Management of dysphagia in MS

Transcription

1 Management of dysphagia in MS Marta Renom Speech and Language Therapist CEM-CAT (UNeR) Barcelona

2 INTRODUCTION Normal swallowing Dual function: transporting / protecting airway oral phase pharyngeal phase oesophageal phase brainstem cerebellar cognitive Dysphagia in MS: 33 to 43% (Calcagno 2002)

3 INTRODUCTION Classification According to: 1. Consistency affected Liquids EDSS Severity Solids EDSS 8

4 INTRODUCTION Classification According to: 1. Consistency affected 2. Severity mild moderate safety efficacy severe penetration aspiration nutrition hydration

5 INTRODUCTION Consequences of dysphagia Morbidity / mortality Nutrition / hydratation Quality of life Independence Level of participation

6 ASSESSMENT AND TREATMENT History taking & screening Comprehensive clinical assessment Instrumental assessment Rehabilitation Pharmacological treatment Enteral feeding

7 ASSESSMENT Clinical observations Voice Cough Laryngeal elevation Posture Secretions Palatal gag Linden 2005 The probability of correctly predicting subglottig penetration from clilnical observations (n=249) (success to predict 2/3)

8 Main signs and symptoms ASSESSMENT Altered feeding habit Cough and/or choking while or after eating and drinking

9 Other signs and symptoms Food sticking in throat ASSESSMENT Need to repeat the swallowing act Dyspnoea during or after meals Weight loss Recurrent episodes of infections of the upper airways Episodes of either unexplained fever or pneumonia DYMUS Questionnaire Bergamashi et al: The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. Journal of the Neurological Sciences 269 (2008) 49-53

10 Oral anatomy ASSESSMENT Sensory-motor assessment Muscular tone Oropharyngeal reflexes Movement execution Functional assessment Cognitive evaluation Nutritional evaluation Impact in daily life V-VST Clavé et al MNA Guigoz 2006 SWAL-QOL / SWAL-CARE McHorney CA, et al. 2002

11 ASSESSMENT Instrumental assessment Videofluoroscopy Fiberoptic endoscopic laryngoscopy Electromyography Manofluoroscopy Dysphagia outcome and severity scale O Neil KH, Purdy M, Janice F. Dysphagia 1999 Eight-point-penetration-aspiration-scale: Rosenbeck JC, Robins JA, Roecker EB et al. Dysphagia 1996

12 Therapeutic methods of functional swallowing therapy Disturbance Reduced lingual control Impaired tongue base retraction Restitution Tongue exercises Tongue exercises Masako manoeuvre Compensation Head anteflexion Head anteflexion Mendelsohn manoeuvre Adaptation Thickening of liquids Smooth consistency Delayed / absent swallowing reflex Stimulation of the faucial pilars Tongue exercises Supraglottic swallowing Head anteflexion Enhancing taste/temperature Reduced laryngeal closure Positional, compression and respiratory support strategies Pitch / Phonatory exercises Supraglottic swallowing Turning the head to the stronger side Thickening of liquids Dysfunction of the upper oesophageal sphincter Ex: maximizing extent and timig of hyoid/laryngeal elevation Shaker manouvre Mendelsohn manoeuvre Thin consistency Reduced pharyngeal contraction Whistling, sucking, snarling Turning head to affected side Tilting head to stronger side Effortful swallowing Smooth consistency Diminished pharyngeal and/or laryngeal sensation No evidence-based restitution method Supraglottic swallowing (if silent aspirations) Repeated swallowing Enhancing taste/temperature Prosiegel M, Schelling A, Wagner-Sonntag E (2004) Dysphagia and multiple sclerosis. Int MS J 11:22-31

13 REFERENCES Neuromuscular electrostimulation Verin E, Maltete D, Ouahchi Y, et al. Submental sensitive transcutaneous electrical stimulation (SSTES) at home in neurogenic oropharyneal dysphagia: a pilot study Annals of Physical and Rehabilitation Medicine 54 (2011) Domenico A. Restivo, Antonino Casabona, Diego Centonze et al. Pharyngeal electrical stimulation for dysphagia associated with multiple sclerosis: A pilot study Brain Stimulation xxx (2012) 1-6 Intraluminal electrical pharyngeal stimulation

14 Intervención en la disfagia en la EM TRATAMIENTO Pharmacological treatment D. A. Restivo, R. Marchese-Ragona, F. Patti, et al.: Botulinum toxin improves dysphagia associated with multiple sclerosis European Journal of Neurology 2011, 18: Potential benefit from botulinum neurotoxin type A treatment in MS patients with dysphagia associated with upper esophageal sphincter hyperactivity

15 REFERENCES Bernabeu M: Disfagia Neurógena: Evaluación y tratamiento. Fundació Institut Guttmann. Blocs 14. Badalona 2002 De Paw A et al (2002) Dysphagia in multiple sclerosis. Clinical Neurology and Neurosurgery 104: Prosiegel M et al. (2004) Dysphagia and Multiple Sclerosis. The International MS Journal 2004; 11:22-31 Terré-Boliart R et al (2004): Disfagia orofaríngea en pacientes afectados de esclerosis múltiple. Revista de Neurología 39(8): Abraham S (1997) Neurologic impairment and disability status in outpatients with multiple sclerosis reportingg dysphagia symptomatology. J Neur Rehab 11:7-13 Giusti A, Giambuzzi M (2008) Management of dysphagia in MS. Neurol Sci 29: Tassorelli C et al (2008) Dysphagia in multiple sclerosis: from pathogenesis to diagnosis. Neurol Sci 29; Bergamaschi R et al (2008): The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J Neurol Sci 269:49-53 Calcagno P et al (2002) Dysphagia in multiple sclerosis prevalence and progrnostic factors. Acta Neurol Scand 105:40-43 Poorjavad M et al (2010) Oropharyngeal dysphagia in multiple sclerosis. Multiple Sclerosis. 16(3) Bogaardt H et al (2009) Use of neuromuscular electrostimulation in the treatment of dysphagia in patients with multiple sclerosis. Ann Otol Rhinol Laryngol.

16 REFERENCES DePippo K et al: Validation of the 2 oz. Wather swallow test for aspiration following stroke. Arch Neurol 1992; 49: Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with stroke: rehabilitation, prevention. Edinburg 2002 Guigoz Y: The Mini-Nutritional Assessment (MNA ) Review of the literature What does it tell us? The Journal of Nutrition, Health & Aging 2006 ; volume 10, Num 6 Clavé P et al. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clin Nur Dec; 27(6):806-15