Dysphagia Awareness, Exercises of Voice

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Dysphagia

Alexis Stevenson

Lead Specialist SaLT

CLDT

Havering/NELFT

 To gain a better understanding of:

Aims of session

 What is dysphagia  How we swallow  Problems caused by dysphagia  Recognising when something is going wrong  Understand Risks

What do we need to

eat & swallow safely?

Understand what we

can and cant eat

Trigger a

swallow

Coordinate Tongue, Jaw and Lip Movements

• Dysphagia is a physical difficulty in the ability

to chew and swallow foods and or liquids.

What is Dysphagia?

• There is a voluntary element and an involuntary

element

• There are 4 areas where this process can be

affected.

1. The oral preparatory ( voluntary )

2. Oral stage ( voluntary )

3. Pharyngeal stage (voluntary/involuntary )

4. Oesophageal stage (involuntary )

Oral phase

In this first phase the mouth is opened and a piece of solid food or liquid is taken in. The mouth closes, and with intake of a hard consistency, chewing follows. The cheek muscles are tightened to prevent remnants of food remaining in the cheek pouches. Chewing mixes the food with saliva and prepares it for swallowing. When the chewing process is completed, the food (or bolus) is collected in the centre of the tongue and the person is ready to transfer the bolus. This first phase of the swallowing process is entirely voluntary.

Transfer of bolus

When the bolus has been collected in the centre of the tongue, the tip of the tongue is placed behind the teeth creating a groove in the tongue. This allows the bolus to slide into the pharynx (the throat). The sliding into the pharynx is voluntary and involuntary process. The tongue makes a wave-like movement, thus propelling the food bolus into the back of the mouth. When the bolus reaches certain receptors in the pharynx, the swallowing becomes a reflexive process.

Beyond this point on swallowing is an entirely reflexive (an automatic process)

Oesophageal phase

In this last phase of the swallowing process, the bolus enters the oesophagus and is transported further down towards the stomach by peristaltic contractions. In this final phase, the muscles in the neck relax, the larynx is lowered and the vocal folds open, allowing the patient to take a breath.

Signs of difficulties in eating and

drinking

 Coughing (immediate or delayed)

 Fatigue/pace

 Eyes watering, blinking,^ ^ Wheezing widening or shutting

 Facial Grimacing

 Change in colour; white, red, blue

 Noisy or wet voice quality

 Change in breath rate

 Effortful swallowing

 Chest infections  Overfilling of the mouth  Food spilling from the mouth  Regurgitation  Refusal to eat or drink  Prolonged process

1. Neurological causes :

Causes Can you name some?

2. Congenital and developmental conditions
3. Obstruction
4. Muscular conditions
5. Aging and health issues
6. Physical Trauma

 Inhalation of caustic agents e.g. caustic drugs

 Fungal infection of the oropharynx or oesophagus

 Cervical spine displacement

Physical or Motorised causes

 Oedema or inflammation of the connective tissues

 Obstruction e.g. tumour/growth or physical object

 Pharyngeal pouch

 Oesophageal web or stricture

 Surgery

 Dry mouth

Video clip

Guide to Areas of Risk

This guide identifies the factors that increase the risk of negative health consequences arising from a person’s dysphagia.

The negative health consequences are asphyxiation

and/or choking episode, aspiration incidents,

dehydration and poor nutritional status.

Proforma for indicating degree of negative health risks for individual clients

Negative health consequence:_____________________________

Intrinsic factors (^) risk (0)Low Increasingrisk (1) risk (2) High Extrinsic factors (^) risk (0)Low Increasingrisk (1) Risk (2) High

Level of learning disability/cognitive function Physical environment

Alertness/cooperation Social environment Distractibility Access to specialised equipment Fatigue Staffing level Rapid decline in function due to ill health (decompensation) Staff adherence

Seizure activity Family adherence Oral health problems Additional risks Underlying respiratory problem Quality of life/loss of dignity Posture control Injury/discomfort Behavioural difficulties Unmanaged pain Mental health problems Medication Totals

 All Persons with dysphagia present with a level of risk when eating and drinking.

Responsibilities to in Day to Day

Feeding

 All staff are responsible in carrying out SaLT guidelines and reporting any changes in the persons ability to eat and drink safely  All staff are responsible for acknowledging their own and others capability in managing persons with eating and drinking difficulties.  Staff are responsible for reporting if they are having difficulties understanding or following the guidelines.  We would recommend that all staff access regular dysphagia awareness training.