LOOKING AT THE WHOLE SWALLOWING PICTURE IT IS NOT ALL ABOVE THE SHOULDERS

Transcription

1 LOOKING AT THE WHOLE SWALLOWING PICTURE IT IS NOT ALL ABOVE THE SHOULDERS

2 HISTORY SO TINA WHERE D THESE IDEAS COME FRO orry to say it but in 1990, it wasn t school or externship L even though I love oth!!!!!!!!!!!!!!!!!!!!! We have come along way as a profession but we need o further! odified Barium Swallows xperience acute rehabilitation hospital, acute care, HHC, SNF ocused care with: geriatrics, Stroke, TBIs, PD, MS nterdisciplinary Team Interaction and a little common sense ontinuing education Neurodevelopmental Techniques (NDT), Myofascia elease, VitalStim, LSVT LOUD, Beckman Oral Motor, ASHA Dysphagia Spec nterest Division, Esophageal Courses for SLPs, Respiratory Training with RTs

3 SHOUT OUT TO ESPA, TGH staff, ASHA Dysphagia Special Interest Division, IAO, all the SLPs, PTs, OTs, RNs, dietitians, RTs I ve learned m and My Mom! ese individuals and groups have taught me and I hope wil ntinue to teach me!!!

4 LETS START WITH THE BRAIN hought Processes Do I know I need to eat? Do I have the cognitive initiation to start eating and the sustained attention spa to continue eating without assistance? Am I consciously or unconsciously avoiding any items? ecision Making Do I have the ability to make decisions about diet decisions? Do I have the ability to make and communicate my meal/diet preferences?

5 BRAIN SITES OF LESION rainstem ocalized within Cortex ultiple sites ensation and Motor Sensation only Motor only

6 WHAT DO MY EYES HAVE TO DO WITH IT? oes the food/liquid visually appeal to me? oes this matter? hat does double vision have to do with it? Site of lesion? Accompanying nausea- position/timing intake is crucial

7 WHAT ABOUT MY SMELL AND TASTE? mell has proven impact aste has proven impact

8 WHAT ABOUT THE ENVIRONMEN AROUND ME? nvironment Sound Music Colors Distraction-Overload Other people Modeling/Engagement

9 pinal Impingement CERVICAL NECK

10 ORAL STRUCTURE ips ongue heeks on t forget the Jaw Opening Closure eeth tretching, Resistance Training, Icing, Sustained compression, Suck & wallow, Spitting Are straws always bad??is spitting good or bad?

11 MOUTH TO THROA oft Palate-Closure nterior-posterior Walls Contraction Stripping action yolaryngeal elevation and excursion Epiglottal Inversion

12 TOP OF ESOPHAGUS TO STOMACH ricopharyngeus (C-P) ortic Arch astro-esophageal Junction -P opening eristalsis or lack of arriers : Hiatal Hernias, Barretts Esophagus, Schatzki Ring, Strictures roblems: Vomiting, Spitting, Expectoration

13 THE STOMACH astric Emptying mpairments in absorption ral intake with Tube Feed intake even flushes matter

14 INTESTINES-BOWEL onstipation bstructions ther: Irritable bowel syndrome w let s go back up and out

15 WHAT ABOUT POSTURE ead/neck Control Flexion Extension Retroflexion Tremors Head/Neck ROM Rigidity Positioning: Upright, positioned for optimal head/neck function, does fatigue matter?, Is a chin tuck really the answer to everything? Head turn to the left, to th right, midline. Should we ever let someone swallow looking up at the ceiling?

16 WHAT ABOUT POSTURE 2? houlders/upper/lower Back Respiratory impact for airway clearance abilities Compression/Barriers to esophageal transit Energy usage (conservation, small meals, diet consistency)

17 THE LUNGS # 1? pper id ase nhalation capabilities xhalation capabilities imitations: Conditions that reduce ability to clear Chronic Obstructive ulmonary Disease, Congestive Heart Failure, Lobectomies, Asthmatic onditions The body demands oxygen the lungs are jealous!

18 THE LUNGS # 2? What can I handle? Clean, clear secretions and clean, clear water Frazier Water Protocol Amounts vary with every BODY What is my overall physical condition? Benefits vs Risk Gastric contents, food items, acidic items, gastric contents Don t be afraid of aspiration be afraid of the body not managing it!!!!!! Temperature-Breath Sounds-Weight maintenance- Calorie counts-urine color- Bowel movements

19 WHAT DOES OUR HEART HAVE TO DO WITH IT? xygen levels espiratory rates nergy level ur HEART and LUNGS are JEALOUS!!!!!!!

20 HOW CAN I ENHANCE M SWALLOWING EVAL & TREATMEN WITH PT, OT, RT, DIETITIAN, PHARMACIS & NURSING EYES ystemic Impairments (tone, rigidity, fatigue) Often the swallow models the walking (even if you don t have MBSS, FEES input ifferent times of the day When is the biggest meal? What is my weight? luid retention? Caloric needs? Fiber needs? ow am I handling my medications? If we don t assess-who is? What ifference does it make? edication impact (there are classes and books written.) Pain - constipation Muscle relaxers smooth muscle impact Antibiotics gastric irritation, thrush ( or red or yellow?) Systemic neuro meds ex: PD meds, neuro stimulants

21 EQUIPMENT RECOMMENDATIONS Eyes, Ears, Hands, Good History questions, TRAINING/CEUS MBSS/FEES, stethoscope, 02 sat monitor, incentive spirometer-right side up, upside down, respiratory strength trainer, EMST-150, acapellas, whistles, kazoos, etc, NeuroMuscularElectrical Stimulation