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Swallowing disorders (2) (Indicators of swallowing disorder (Cough/choke…
Swallowing disorders (2)
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Behavioural influences
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Poor judgment, impulsive behaviour eg. brain injury
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Attempt to eat, talk at same time
Fail to appreciate impt of eating: lack motivation, depressed, taste diff after radiotherapy, chemo, just eat bcos they have to, X bcos they enjoy it
Psychosocial impact
Eating, drinking is source of human pleasure
Represents complex, multilayered condition that may impact emotional, social life, r/s
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Clinical assessment
- Case history, pt obsv: are they drooling when talking to you?
2.Oromotor: think about how tongue fns, speed, range of motion might impact swallow
- Trials of foods, fluids of diff consistencies to find out aspiration risk: a) thicker fluids easier to control in mouth, safer for ppl w poor oral control, poor laryngeal protection, BUT might be too thick so need more effort, might be harder, b) Pureed foods easier to chew, stay tgt as bolus
Instrumental assesment
VFSS
X-ray procedure, digitally recorded
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Provides specific info about pharyngeal stage, degree of aspiration
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Compensatory techniques
Posture: sit upright at least 45 degrees, feet flat on floor, 90 degrees from hip, head look front and centre, slight downward chin tuck, remain upright after swallowing
Delivery
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Rate of intake: how quickly you're presenting spoon, problem in day care where meal times are too short
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Sensory techniques
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Sour, carbonated, textured bolus
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Bolus control, clearance
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X laugh/talk when eating, go slowly, stay upright for another 20-30 to reduce chance of reflux
Give small mouthful, check of residue b/w mouthfuls, make sure each mouthful finished before presenting the next one, ensure all residue cleared after meal
Modify bolus
Fluids
Thin fluids eg. water,tea, coffee, juice
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Mildly thick fluids eg. nectar, 1/4 thick
Moderately thick fluids eg. honey, 1/2 thick
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Foods
Regular foods eg. full, regular diet, sandwiches
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Minced, moist diet eg. chopped/diced
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Rehab techniques
Combination of
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Indirect, non-swallow exercises
working on muscles, structures invl in swallowing eg. oromotor exercises (lip, tongue, jaw), muscle strengthening exercise