Transcript Predicting Pneumonia risk in patients with dysphagia: feed

PARKINSON’S DISEASE
Rebecca L. Gould, MSC, CCC-SLP
[email protected]
(561) 833-2090
www. med-speech.com
Parkinson’s Disease impacts
voice and swallowing
WHY?
THE LARYNX
Functions of the Larynx
breathing
thoracic fixation
coughing
swallowing
voice/phonation
“More than 15 million
Americans have some degree
of dysphagia, and with regular
treatment 83% recover or
significantly improve”.
Bello, J. (1994) compiled by Communication Facts.
ASHA Research Division
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SWALLOWING STAGES BY
PHASE
Oral Phase
• Food enters oral cavity
• Mastication and bolus formation
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SWALLOWING STAGES BY
PHASE (cont’d)
Oro-pharyngeal Phase
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•
•
•
Tongue elevates and propels bolus to pharynx.
Soft palate elevates to seal nasopharynx.
Larynx and hyoid bone move anterior and upward.
Epiglottis moves posteriorly and downwards to
close.
• Respiration stops.
• Pharynx shortens.
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SWALLOWING STAGES BY
PHASE (cont’d)
Esophageal Phase
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•
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•
Upper esophageal sphincter relaxes.
Bolus passes to esophagus.
Esophageal contracts sequentially.
Lower esophageal sphincter relaxes.
Bolus reaches stomach.
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“Radical dietary changes and
artificial feeding are drastic
measures by any standards”.
M.J. Feinberg, MD (1990)
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RESIDUAL
Leftover material
in the oral
pharynx after
swallow has
occurred.
PENETRATION
Entry of material
into the laryngeal
vestibule to the
level of the vocal
folds.
ASPIRATION
Entry of material
below the level
of true vocal
folds.
Incidence and patient characteristics
associated with silent aspiration in the
acute care setting
Coughing is a physiologic response to
aspiration in normal healthy individuals. No
cough in response to aspiration
silent
aspiration
Smith, C.H. et al (1999)
Gurgly vocal quality
predictive of who will
aspirate on VFSS
Linden (1993)
SCALE PREDICTIVENESS OF
PNEUMONIA RISK IF FED
FACTORS
• Multiple or progressive disease/one diagnosis
• Multiple medications (>5)/ <5 medications
• NPO (PEG)/ oral
• Oral hygiene fair – poor/ good – excellent
• Smoker / non-smoker
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SCALE PREDICTIVENESS OF
PNEUMONIA RISK IF FED (cont’d)
FACTORS
• Inpatient / outpatient
• Physical ability (mobile)/ sedentary
• Reflexive cough (present) / absent – delayed
• Cognitive status (fair-poor)/ good – excellent
• Secretion Pooling (minimal) / copious
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SCALE PREDICTIVENESS OF
PNEUMONIA RISK IF FED (cont’d)
Score
•<7 =
• 5–6 =
• <3 =
Use extreme caution
fair – good
good – excellent
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General Postural/ Feeding
Instructions
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•
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•
Upright, 90 degree position
Concentrate on each swallow
Take full tsp.
Pause between bites/sips
General Postural/ Feeding
Instructions (cont’d)
• Alternate liquid/dry swallows
• Refrain from talking while
chewing/swallowing
• Chew each bite thoroughly
• Hold breath, swallow high and hard,
swallow again
COMMUNICATION
“MUTUAL
UNDERSTANDING OF
SHARED
INFORMATION”
Relative vocal loudness level of an
individual with Parkinson’s
Disease
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•
•
•
•
Shout
Loud
Normal loudness
Soft
Very soft
» Vocal loudness
level of an
individual with
Parkinson’s
Disease
THINK
LOUD!
THINK
BREATHE!
Conversational Strategies
Checklist
• Gain eye contact with
your communication
partner before speaking.
• Avoid speaking when
you are tired.
• Speak in a quiet
environment.
• Take your time while
speaking.
• Exaggerate your
articulatory movements.
Conversational Strategies
Checklist (cont’d)
• Speak louder.
• Take natural pauses while speaking.
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•
•
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Keep your face free from distractions.
Use body language to convey turn taking.
Allow yourself time for a conversation.
Avoid repeating words and phrases.
Use body language to convey turn taking.
Conversational Strategies
Checklist (cont’d)
• Rephrase your message if your communication
partner does not understand you.
• Use an alternative system to communicate if
your speech is difficult to understand.
• Appreciate your communication partner’s
efforts.
• Be patient with yourself.
THERAPY
“The human body is one of
the greatest compensatory
mechanisms.”
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