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February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
February Speaker: Julie Girgis
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February Speaker: Julie Girgis

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SLP Julie Girgis from Rancho Los Amigos gave an excellent presentation on dysphagia at our General Meeting on February 17th, 2011.

SLP Julie Girgis from Rancho Los Amigos gave an excellent presentation on dysphagia at our General Meeting on February 17th, 2011.

Published in: Career, Health & Medicine
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  • 1. A BRIEF OVERVIEW OF DYSPHAGIA, THE IMPORTANCE OF ORAL HYGIENE, AND THE FRAZIER WATER PROTOCOL Julie Girgis, M.A., CCC-SLP Rancho Los Amigos National Rehabilitation Center Downey, California CSUF-NSSLHA Thursday, February 17, 2011
  • 2. What is Dysphagia?
    • “ Difficulty with swallowing”
    • Can be caused by weakness or decreased sensation in oral, pharyngeal and/or esophageal cavity.
    • Weakness or decreased sensation can be caused by damage to the anatomical structure or the nerves innervating those areas.
      • Examples of injuries or diseases?
  • 3. DIAGRAM OF THE SWALLOWING MECHANISMS
  • 4. How can you tell if a person has dysphagia?
    • Bedside Swallow Evaluation (BSSE)
      • Coughing and/or choking
        • During eating or drinking
        • Shortly after eating or drinking
      • Throat clearing after swallowing
      • Wet, gurgly sound in the throat after eating or drinking
      • Increased drooling or saliva
      • Effort while attempting to swallow
      • Extra swallows needed to swallow one mouthful of food/drink
      • Runny nose or watery eyes
      • Sudden increase in temperature within 30-60 minutes after food/drink
  • 5. How can you tell if a person has dysphagia?
    • Instrumental Assessment
      • Modified Barium Swallow (MBS)/ Videofluoroscopic Swallow Study (VFSS)
        • Good for evaluating swallow and esophageal function
      • Flexible Endoscopic Evaluation of Swallowing (FEES)
        • Good for evaluating swallow, vocal fold function/integrity, voice, structures in the pharynx
  • 6. Possible Consequences of Dysphagia
    • Aspiration
      • May occur if food, liquid, or secretions have passed below the level of the vocal folds and into the lungs as a result of entering the airway instead of the esophagus .
        • Coughing
        • Throat-clearing
      • Silent Aspiration
    • Aspiration Pneumonia
      • Infection in the lungs from acute or chronic aspiration of fluids, foods, or oral secretions from the mouth
  • 7. BEGINNING OF ASPIRATION (AKA ‘PENETRATION’)
    • Laryngeal penetration is demonstrated by the bolus (i.e. food, liquid or secretions), entering above the level of the vocal folds
    • Discoordination of laryngeal elevation and pharyngeal contraction
    • Tongue base residue present
  • 8. ASPIRATION
    • Entrance of the bolus into the airway below the vocal folds
    • Delayed laryngeal closure
    • Tongue base and vallecular residue remain
    • Material remains throughout the pharynx instead of one cohesive bolus
  • 9. Possible Consequences of Dysphagia (cont.)
    • Weight Loss and Malnutrition
      • May occur if a person loses appetite due to fatigue or difficulty with chewing or swallowing.
    • Dehydration
        • May occur when a person is unable to swallow enough liquids.
    • Quality of Life
      • Related to satisfaction of eating
      • Socialization
  • 10. A Glimpse at Pneumonia
    • Aspiration pneumonia commonly occurs when chest x-rays show infection of the RIGHT LOWER LOBE of the lung.
  • 11. How can dysphagia be treated?
    • Modify the diet texture as appropriate
      • Ex. Pureed foods and thickened liquids
    • Oral Motor and Pharyngeal Strengthening Exercises
    • Food and liquid trials with Speech Therapy
    • Neuromuscular Electrical Stimulation (NMES)
    • Gastrostomy Tube
  • 12. What does oral hygiene have to do with dysphagia?
    • Oral hygiene :
      • keeping a person’s mouth, lips, and teeth clean
        • Bacteria
        • Secretions
        • Food
        • Drink
        • Blood
  • 13.
    • Aspiration can occur even when a person is not eating anything by mouth (NPO).
      • How?
    • Research has shown that if a person is not eating by mouth, but unable to manage their own secretions, they are at risk for aspirating their secretions
      • May lead to aspiration pneumonia
    What does oral hygiene have to do with dysphagia?
  • 14. So the question is … Can a person who is unsafe to eat/drink by mouth or is drinking thickened liquids because they are at risk for aspiration DRINK REGULAR WATER OR ICE CHIPS???
  • 15. FRAZIER WATER PROTOCOL (FWP) (Free Water Protocol)
    • What is it?
      • The ability for patients on thickened liquids to receive regular-thin water (including small ice chips) between meals
      • The ability for patients who are taking nothing by mouth (NPO) to receive regular-thin water (including small ice chips) sporadically throughout the day
  • 16. How is it initiated?
    • The SLP will complete a formal Bedside Swallow Evaluation or ongoing evaluation during dysphagia therapy.
    • If appropriate, the SLP will discuss the recommendation with the physician and receive a written order.
    • The SLP will notify members of the interdisciplinary team (PT, OT, Nsg) and post written precautions at bedside.
  • 17. As a Speech-Language Pathologist, you responsibility is…
    • Know your patients
    • Know your patient’s wants and needs
    • Know your material
    • Know what you’re looking for
    • Know your options for treatment
    • Know your patient’s goals Know your goals

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