texture is smooth and creamy like pudding (not too watery). Bite Sized Food is cut into pieces between the size of a quarter and a nickel. Food is cut on the plate by program staff or by the person with necessary assistance.

16 Food Texture Description What is a Mechanical Soft Diet? Foods are soft and mechanically altered so that they are easy to chew and swallow. Meats must be very tender small pieces, or ground and moistened with sauces or gravy. Chopped food should be smaller than 1/4 inch in size. Ground food is chunky like ground meat or hash and is moist not dry.

17 Liquid Consistency Descriptions Thin- Regular liquids like water Honey- Less pourable, drizzle from a cup or bowl Nectar-Easily pourable and similar to thicker cream soups Pudding- Hold their own shape, not pourable, eaten with a spoon

18 Follow Up Training must be provided to staff Mealtime protocol should be available and followed Diet texture should be consistent with Physician s Order, HCMP, Health Passport, etc. Any complications or progress observed during feeding should be documented Refer all swallowing concerns to SLP/swallowing specialist and follow up on clinical recommendations

19 Meal Examples

20 Meal Examples

21 Meal Example

22 Questions/Comments???

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