Dysphagia treatment techniques pdf

Open jaw as far as you can and hold for 10 seconds. For a tight esophageal sphincter achalasia or an esophageal stricture, your doctor may use an endoscope with a special balloon attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus dilation. Part iiimpact of dysphagia treatment on normal swallow function author. Mtd, one could expect dysphagia symptoms to improve with cmt. Exercises are expected to impact swallowing mechanics and impact bolus flow. Hold the food or drink in your mouth and think about swallowing, then swallow. Exercise rehabilitation has long been a treatment for patients with dysphagia. Dpns dysphagia treatment techniques were developed utilizing reflex stimulation through the thermal cold modality, first used in treatment by margaret rood, pt in the 1950s.

A variety of exercises exist, ranging from direct to indirect, isolated to combined and those incorporating swallowing or non swallowing exercises. Dec 17, 2015 pdf the speech and language pathologist provides nonsurgical, nonpharmacological treatment to patients with oropharyngeal dysphagia. The clinician practices direct, targeted reflex triggering to generate muscle group contraction. It may help to put down your spoon or fork between bites, or put down your cup between sips. These results have broad implications for the treatment plan of patients exhibiting dysphagia associated with mtd. Typically modified barium swallow study mbss or fees 2. Swallowing and respiration are considered reciprocal functions. Behavioral treatment for adults with oropharyngeal dysphagia. Pdf treatment techniques and site considerations regarding.

Outcome measurement tools can also serve as a quick, objective means of communicating treatment results to referring physicians, hospital administrators, or. This systematic rehabilitation approach works to improve hy0 laryngeal excursion, speed up laryngeal vestibule closure reaction times and enhance swallowing posture by providing the tools to acce lerate swallow function. Dysphagia is within the scope of occupational therapy practice as supported by educational curriculum and a history of application in practice. Dysphagia treatment can be divided into direct treatment and indirect treatment. Causes, assessment, treatment, and management dysphagia, or difficulty in swallowing, is a condition with a strong agerelated bias. May 01, 2010 the mcneill dysphagia therapy program is a systematic exercisedbased therapy framework for the treatment of dysphagia in adults. You may be referred to a speech and language therapist slt for swallowing therapy. Dysphagia in adults is a swallowing problem involving the oral cavity. It is being made available free of charge to all physicians and speech language pathologists to be used with their patients.

Swallowing is a behaviour that healthy individuals carry out effortlessly more than times per day 1. International journal of radiation oncologybiologyphysics, 2008. Patients with muscle tension dysphagia received circumlaryngeal massage with an slp 77% reported improvement in symptoms use of additional therapy techniques rvt, breath work, home throat massage, and tongue stretches were not significantly associated with improvement in dysphagia symptoms. Tips, techniques and tools for managing dysphagia in children. Vess, ma cccslp participants will receive a full pdf of the presentation, if requested. Occupational therapists and occupational therapy assistants provide. Dysphagia, or difficulty swallowing, can have a devastating effect on health and quality of life, and is a growing problem in the adult population list et al. Compensatory strategies may be short term or used more longterm, such as with patients with head and neck cancer. Swallowing exercises and postures dysphagia treatment. Much of todays current treatments center around strength alone with little evidence based research. Lee silverman voice treatment program and swallowing sharkawi, a. When treating persons with swallowing difficulties, the first step is to diagnose the cause or. Preventing aspiration pneumonia requires both the effort to minimize aspiration and the techniques to avoid pneumonia onset even if the patient experiences aspiration.

In direct treatment, the clinician works directly with the resident, teaching him or her compensatory strategies. Helps upward movement of the larynx voice box and the opening of the esophagus. Patientpresentswithseveritytypedysphagiacharacterizedbyunderlyingcauseresultinginwhati. Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with covid19 related respiratory issues. Swallowing and respiration are the only two systems in the body that share a common part of the body, namely the throat. Compensatory strategies can be used to alter posture, timing of the swallow, laryngeal closure.

According to the national institute on deafness and other communication disorders nidcd, dysphagia happens when there is a problem with the structures, muscles, and neural control of the swallowing process. Dysphagia pathophysiology of swallowing dysfunction, symptoms. Management and treatment of dysphagia the speechlanguage pathologist may also initiate treatment techniques to improve your childs swallow function or reduce food avoidance and behavioral issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy. I have been in treatment for the reflux, but the swallowing problem remains. If the individuals swallowing safety and efficiency cannot reach a level of adequate function, or if swallow function does not support nutrition and hydration adequately, the swallowing and feeding team may recommend alternative avenues of intake e. A beginning list of dysphagia exercises that have evidence base i collected and typed these exercises up from the handouts that. It is necessary to search for effective therapies that could prevent pneumonia.

Only if these factors are met can the various effects of rehabilitation training be expected to become apparent. The feasibility design was informed by guidance set. Please work directly with a licensed medical professional before implementing any of the following therapy exercises. Domain and process clearly defines swallowing and the eating process as an essential activity of daily living and a critical component of an.

An slt is trained to work with people with eating or swallowing difficulties. These exercises help strengthen swallowing muscles. Collect all the saliva in your mouth onto the center of your tongue. Treatment will depend on whether your swallowing problem is in the mouth or throat oropharyngeal dysphagia, or in the oesophagus oesophageal dysphagia. Examples of direct dysphagia treatment interventions include sensory stimulation, diet modification, muscle strengthening, rom exercises, and caregiver. Mar 20, 2020 the goals of dysphagia treatment are to maintain adequate nutritional intake for the patient and to maximize airway protection. An analysis of patient outcomes using vitalstim therapy compared to traditional swallow therapy mary kiger, mscccslp,1 catherine s. As stated above, oralmotor goals and techniques are interwoven throughout at least six different treatment regimes today. Exercises to strengthen the tongue and throat pharynx. So, i would like to try some of these exercises specifically the supraglottic maneuver, the supersupraglottic maneuver, the hardeffortful swallow, the jawopening, and the closure of the larynx. Treatment techniques and site considerations regarding dysphagia related quality of life in cancer of the oropharynx and nasopharynx. Slts use a range of techniques that can be tailored for your specific problem, such as teaching you swallowing exercises.

Good oral hygiene, consistency in eating environment and seating, six small mealshydration opportunities versus 3 large, include spicysweetsour foodsliquids. Please read the disclaimer before reading any of the exercises below. The incidence of oropharyngeal dysphagia in parkinsons disease pd is very high. Most swallowing problems can be managed, although the treatment you receive will depend on the type of dysphagia you have. Dysphagia can often have severe consequences including an exacerbation or worsening of copd and pneumonia. Slps also recognize causes and signssymptoms of esophageal dysphagia and make. Dysphagia goals pages 1 9 flip pdf download fliphtml5. Occupational therapy education on dysphagia all occupational therapy practitioners, as part of their entrylevel education, are taught various domains of practice. Brown, phd, cccslp,2 and lynn watkins, mspt1 1whitaker rehabilitation center, winstonsalem, usa. If your older adult used to take oral medications with water, theyll now need to. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a. After you swallow, gently clear your throat and swallow again. Some maneuvers may serve as a compensatory strategy and.

Dysphagia is defined as problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction models of swallowing function may represent the biomechanics of swallow function and bolus movement for liquids or may discuss physiological activity for liquid and solids see, e. Dysphagia treatment is decided upon once a diagnosis is confirmed however many facets should be involved in that determination the clinician will choose a treatment program, based on the etiology, mental and physical capacity, and quality of life. Disorders of oral and pharyngeal swallowing are usually amenable to rehabilitation, including dietary modification and training in swallowing techniques and maneuvers. Pdf therapeutic approaches to dysphagia treatment in. At cleveland clinic, weve assembled an entire team of all the specialists you need including gastroenterologists, radiologists, pathologists, thoracic surgeons and swallowing therapists to offer leadingedge diagnosis and treatment options. Treatment case studies group activity role of a speechlanguage pathologist in feeding disorders overall role of slp when evaluating and treating swallowing disorders. Because a variety of medical specialists can be involved in the care of the patient with dysphagia, all must. Choosing cmt over other treatment modalities initially can potentially lead to a faster resolution of dysphagia and dysphonia. Respiration and swallowing hardemark cedborg al, sundman e, boden k, hedstrom hw, kuylenstierna r, ekberg o, eriksson li 2009 coordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans.

They should discuss the treatment protocol with the patient and their family. A modified barium swallow study is performed by the slp and a radiology technician. Dysphagia treatment is decided upon once a diagnosis is confirmed. Exercise based therapy for the treatment of dysphagia. This posture may make swallowing easier and will lower the chance of food or drink going into your windpipe. Be sure you swallow all the food in your mouth before putting in more. Treatment for dysphagia involves traditional therapy 4, 5 diet modification, exercises to strengthen the oropharyngeal musculature, compensatory maneuvers to facilitate laryngeal elevation and closure during swallowing, and techniques to stimulate and strengthen the swallowing reflex and advanced vitalstim therapy. Download free pdf treatment techniques and site considerations regarding dysphagia related quality of life in cancer of the oropharynx and nasopharynx international journal of radiation oncologybiologyphysics, 2008. The most common neurological conditions associated with dysphagia. Some treatment techniques for dysphagia include postural adjustments, swallow maneuvers, thickened liquids, oralmotor exercises, diet modifications and acupuncture.

Treatment approaches for esophageal dysphagia may include. Feasibility and acceptability of combining cognitive. Swallowing exercises for dysphagia verywell health. Other medical professionals that may be involved in management of your childs feeding swallowing impairment include. Previous results should be interpreted cautiously as there is a lack of evidence to support the use of compensatory or rehabilitative app. Methods this is a multicentre, prospective, longitudinal nonrandomised single cohort study to explore feasibility and acceptability of a cbt enhanced swallowing therapy intervention cbest in hnscc patients. All rights associated with this ed material will be enforced. Free swallow exercises pdf national foundation of swallowing. Dysphagia treatment, swallowing treatment, chin tuck, thermal stimulation, estim, swallowing maneuvers, supraglottic swallow, supersupraglottic swallow, shaker maneuver, masako, effortful swallow, mendelsohn maneuver, jaw opening exercise, muscle stimulation, nmes, vitalstim.

Head and neck cancer squamous cell carcinoma hnssc patients report substantial rates of clinically. Dysphagia is the term used to refer to an impairment or disorder of the process of. A team approach is now in its fourth edition, which speaks to our continuing emphasis on a multidisciplinary ap proach to dysphagia, but also, to the willingness of original, new and extended team members to be involved in this project. Current best evidence, client values, and clinical expertise should be incorporated into decisions about the use of treatment techniques. Dysphagia presentation and management following coronavirus.

Compensatory techniques are used to alter the swallow, however compensations may not create a lasting effect to the swallow. The goal of dysphagia therapy is to facilitate improved oral. Traditional dysphagia therapy improves swallowing in ms. Pdf oropharyngeal dysphagia treatment researchgate. The spanish pdf was created with the assistance of stephanie jacobson, ma, cccslp. Npo techniques and newly developed therapeutic exercises. Utilizing the inherent reflex system with the muscle groups of the. Treatment guide swallowing and esophageal disorders.

Swallowing exercises national foundation of swallowing. Weak muscles in the tongue or cheek, stroke, another nervous system disorder, surgery, gastroesophageal reflux disease gerd, tumors, and diabetes can all be causes of. Pdf on sep 3, 2019, ali akbar dashtelei and others published therapeutic approaches to dysphagia treatment in parkinson disease. A variety of exercises exist, ranging from direct to indirect, isolated to combined. Feb 06, 2019 the findings indicate that although swallowing function becomes safer after treatment in both groups, tdt techniques seem to be better at reducing penetration, aspiration, and pharyngeal residue. Effects of therapy in oropharyngeal dysphagia by speech and. Improves movement of the tongue base and pharynx throat. Rehabilitative exercises are those meant to change and improve the swallowing physiology in. Laryngeal manipulation for dysphagia with muscle tension. This includes the number of repetitions, the number of seconds each exercise should be performed, and the rest period between exercises. An approach to treatment that makes sense given what we know about anatomy, physiology, normal feeding swallowing development, swallowing function, etc. Jun 10, 2020 patients with muscle tension dysphagia received circumlaryngeal massage with an slp 77% reported improvement in symptoms use of additional therapy techniques rvt, breath work, home throat massage, and tongue stretches were not significantly associated with improvement in dysphagia symptoms. For people who are unable to swallow, if these forms of therapy arent helping, a feeding tube may become necessary.

Identify at least two evidencebased treatments for swallowing rehabilitation. Oralmotor techniques in articulation and phonological therapy. A clinical swallow exam is performed by the slp while you are drinking and eating various textures and amounts. With each bite or sip, swallow 2 to 3 times before taking the next bite or sip. Swallowing is essential for nourishment and hydration, yet also affords us pleasure and is central to social events in our daily lives. It is a broad term that describes a wide range of symptoms associated with a decline in memory, communication, and other thinking skills. Swallowing pediatric feeding and andrews university. Caregivers guide to dysphagia in dementia national. Drawing from physical and occupational therapy procedures, he advocated the use of exercises to strengthen weakened musculature. The goals of treatment for these areas are different but overlapping, and each includes oralmotor therapy in its daily practice. Your physician or speechlanguage pathologist will select which exercises are useful to improving your swallowing function. Aug 16, 2015 check pages 1 9 of dysphagia goals in the flip pdf version. A swallowing disorder, known as dysphagia, may occur as a result of various medical conditions.