Pediatr Pulmonol. Folia Phoniatr Logop. Google Scholar. 2008;13(3):8–11. goals of care. A multidisciplinary team approach to dysphagia management involving speech pathologists, physiotherapists, dietitians, physicians, and nursing staff resulted in improved weight and caloric intake [114]. 1986;1:73–7. J Trauma. 2012;17(5):13, 15. Absent or decreased gag reflex 2. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. find I feel more comfortable and competent when proposing it to the family than I Terre R, Mearin F. Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. Burkhead LM, Sapienza CM, Rosenbek JC. use of swabs and mouth moisturizer for oral comfort. Mackay et al. Speech Pathology Australia. I am surprised at how many doctors don’t know that tube feedings Involvement of the patient, family and caregivers, is also critical to ensuring that management strategies generalize to functional settings, such as the home [115]. Elpern EH, Scott MG, Petro L, Ries MH. FEESST can also tests laryngopharyngeal sensory function [66]. Arend: I explain bluntly to the doctor what I am seeing and what I expect in the future with The argument against electrical stimulation for dysphagia. Brain Injury Rehabilitation Service, Westmead Hospital, University of Sydney, PO Box 533, Wentworthville, Sydney, NSW, 2145, Australia, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia, You can also search for this author in An effortful breath hold with the super-supraglottic swallow aims to close the airway before and during the swallow [43]. Thus, postures may not be suitable for some patients with TBI. Am J Speech Lang Pathol. Other swallowing maneuvers (the Mendelsohn maneuver, effortful swallow and Masako maneuver), can be considered compensatory, but when ‘repeated in the context of an exercise regime, may facilitate overall change in swallowing physiology.’ [81] These will be discussed in following rehabilitation section. Swallowing disorders in severe brain injury: risk factors affecting return to oral intake. • Crary MA, Carnaby GD. Arend: In the acute hospital, I find good communication with the staff and explaining the Much of the research regarding the management and treatment of dysphagia in general is in its infancy: larger and more rigorous studies are required to demonstrate treatment efficacy. 1991;100:678–81. However, as with many dysphagia studies, groups were heterogeneous, small and the authors noted the research was ‘exploratory in nature and lack the rigor of larger controlled studies.’ [96] Thus, while promising, further research into this program is required. mind about the risk/benefit considerations that went into their initial decision. Another study found that tracheostomy removal did not change subjects’ aspiration or dysphagic status [58]. [76] Irrespective of this, supportive evidence for these management strategies is limited and has not necessarily provided recommendations on how best to prescribe and apply them [77]. goals are very important. 1999;80:365–71. Highly distractible patients may slow their rate of intake so they eat and drink less [40], placing them at risk of malnutrition or dehydration. Curr Phys Med Rehabil Rep 2, 219–230 (2014). Management of Dysphagia Following Traumatic Brain Injury, https://doi.org/10.1007/s40141-014-0064-z, Swallowing Disorders (RE Martin, Section Editor). The management of dysphagia following TBI requires a multifaceted, individualized approach that incorporates the contributory and causative cognitive-communication, behavioral, physiological, and pharmacological factors, any concomitant injuries and the pathoanatomic features of the TBI. Swallowing disorders in persons with cerebrovascular accident. Dysphagia. 1989;4(4):42–50. are if the patient can’t swallow. experience, so if the patient is comfortable while showing signs of aspiration, goals 13, Swallowing and Swallowing Disorders (Dysphagia); and 15, Gerontology. Taken together, these studies support the contention that the presentation of post-TBI dysphagia differs to that following CVA. Laryngoscope. Recovery of oral nutrition after head injury in adults. Dysphagia. As a bedside assessment, it is a simple and economical way of screening patients with tracheostomies for aspiration [73]. 1998;50:311–9. 2003;18:231–41. I don’t mean to minimize Am J Med. Tracheotomised patients with TBI are likely to be dysphagic because of their neurological impairment, medications [5], intercurrent medical co-morbidities [37], or a combination of these factors. [62] Trialing different consistencies, viscosities and volumes of food and fluid allows optimization of the patient’s swallowing regime. With Dementia,”, Palliative Care in Dysphagia and Dementia, American Journal of Speech-Language Pathology (AJSLP), Journal of Speech, Language, and Hearing Research (JSLHR), Language, Speech, and Hearing Services in Schools (LSHSS), Contemporary Issues in Communication Science and Disorders (CICSD). Brenda Arend, MA, CCC-SLP, is a speech-language pathologist at Providence St. Peter Participant: To start, if a participant was to remember or put into practice only one idea from Krival: I think we as therapists are also pretty focused on how we would experience dysphagia, not on how our patients are. 1981;70:70–6. Arend: I would probably show them the video or stills from the study, to start, along with 1999;14(5):475–85. As with the postural adjustments, these maneuvers provide an ‘immediate but only transient approach to the underlying physiologic deficit.’ [81] The supraglottic swallow functions to close the vocal folds before and during the swallow [43] and clear bolus residue from the airway post-swallow [82]. Duffy JR. Motor speech disorders: substrates, differential diagnosis, and management. However, CVA and TBI populations are quite different. Participant: I was wondering two things: How do you suggest we introduce our “role” or skill set If family decides on feeding tube, patient Swallowing disorders in closed head trauma patients. Yoneyama T, Yoshida M, Ohrui T, et al. With Dementia,” Journal of Gerontologic Nursing). Patients can also be at risk of aspiration if they are so distracted they forget to swallow [40]. The potential effect of prolonged intubation in TBI patients with dysphagia has not been investigated. Strength-training exercise in dysphagia rehabilitation: prinicples, procedures, and directions for future research. with training, support and appreciation for their efforts. Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. 1999;51:199–212. 13, Swallowing and Swallowing Disorders (Dysphagia); and 15, Gerontology. Electrode placement can be difficult as the muscles are small and overlapping [105]. In a recent online chat, John R. Ashford emphasized the importance of good oral hygiene to the overall health of dysphagia patients and infection control. in a chart note. Adams JH, Graham DI, Scott G, Parker LS, Doyle D. Brain damage in fatal non-missile head injury. Evidence-based systematic review: oropharyngeal dysphagia behavioral treatments. Predictors of aspiration pneumonia: how important is dysphagia? Providing simplified, written instructions of a series of steps that a patient may have to learn, perform and recall is an effective way of assisting patients to learn new sequences of actions [40] such as adjusting posture for safer swallowing. Terre R, Mearin F. Evolution of tracheal aspiration in severe traumatic brain injury-related oropharyngeal dysphagia: 1-year longitudinal follow-up study. Despite this, common treatment and management strategies for patients with neurogenic dysphagia have relevance to TBI. Participant: What is your thinking about milk-based products if patient has thick mucus but will Disadvantages of FEES include the inability to observe the oral cavity, tongue base movement, pharyngeal wall contraction and degree of laryngeal elevation or cricopharyngeal opening during swallowing [62, 69]. Post-tracheostomy aspiration. Nancy B. Swigert, M.A.,CCC-SLP, BCS-S BAPTIST HEALTH LEXINGTON NSWIGERT@BHSI.COM 2016 … 2007;21(4):563–73. Dysphagia. Available in English and Español. Arend: Assuming you mean in discussions related to swallowing, as we don’t manage the overall 1995;23:486–90. Participant: When the need arises to confer with a substitute decision-maker/POA [power of attorney] PubMed  Motor impairment following TBI depends on the site/s of injury and can include spasticity, weakness, ataxia, apraxia and extrapyramidal movement disorders [100]. Family education programs must explain dysphagia and provide training in feeding techniques and management strategies where appropriate, as increasing the family’s awareness of these potential issues may assist with compliance with therapy and strategies in the home environment [115]. are if the patient can’t swallow. Bogaardt HCA, Grolman W, Fokkens WJ. The multifactorial nature of post-TBI dysphagia necessitates a comprehensive assessment of all the potential causal factors [23••]. Pelletier CA, Lawless HT. 2008;117(4):279–87. 2004;19:192–206. Find more similar flip PDFs like DYSPHAGIA GOALS. Laryngoscope. Krival: DiBartolo (2006) is a review article, which is always a fabulous place to start as (Titled “Careful Hand Feeding: A Reasonable Alternative to PEG Tube Placement in Individuals Med J Aust. The social and psychological impacts of dysphagia can reduce patients’ quality of life [17]. Behavioral dysphagia management techniques targeting swallowing physiology are often divided into ‘compensatory’ and ‘rehabilitation’/direct therapy strategies [65, 75]. As such, the management for dysphagia post-TBI must be multifactorial, team-based and involve the patients’ families and carers. Some patients, particularly those with tactile defensiveness, agitation or confusion may find the transnasal placement of the endoscopy too uncomfortable [64]. Limited evidence suggests that sEMG can be an effective adjunct to these exercises [81, 103]. Rowe LA. In patients where oral feeding is contraindicated due to low responsiveness, sensory stimulation (tactile, olfactory, gustatory, auditory and visual) to has been suggested to improve patient responsivity [8, 9]. not feel we have to rehab them—and we can focus on quality of life and involve the Curr Opin Otolaryngol Head Neck Surg. 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