dental care dysphagia kathleen funck. who am i? –kathleen funck where did i graduate? –lsu...
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Dental Care
DysphagiaKathleen Funck
• Who am I? – Kathleen Funck
• Where did I graduate? – LSU Health New Orleans 2014
• Where do I work?– Veterans Affairs Medical Center
• What’s my focus?– Degenerative Diseases
About meKathleen Funck, MCD, CCC-SLP
What we will cover today:Agenda
Kathleen Funck
Welcome
Evaluation and Treatment
Dysphagia
Who is involved?
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5 Surprise
Kathleen Funck
• United States Department of Veterans AffairsDefines it as
- A swallowing disorder
• National Institute on Deafness and Other Communication Disorders
Defines it as-having difficulty swallowing and may
even experience pain while swallowing
What is it?Dysphagia
Kathleen Funck
Etiologies
1 Approximately 71 to 73% of patients with a stroke have swallowing disorders
Strokes
51% of patients admitted with severe hcad injury showed pharyngeal problems affecting swallowing
Head Injuries
4 Approximately 300,000 to 600,000 people each year
Progressive Neurologic Diseases
No case is the same and no individual
should be treated the same. Every case is unique and different.
2
Head and Neck Cancer
3 severity can depend on the tumor size, staging and location, and the type of surgical resection and reconstruction.
entry of secretions, food, or any foreign material into the airway that travels below the level of the true vocal folds.
Material breaches vocal folds into trachea and potentially into lungs without any signs
refers only to acts associated with bolus transfer and transport from the oral cavity to the stomach
the food, liquid, or other material placed in the mouth for ingestion
the entry of secretions, food/liquid, or any foreign material into the laryngeal vestibule above the level of the true vocal folds which are then ejected from the airway. This can occur normally and can also occur before, during, or after the pharyngeal swallow.
A channel, or depression between the base of the tongue and the epiglottis
Kathleen Funck
Terminology
Aspiration
Bolus
Degluttion
Laryngeal Penetration
Vallecula
Silent Aspiration
Phases of a Swallow
Kathleen Funck
• Velopharyngeal port closes• Hyoid bone and larynx
begin ascent • Epiglottis folds down • Tongue to the posterior
pharyngeal wall • Pharyngeal constrictors• Cricopharyngeus muscle • UES.
Pharyngeal Phase
1
Oral Phase
• UES opens and food is propelled down through the esophagus
• LES opens and food goes into stomach
Esophageal Phase
Oral Preparatory:reducing food to a bolus and position it for transport.
Oral Transport: bolus is prepared for transport from the anterior to posterior oral cavity
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Kathleen Funck
EveryoneWho is involved?
Family and FriendsDietians, Dental
Care
Speech, Physical,
Occupational Therapy
Doctors and the Nursing Staff
Your Logo
Multi-disciplinary Approach
• Speech Language PathologistThe goal is to maximize the safety and efficiency of eating.
-Feeding evaluations and treatments
84% in hospitals90% in residential health care
• Dental CareThe goal is to provide daily dental and denture hygiene
Kathleen Funck
Symptoms
• Hesitation to swallow• Painful swallow• Constant feeling of a
lump in the throat• Food sticking in the
throat• Regurgitation
• Hoarse voice• Repetitive swallowing• Coughing during or
after swallow• The feeling having to
“wash down” foods• Unexpected weight
loss
Kathleen Funck
It includes a structural and functional evaluation of the muscles and structures used in swallowing, functional evaluation of actual swallowing ability, and judgments of adequacy of airway protection and coordination of respiration and swallowing
Videofluorscopic swallowing evaluation (VFSS) Fberoptic endoscopic evaluation of swallowing (FEES)
Evaluations
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Standardized Testing
Instrumental Evaluation
Bedside Evaluation
Swallowing Ability and Function Evaluation (SAFE)Mann Assessment of Swallowing Ability (MASA)
Kathleen Funck
Bedside Evaluation
• Past medical history• Current medical status and medications• Nutrition/Hydration• Respiratory status• Cognitive/Communicative history• Posture and Movement• Alertness and Awareness• Auditory and Visual Acuity
• Oral Motor Exam• Laryngeal Function• Respiratory Status
• Trial Swallows
Kathleen Funck
Videofluoroscopic Swallow Study
• Bolus Size• Texture• Position of Patient• Radiographic focus of the
structures
• More Accurate
VFSSVideofluoroscopic Swallow Study
VFSSVideofluoroscopic Swallow Study
Treatment
Your own footer Your Logo
3• Head Down• Head Back
• Head Turn
• Head Tilt and turn
Postures
• Take a breath• Hold it while swallowing• Then cough after the swallow
Supraglottic Swallow
1
same procedure as with the supraglottic swallow, but bear down while holding breath
Supersupraglottic Swallow
2
Turn head to weak side and tilt head to strong sidelearns to use muscles to keep the larynx elevated for several seconds after the swallow.
Mendelsohn Maneuver
4
• Tapping or rubbing of the faucial pillars using frozen q-tips, or lemon ice• Presenting a warm or cold bolus• strong tastes or textures• Pressing the spoon on the tongue when food is presented
Thermal and Tactile Stimulation
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Kathleen Funck
Diets
Level 2: Mechanical Altered
Level 1: Pureed
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Level 3: Advanced
Level 4: Regular
Kathleen Funck
Liquids
Thick
Thin
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Material aspirated is heavily colonized with bacteria.Rapid development of extensive bacterial colonies around the teeth will lead to colonization by respiratory pathogens.The risk becomes increasingly prevalent the longer a dependent patient resides in a health care environment. All of these patients are at elevated risk for aspiration-related pneumonia if not provided good dental hygiene.
Kathleen Funck
Important?
Patient
Professional Staff
Better quality of life
Test your knowledge
Kathleen Funck
True FalseOR
Stroke is the leading cause of neurologic dysphagia?
Kathleen Funck
True FalseOR
More than 60,000 people die annually from complications related to dysphagia, making it the sixth leading cause of death in the United States?
Kathleen Funck
True FalseOR
Videofluoroscopic examination is essential and the same assessment techniques may be used with all patients with dysphagia?
Kathleen Funck
True FalseOR
