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Adult Neurologic Dysphagia
Adult Neurologic Dysphagia
TBI
Evaluation scale
GCS, RLAS, FIM, FOIS
therapy
•ROM exercise
•Resistance exercise
•thermal-tactile sti.
•Changing diet
•Changing posture
•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
Diffuse-DAI (diffuse axonal injury)
Cerebellum
ataxia
bolus control X
hypotonia→residue
therapy
•Compensatory strategies
•Tube feeding: PEG
Brainstem
lower (medulla延腦)
major swallowing center
NA
NTS
therapy
•Thermal-tactile stimulation
•Mendelsohn maneuver
•Head rotate to weak side
•Circopharyngealmyotomy
high (pons橋腦)
severe hypertonicity
recovery: slow & difficult
therapy
•Head rotate to each side
•Buccal & neckmassage (reduce tone)
•Thermal-tactile stimulation
Hemispheric
Left
Apraxia of swallow
•delay in initiating oral swallow
•Mild delayoral transit
•Mild delay intriggering pharyngeal swallow
therapy
Sensory enhancement procedures
right
•Mild Delay oral transit
•Mild delay in triggering pharyngeal swallow
•Mild reduced laryngeal elevation
therapy
•
Chin down posture
•Thermal-tactile stimulation
•supraglottic swallow
•Falsetto exercise
Subcortical
therapy
•Head rotateto each side
•Thermal-tactile stimulation
•Mendelsohn maneuver
•Super-supraglotticswallow
PD
•Mendelsohn maneuver
•ROM exercise
•Bolus propulsion exercise
•Effortful swallow
•Medication
•Changing diet
Functional neuroanatomical relative to swallowing
Dementia
considerations
•prolong oral feeding
•life quality, dignity, comfort
•Individualized treatment options
•Caregiver education
Cortical brain function
