effortful swallow contraindications

Causes of dysphagia among different age groups: A systematic review of the literature. Wirth, R., Dziewas, R., Beck, A. M., Clav, P., Hamdy, S., Heppner, H. J., Langmore, S., Leischker, A. H., Martino, R., Pluschinski, P., Rsler, A., Shaker, R., Warnecke, T., Sieber, C. C., & Volkert, D. (2016). Consideration of the underlying neurophysiological impairment is necessary for understanding swallow function and deficits. The scope of this page is swallowing disorders in adults (18+). (2014). Special considerations may need to be made regarding PPE for COVID-19. Dysphagia in AIDS. HARD / EFFORTFUL SWALLOW . Dysphagia, 16(3), 190195. (2010). International Journal of Speech-Language Pathology, 17(3), 222229. determining the effectiveness and possible impact of current diet on overall health (e.g., positioning, feeding dependency, environment, diet modification, compensations). Due to the interprofessional nature of dysphagia management, clinicians should be aware of multiple options for dysphagia intervention, including medical, surgical, and behavioral treatment. Effects of transcutaneous neuromuscular electrical stimulation on swallowing disorders: A systematic review and meta-analysis. (2003). Prosthetics (e.g., palatal obturator, palatal lift prosthesis) can be used to normalize pressure and movement in the intraoral cavity by providing compensation or physical support for patients with structural deficits/damage to the oropharyngeal mechanism. World Journal of Gastroenterology, 18(23), 29732978. support adequate nutrition and hydration and return to oral intake (including incorporating the patients dietary preferences and consulting with family members/caregivers to ensure that the patients daily living activities are being considered); determine the optimum supports (e.g., posture, or assistance) to reduce patient and caregiver burden while maximizing the patients quality of life; and. Intraoral appliances (e.g., palatal plates) are removable devices with small knobs that provide tactile stimulation inside the mouth to encourage lip closure and appropriate lip and tongue position for improved swallow function. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. -adrenergic-blocking agents in bronchospastic diseases: A therapeutic dilemma. Techniques and exercises: Maneuvers: Chin tug and turn. American Journal of Speech-Language Pathology, 25(4), 453469. Economic and survival burden of dysphagia among inpatients in the United States. https://doi.org/10.1007/s00455-013-9471-z, Fukuoka, T., Ono, T., Hori, K., Tamine, K., Nozaki, S., Shimada, K., Yamamoto, N., Fukuda, Y., & Domen, K. (2013). See the Service Delivery section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Incidence refers to the number of new cases of dysphagia identified in a specified time period. https://doi.org/10.1111/j.1468-3148.2005.00250.x, Cheney, D., Siddigui, M., Litts, J., Kuhn, M., & Belafsky, P. (2015). These muscles contract in a stereotypic sequence during swallowing and are involved in the biomechanics of hyolaryngeal excursion. Parkinsonism & Related Disorders, 18(4), 311315. INSTRUCTIONS SLPs may also make recommendations regarding continuing per os (P.O.) . Dysphagia in multiple sclerosis. ASHA does not require any additional certifications. https://doi.org/10.1044/2020_AJSLP-19-00063, Garca-Peris, P., Parn, L., Velasco, C., de la Cuerda, C., Camblor, M., Bretn, I., Herencia, H., Verdaguer, J., Navarro, C., & Clave, P. (2007). A randomized controlled trial. Percutaneous endoscopic gastrostomy (PEG) tubes may not be appropriate in all populations and may not necessarily improve outcomes or quality of life (Ayman et al., 2016; Plonk, 2005). (2007). Hold this posture for 3-5 seconds. Management of GERD-related chronic cough. This includes external scientific research as well as data gathered on a specific person. SLPs interpret and apply the results of imaging to dysphagia treatment plans and make recommendations and referrals as appropriate. Dysphagia, 33(2), 173184. https://doi.org/10.1016/j.jmu.2013.10.008, Huckabee, M. L., & Steele, C. M. (2006). Background: Neuromuscular electrical stimulation has been used to improve swallowing function in neurologic patients with dysphagia, but its effect on patients with dysphagia and Parkinson's disease remains unclear. In addition to determining the type of assessment and treatment that is optimal for adults with dysphagia, SLPs consider other service delivery variables that may affect swallowing outcomesvariables such as format, provider, dosage, and timing. The presence of the two abnormalities indicated that this young patient had cricopharyngeal hypertonicity. Consequences of dysphagia include malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death. The effortful swallowing used in our protocol aims to increase muscle strength, improve coordination, and reduce the posterior movement of the tongue base [ 9 ]. Robbins, J., Gensler, G., Hind, J., Logemann, J. https://doi.org/10.1136/jnnp.52.2.236, Barikroo, A., Carnaby, G., & Crary, M. (2015). Other studies suggest that dysphagia occurs in 29%64% of stroke patients (Barer, 1989; Flowers et al., 2013; Gordon et al., 1987; Mann et al., 1999). British Journal of Anaesthesia. https://doi.org/10.1044/leader.FTR3.08082003.4. side effects of some medications (e.g., Balzer, 2000); metabolic disturbances (e.g., hyperthyroidism); infectious diseases (e.g., COVID-19, sepsis, acquired immune deficiency syndrome [AIDS]); Meux & Wall, 2003); pulmonary diseases (e.g., chronic obstructive pulmonary disease [COPD]); identifying signs and symptoms of dysphagia; identifying normal and abnormal swallowing anatomy and physiology supported by imaging; identifying indications and contraindications specific to each patient for various assessment procedures; identifying signs of potential disorders in the upper aerodigestive and/or digestive tracts and making referrals to appropriate medical personnel; assessing swallow function as well as analyzing and integrating information from such assessments collaboratively with medical professionals, as appropriate; providing treatment for swallowing disorders, documenting progress, adapting and adjusting treatment plans based on patient performance, and determining appropriate discharge criteria; identifying and using appropriate functional outcome measures; understanding a variety of medical diagnoses and their potential impact(s) on swallowing; recognizing possible contraindications to clinical decisions and/or treatment; being aware of typical age-related changes in swallow function; providing education and counseling to individuals and caregivers; incorporating the clients/patients dietary preferences and personal/cultural practices as they relate to food choices during evaluation and treatment services; respecting issues related to quality of life for individuals and/or caregivers; practicing interprofessional collaboration; educating and consulting with other professionals on the needs of individuals with swallowing and feeding disorders and the SLPs role in the diagnosis and management of swallowing and feeding disorders; advocating for services for individuals with swallowing and feeding disorders; performing research to advance the clinical knowledge base; and. Please see ASHAs resource on Alternative Nutrition and Hydration in Dysphagia Care for further information. Different management approaches may be necessary for individuals with dysphagia that has resulted from an acute event, a chronic/stable condition, or a progressive neurological disorder. https://doi.org/10.1177/0194599814549156, Bloem, B., Lagaay, A., van Beek, W., Haan, J., Roos, R., & Wintzen, A. Journal of Medical Ultrasound, 21(4), 181188. International Journal of Language & Communication Disorders, 53(5), 909-918. https://doi.org/10.5056/jnm.2014.20.1.79, Falsetti, P., Caterina, A., Palilla, R., Bosi, M., Carpinteri, F., Zingarelli, A., Pedace, C., & Lenzi, L. (2009). assessment of respiratory status, cough, and throat clearing abilities. Dysphagia may develop secondary to damage to the central nervous system (CNS) and/or cranial nerves, and to unilateral or bilateral cortical and subcortical lesions, such as, Dysphagia may also occur from problems affecting the head and neck, including, Dysphagia may be associated with other factors, such as. https://doi.org/10.1001/archneur.1992.00530360057018, DiBardino, D. M., & Wunderink, R. G. (2015). https://doi.org/10.1016/j.jpor.2012.02.001, Skoretz, S. A., Flowers, H., & Martino, R. (2010). This simple exercise can strengthen muscles to improve your swallowing ability. SLPs examine the influence of diet texture modifications on swallowing physiology, including airway protection, during a comprehensive assessment of an individuals swallowing status prior to recommending these changes as part of treatment. Adult Dysphagia. Journal of Stroke & Cerebrovascular Diseases, 18(5), 329335. Such knowledge increases pertinent communication with other health care providers and facilitates selection of the best treatment options for individual patients (Groher & Crary, 2010). Goal The goal of this activity is to keep food or fluid from getting stuck in your pharynx, or throat, by improving the force and timing of your swallow. understand issues relative to radiation equipment, equipment maintenance, and safety. Indications for an instrumental exam include the following: General contraindications for an instrumental exam include, but are not limited to, the following: Instrumental assessment may include components of non-instrumental swallowing assessment (see above for further details). Developing the tongue holding maneuver. Journal of Oral Rehabilitation, 44(1), 5964. Kalf, J. G., de Swart, B. J. M., Bloem, B. R., & Munneke, M. (2012). https://www.swallowingdisorderfoundation.com/about/swallowing-disorder-basics/, National Institute on Deafness and Other Communication Disorders. SLPs also recognize causes and signs/symptoms of esophageal dysphagia and make appropriate referrals for its diagnosis and management. A 5-year longitudinal study. Archer, S. K., Smith, C. H., & Newham, D. J. Impact of texture modifications on medications (e.g., some medications may not be available in liquid form, and crushing others may change their effectiveness; Cichero, 2013; Steadman et al., 2022). This system is a specialized form of neuromuscular electrical stimulation (NMES) administered through uniquely designed external skin electrodes. Dehydration among long-term care elderly patients with oropharyngeal dysphagia. https://doi.org/10.1177/0003489414558107. The ASHA Leader, 9(7), 822. SLPs should also be familiar with other diagnostic procedures performed by different medical specialists that yield information about swallowing function. choking. https://doi.org/10.1016/j.otc.2013.08.002, Vose, A., Nonnenmacher, J., Singer, M., & Gonzlez-Fernndez, M. (2014). Lupus, 11(5), 322324. (2012). https://doi.org/10.1592/phco.19.11.974.31575, Terr, R., & Mearin, F. (2009). Archives of Gerontology and Geriatrics, 56(1), 19. Although the body of literature concerning the value of electrical stimulation for swallowing is large, the benefits remain unclear (Carnaby-Mann & Crary, 2007; Clark et al., 2009; Humbert et al., 2012; Sun et al., 2020). https://doi.org/10.1002/(SICI)1097-0347(199709)19:6<535::AID-HED11>3.0.CO;2-4, Macht, M., Wimbish, T., Bodine, C., & Moss, M. (2013). Aslam, M., & Vaezi, M. F. (2013). SLPs also have expertise in communication disorders that may affect the diagnosis and management of swallowing disorders. Dysphagia in amyotrophic lateral sclerosis: Prevalence and clinical findings. Squeezing hard with their tongue and throat https://doi.org/10.1016/j.apmr.2006.11.002. The FEES is a portable procedure that may be completed in outpatient clinic space or at bedside by passing an endoscope transnasally (Langmore et al., 1988). Clinical Neurology & Neurosurgery, 104(4), 345351. Otolaryngologic Clinics of North America, 46(6), 965987. Assessing and treating dysphagia: A lifespan perspective. Chua, S., Dodd, H., Saeed, I. T., & Chakravarty, K. (2002).

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