Voice Disorders ReviewDysphagiaSlide 3Dysphagia in PreemiesNormal SwallowSlide 6Slide 7Slide 8Common Signs of DysphagiaDysphagia AssessmentSwallowing AssessmentDysphagia TreatmentSwallowing PrecautionsNonoral FeedingVoice Disorders ReviewVoice Disorders ReviewA voice disorder is a problem related to A voice disorder is a problem related to ____________. Voice disorders are broken into ____________. Voice disorders are broken into three categories:____________________.three categories:____________________.Vocal fold paralysis is a type of _______ voice Vocal fold paralysis is a type of _______ voice disorder. What is another type?disorder. What is another type?Vocal nodules are a type of _____ voice Vocal nodules are a type of _____ voice disorder. How are they different from disorder. How are they different from polyps? How are nodules and polyps polyps? How are nodules and polyps treated?treated?Carcinoma is a type of _______ voice disorder. Carcinoma is a type of _______ voice disorder. What are treatment options?What are treatment options?What is involved in a voice assessment?What is involved in a voice assessment?DysphagiaDysphagiaImpaired SwallowingImpaired SwallowingDysphagiaDysphagiaImpairment in the ability to swallowImpairment in the ability to swallowAffects 16-22% of those over 55Affects 16-22% of those over 55Causes include:Causes include:StrokeStroketraumatic brain injurytraumatic brain injuryprogressive neurological diseasesprogressive neurological diseasessurgery to structures involved in swallowing, surgery to structures involved in swallowing, head and neck cancerhead and neck cancerdementiadementia(Plante & Beeson, 2008)(Plante & Beeson, 2008)Dysphagia in PreemiesDysphagia in Preemies32 weeks gestation – suck, swallow 32 weeks gestation – suck, swallow and breatheand breatheMany SLPs work in NICUs.Many SLPs work in NICUs.Infants on ventilatorsInfants on ventilatorsBaby’s first bottleBaby’s first bottlehttp://http://youtu.be/zOd7-KFNhyEyoutu.be/zOd7-KFNhyENormal SwallowNormal SwallowPhase One- Phase One- Oral Preparatory Oral Preparatory PhasePhasePreparation of food Preparation of food in mouth for in mouth for transport to transport to stomachstomachTongue moves food Tongue moves food into a bolusinto a bolusNormal SwallowNormal SwallowPhase Two- Phase Two- Oral Transport PhaseOral Transport PhaseTransport of the Transport of the bolus from the oral bolus from the oral cavity into the cavity into the pharynxpharynxDifficulty with this Difficulty with this phase may prevent phase may prevent moving food out of moving food out of oral cavity to be oral cavity to be swallowedswallowedNormal SwallowNormal SwallowPhase Three- Pharyngeal Phase Three- Pharyngeal PhasePhaseMovement of the bolus Movement of the bolus through the pharynx through the pharynx into the esophagusinto the esophagusIf the food does not If the food does not clear the throat during clear the throat during this phase, the this phase, the individual risks individual risks aspiration of food into aspiration of food into the airway.the airway.Normal SwallowNormal SwallowPhase Four- Phase Four- Esophageal PhaseEsophageal PhaseTransportation of Transportation of the bolus to the the bolus to the stomach by the stomach by the esophagusesophagusPeristaltic Peristaltic contractionscontractionsCommon Signs of Common Signs of DysphagiaDysphagiaChoking or coughing when swallowing food or Choking or coughing when swallowing food or liquidliquidDifficulty initiating a swallowDifficulty initiating a swallowDifficulty chewing foodDifficulty chewing foodDifficulty controlling food in the oral cavityDifficulty controlling food in the oral cavityFood sticking in the throatFood sticking in the throatReflux of food from the esophagus or stomachReflux of food from the esophagus or stomachAspiration pneumonia is the most common Aspiration pneumonia is the most common medical complication caused by dysphagia. medical complication caused by dysphagia.Dysphagia AssessmentDysphagia AssessmentBedside Swallowing Evaluation (BSE)- Bedside Swallowing Evaluation (BSE)- to determine if the person has oral to determine if the person has oral dysphagia or signs of aspirationdysphagia or signs of aspirationModified Barium Swallow (MBS)- xray Modified Barium Swallow (MBS)- xray to assess movement of pharyngeal to assess movement of pharyngeal structures during swallowingstructures during swallowinghttp://www.youtube.com/watch?http://www.youtube.com/watch?v=hf2kRD85zvc v=hf2kRD85zvcSwallowing AssessmentSwallowing AssessmentFiberoptic Endoscopic Examination Fiberoptic Endoscopic Examination of Swallow (FEES)- flexible scope of Swallow (FEES)- flexible scope used to view the pharyngeal area used to view the pharyngeal area before and after the swallowbefore and after the swallowhttp://www.youtube.com/watch?http://www.youtube.com/watch?v=DB_E2BygPJk v=DB_E2BygPJkDysphagia TreatmentDysphagia TreatmentPostural changePostural changeSwallow maneuversSwallow maneuversConsistency changeConsistency changehttp://www.youtube.com/watch?v=S9XuAtk0520&feature=relatedhttp://www.youtube.com/watch?v=S9XuAtk0520&feature=relatedSwallowing precautionsSwallowing precautionsSwallowing PrecautionsSwallowing PrecautionsSit upright while eating and for at least Sit upright while eating and for at least 20 minutes after eating20 minutes after eatingTake small single bites of food one at a Take small single bites of food one at a timetimeAlternate bites of food with liquidAlternate bites of food with liquidSwallow 3-4 times after each biteSwallow 3-4 times after each biteAvoid using a strawAvoid using a strawCheck for oral pocketing on the right/left Check for oral pocketing on the right/left side of the mouthside of the mouthNonoral FeedingNonoral FeedingNasogastric tubeNasogastric tubePercutaneous endoscopic Percutaneous endoscopic gastrostomy (PEG) tubegastrostomy (PEG) tubehttp://www.youtube.com/watch?http://www.youtube.com/watch?v=vhHUpyDgbLg