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Adult Neurologic Dysphagia (TBI (Evaluation scale (GCS, RLAS, FIM, FOIS),…
Adult Neurologic Dysphagia
Cerebellum
ataxia
bolus control :red_cross:
hypotonia張力過低→residue殘留
therapy
:check:Compensatory strategies
:check:Tube feeding：PEG 胃造廔
Functional neuroanatomical relative to swallowing
Brainstem
lower (medulla延腦)
major swallowing center
Nucleus ambigus (
NA
)
nucleus tractus solitarius (
NTS
)
therapy
:check:Thermal-tactile stimulation
:check:Mendelsohn maneuver
:check:Head rotate to weak side
:check:Circopharyngeal myotomy
環咽肌切開術
high (pons橋腦)
severe hypertonicity
張力過高
recovery: slow & difficult
therapy
:check:Head rotate to each side
:check:Buccal & neck massage (reduce tone)
:check:Thermal-tactile stimulation
TBI
Diffuse-DAI (diffuse axonal injury)
Evaluation scale
GCS, RLAS, FIM, FOIS
therapy
:check:ROM exercise
:check:Resistance exercise
:check:thermal-tactile sti.
:check:Changing diet
:check:Changing posture
:check:surgery
Swallowing disorders
•Delayed/absencein triggering pharyngeal swallow
•Reduced lip closure
•Reduced tongue range motion w/ poor bolus control
•Reduced laryngeal elevation
•Reduced tongue base motion
•Reduced CP opening
•Uni./bil. pharyngeal wall paresis
•Tracheoesophgealfistula
•Reduced velopharyngealclosure
Dementia
considerations
:check:prolong oral feeding
:check:life quality, dignity, comfort 舒適餵食
:check:Individualized treatment options
:check:
Caregiver education
Hemispheric
Left
Apraxia of swallow
•delay in initiating oral swallow
•Mild delayoral transit
•Mild delay intriggering pharyngeal swallow
therapy
:check:Sensory
:check:enhancement
:check:procedures
right
•Mild Delay oral transit
•Mild delay in triggering pharyngeal swallow
•Mild reduced laryngeal elevation
therapy
:check:
Chin down posture
:check:Thermal-tactile stimulation
:check:supraglottic swallow
:check:
Falsetto exercise
Cortical brain function
Subcortical
therapy
:check:Head rotateto each side
:check:Thermal-tactile stimulation
:check:Mendelsohn maneuver
:check:Super-supraglotticswallow
PD's
therapy
:check:Mendelsohn maneuver**
:check:ROM exercise
:check:Bolus propulsion exercise
:check:Effortful swallow
:check:Medication
:check:Changing diet
