intake without overt signs and symptoms of aspiration for the Bolus Volume/Pacing/Safe Swallowing Strategies 7. OtolaryngologyHead and Neck Surgery, 151(5), 765769. For further information please see ASHAs resource on the Videofluroscopic Swallowing Study. Administration of an interview or a questionnaire that addresses the patients perception of and/or concern with swallowing function (e.g., the 10-item Eating Assessment Tool [EAT-10]; Cheney, 2015). "Prolonged mastication," "inefficient chewing," "no rotary jaw movements," and the like. Aspiration syndromes: Aspiration pneumonia and pneumonitis. The patient will tolerate diet upgrade trials without signs and/or symptoms of aspiration with to safely least restrictive diet with (min/mod/max) verbal, visual and tactile cues For example, coughing and throat clearing may not be correlated with penetration or aspiration of a bolus but may be the result of gastroesophageal reflux, esophageal dysmotility, and common medications (Elvevi et al., 2014; Madanick, 2013; Tafreshi & Weinacker, 1999). See ASHAs Practice Portal page on. Dysphagia and its consequences in the elderly. The role of the SLP in treating individuals with progressive neurological disorders is designed to maximize current function, compensate for irreversible loss of function, assess and reassess changes in status, and educate and counsel patients regarding the progression of the disorder and potential options, including non-oral means of nutrition. Biofeedback incorporates the patients ability to sense changes and aids in the treatment of feeding or swallowing disorders. Patient will utilize thermal tactile stimulation to increase oral sensation for safe consumption of least restrictive diet with (min/mod/max) verbal, visual and tactile cues How to Write S.M.A.R.T. Please see ASHAs Dysphagia Evidence Map. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. SLPs should consider how culture influences activities of daily living (Riquelme, 2004). SLPs should maintain competency of skills through reading current research and engaging in continuing education. overall physical, social, behavioral, and cognitive/communicative status; the patients perception of function, severity, change in functional status, and quality of life; physiological status and vital signs, including heart rate, oxygen saturation, and respiratory rate as well as respiratory/swallowing pattern, which may vary across individuals and across the life span (Martin-Harris et al., 2005); secretion management skills, which might include frequency and adequacy of spontaneous saliva swallowing and the ability to swallow voluntarily; labial seal, anterior spillage and evidence of oral control, including mastication and transit, manipulation of the bolus, presence of hyolaryngeal excursion as observed externally or to palpation, and time required to complete the swallow sequence; behavioral signs and symptoms, such as throat clearing or coughing before/during/after the swallow, which may not always be indicators of penetration and/or aspiration; the impact of fatigue and/or respiratory function on swallowing; changes to physiological status/vital signs/voice quality; and. An inspection of the oral mechanism, cranial nerve assessment, and other observations such as. Patient/care partners access to thickened liquids and/or thickening agents and ability to modify regular texture foods/liquids after discharge. Krekeler, B. N., Broadfoot, C. K., Johnson, S., Connor, N. P., & Rogus-Pulia, N. (2018). swallowing function on P.O. https://doi.org/10.1097/PHM.0000000000001397, Sura, L., Madhavan, A., Carnaby, G., & Crary, M. A. Clinical Neurology & Neurosurgery, 104(4), 345351. https://doi.org/10.1007/BF02493526, Via, M. A., & Mechanick, J. I. this Swallowing assessment allows the SLP to integrate information from the following: Assessment may result in one or more of the following outcomes: Patients with suspected dysphagia may warrant further instrumental assessment to examine the impact of swallowing anatomy and physiology on clinical presentation (McCullough et al., 2005; OHoro et al., 2015). What to Include in Your Goals 1. Aghaz, A., Alidad, A., Hemmati, E., Jadidi, H., & Ghelichi, L. (2018). https://doi.org/10.1007/s00455-001-0065-9, Cabr, M., Serra-Prat, M., Force, L., Almirall, J., Palomera, E., & Clav, P. (2014). https://doi.org/10.1016/j.physbeh.2017.03.018, Hind, J. (2014). The patient will complete daily oral-motor exercise to increase lingual strength and range of motion for adequate lingual elevation and anterior to posterior movement with(min/mod/max) verbal, tactile and visual cues with ___% effectiveness to reduce the risk of food residue falling into the airway Complete a Modified Barium Swallow/Fiberoptic Endoscopic Evaluation of the Swallow to fully assess physiology and anatomy of the swallow and to determine the appropriate diet and/or rehabilitation exercises. https://doi.org/10.1136/jnnp.52.2.236, Barikroo, A., Carnaby, G., & Crary, M. (2015). SLPs should also be familiar with other diagnostic procedures performed by different medical specialists that yield information about swallowing function. Patients who are tactically defensive may need approaches that reduce the level of sensory input initially, with incremental increases as tolerance improves. Critical Care Medicine, 41(10), 23962405. Swallowing function after stroke: Prognosis and prognostic factors at 6 months. ASHA recognizes the autonomy of SLPs in completing the VFSS. Instrumental procedures are the only method that provides visualization of swallowing physiology and laryngeal, pharyngeal, and upper esophageal anatomy, which help diagnose dysphagia. Clinicians should be aware that research into the overall efficacy of dysphagia treatment is ongoing; therefore, treatment options may evolve. OtolaryngologyHead and Neck Surgery, 160(6), 955964. Examining the evidence on neuromuscular electrical stimulation for swallowing: A meta-analysis. Logemann, J. Special considerations may need to be made regarding PPE for COVID-19. Does a water protocol improve the hydration and health status of individuals with thin liquid aspiration following stroke? (2018). International Classification of Functioning, Disability and Health. Modifications to the taste or temperature may also be made to change the sensory input of a bolus. Systematic review and meta-analysis of the association between sarcopenia and dysphagia. Swallowing screening is a procedure to identify individuals who require a comprehensive assessment of swallowing function or a referral for other professional and/or medical services (ASHA, 2004). Dysphagia, 29(1), 1724. 4. Preferred practice patterns for the profession of speech-language pathology [Preferred practice patterns]. Chua, S., Dodd, H., Saeed, I. T., & Chakravarty, K. (2002). Asking the right questions in the right ways. Identifying the prevalence of dysphagia among patients diagnosed with unilateral vocal fold immobility. The concept of setting goals is not new; in fact, it can be traced back to philosophical writings by Aristotle in 384-322 B.C. intake without overt signs and symptoms of aspiration for the highest Complete a Clinical Swallow Evaluation to determine appropriateness of current diet/need for MBS https://doi.org/10.1097/MOO.0000000000000491, Park, J.-S., Kim, H.-J., & Oh, D.-H. (2015). https://doi.org/10.1111/j.1532-5415.2010.03227.x, Shanahan, T. K., Logemann, J. Intraoral appliances (e.g., palatal plates) are removable devices with small knobs that provide tactile stimulation inside the mouth to encourage lip closure and appropriate lip and tongue position for improved swallow function. Garand, K. L., McCullough, G., Crary, M., Arvedson, J. C., & Dodrill, P. (2020). See the Treatment section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Dysphagia may increase caregiver costs and burden and may require significant lifestyle alterations for the patient and the patients family. Roden, D. F., & Altman, K. W. (2013). Annals of Otology, Rhinology & Laryngology, 124(5), 351354. Seminars in Speech and Language, 21(4), 347364. Fiberoptic endoscopic examination of swallowing safety: A new procedure. Patients may also require further assessment or reassessment depending on changes in functional or medical status. Logemann, J. (2003). American Journal of Speech-Language Pathology, 29(2S), 919933. Chest, 137(3), 665673. Please see ASHAs resource on Alternative Nutrition and Hydration in Dysphagia Care for further information. "Each child will have different . American Journal of Physical Medicine & Rehabilitation, 99(8), 701711. Chin tuck for prevention of aspiration: Effectiveness and appropriate posture. Journal of Critical Care, 30(1), 4048. https://www.asha.org/policy/, American Speech-Language-Hearing Association. For some people living with ALS, tilting the chin downwards helps prevent food from going down the windpipe. (Practice Portal). A number of epidemiologic reports indicate that the prevalence of dysphagia is more common among older individuals and that sarcopenia is positively associated with dysphagia (Barczi et al., 2000; Bhattacharyya, 2014; Bloem et al., 1990; Cabr et al., 2014; Roden & Altman, 2013; Sura et al., 2012; Zhao et al., 2018). structural assessment of the face, jaw, lips, tongue, hard and soft palate, oropharynx, and oral mucosa; functional assessment of muscles and structures used in swallowing, including symmetry, sensation, strength, tone, range and rate of motion, and coordination of movement; analysis of headneck control, posture, oral reflexes, and involuntary movements; and. Oral-motor treatments range from passive to active (e.g., range-of-motion activities, resistance exercises, or chewing and swallowing exercises). https://doi.org/10.2147/CIA.S23404, Tabor, L. C., Plowman, E. K., Romero-Clark, C., & Youssof, S. (2018). Techniques https://doi.org/10.1007/s12603-019-1191-0, Balzer, K. (2000). the patients use of additional equipment, as appropriate (e.g., adaptive drinking cups). AGA technical review on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Pharyngeal pressure generation during tongue-hold swallows across age groups. DYSPHAGIA GOALS; The case will consume 1/3 cup ice chips (cut into 1/2 pieces or smaller) on 30 minutes sans overt s/sx of aspiration in 70% of trials for amusement. Prigent, H., et al. Sensory stimulation may be useful for those with reduced response, overactive response, or limited opportunity for sensory experience. functional limits to eliminate pocketing of food in the anterior and lateral sulci with determine the optimum feeding methods and techniques to maximize swallowing safety and feeding efficiency. An SLPs roles include. Compensatory techniques alter the swallow when used but do not create lasting functional change. The intent of many exercises is to provide lasting functional improvement. Eat and exercise, two goals commonly prescribed by speech pathologists in proactive swallowing therapy, were independently associated with favorable outcomes after adjustment for confounding markers of tumor and treatment burden. Consent, refusal, and waivers in patient-centered dysphagia care: Using law, ethics, and evidence to guide clinical practice. 8, AHCPR Publication No. Swallowing safety of oral liquid medications: Assessment using the International Dysphagia Diet Standardisation Initiative framework. Using the Fleming index of dysphagia to establish prevalence. The overall goal is to help the person communicate in more useful and functional ways. Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults. Porto de Toledo, I., Lopes Quirino Pantoja, L., Fontes Luchesi, K., Assad, D. X., De Luca Canto, G., & Neves Silva Guerra, E. (2019). Certain exercises might help coordinate your swallowing muscles or restimulate the nerves that trigger the swallowing reflex. as low as 3% in U.S. inpatients aged 45 years or older to as high as 22% in adults over 50 years of age (Lindgren & Janzon, 1991; National Foundation of Swallowing Disorders, n.d.; Patel et al., 2018; Tibbling & Gustafsson, 1991); as high as 30% in elderly populations receiving inpatient medical treatment (Layne et al., 1989); up to 68% for residents in long-term care settings (National Institute on Deafness and Other Communication Disorders, n.d.; Steele et al., 1997); and. European Archives of Oto-Rhino-Laryngology. Springer. (2016). Archives of Gerontology and Geriatrics, 56(1), 19. ST Goal Bank Cuing Hierarchy Independent Setup/cleanup assistance 1. If the individuals swallowing does not support nutrition and hydration via oral intake, the swallowing and feeding team may recommend alternative avenues of intake (e.g., nasogastric [NG] tube, gastrostomy). GOALS BANK By Ana Paula G. Mumy and Holly Estabrook NOTE: All Objectives With (significant, moderate, minimal, no) cuing in (structured, unstructured) activities with 80% accuracy or in 8 of 10 trials. Journal of Clinical Gastroenterology, 51(5), 417420. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740808/, Mann, G., Hankey, G., & Cameron, D. (1999). Thieme. Journal of Hospital Medicine, 10(4), 256265. https://doi.org/10.1191/0961203302lu195cr, Clark, H., Lazarus, C., Arvedson, J., Schooling, T., & Frymark, T. (2009). ), Normal and abnormal swallowing (pp. Validation of the 3-oz water swallow test for aspiration following stroke. https://doi.org/10.1007/s00455-017-9852-9, Langmore, S. E., Kenneth, S. M. A., & Olsen, N. (1988). )to improve oral motor weakness, tongue base retraction, Examples of maneuvers include the following: Swallowing exercises include exercises of the lips, jaw, tongue, soft palate, pharynx, larynx, and/or respiratory muscles to improve function. Retrieved on March 22, 2021, from https://www.nidcd.nih.gov/health/statistics/quick-statistics-voice-speech-language, OHoro, J. C., Rogus-Pulia, N., Garcia-Arguello, L., Robbins, J., & Safdar, N. (2015). National Foundation of Swallowing Disorders. Speech-language pathologists (SLPs) are the preferred providers of dysphagia services and are integral members of an interprofessional team to diagnose and manage oral and pharyngeal dysphagia. Prevalence of dysphagia in multiple sclerosis and its related factors: Systematic review and meta-analysis. Oropharyngeal dysphagia in older personsfrom pathophysiology to adequate intervention: A review and summary of an international expert meeting. Robbins, J., Gensler, G., Hind, J., Logemann, J. appropriate compensatory techniques to reduce s/s of aspiration and to safely consume least restrictive diet with (min/mod/max) verbal, visual and tactile cues https://doi.org/10.1007/s00455-017-9863-6. (1990). Stroke, 30, 744748. https://doi.org/10.3109/17549507.2015.1024171, Layne, K. A., Losinski, D. S., Zenner, P. M., & Ament, J. SLPs examine the influence of diet texture modifications on swallowing physiology, including airway protection, during a comprehensive assessment of an individuals swallowing status prior to recommending these changes as part of treatment. https://doi.org/10.1016/j.jmu.2013.10.008, Huckabee, M. L., & Steele, C. M. (2006). A patient whose dysphagia is resolving and/or improving should be carefully monitored for the amount and type of oral intake that they can safely tolerate. A non-instrumental swallowing assessment may include a medical chart review as well as an assessment or consideration of, During or following bolus delivery during per os (P.O.) Disfagia como nica manifestacin de miastenia gravis [Dysphagia as the sole manifestation of myasthenia gravis]. Diet Modifications 2. The client will demonstrate the ability to adequately self-monitor swallowing skills and perform identifying clinical presentations of dysphagia; identifying potential risks and benefits initiating or modifying oral intake (e.g., risks of dehydration/malnutrition); determining the need for additional instrumental evaluation; and. (1993). https://doi.org/10.1055/s-0035-1564721, Saito, T., Hayashi, K., Nakazawa, H., Yagihashi, F., Oikawa, L. O., & Ota, T. (2017). With this support, swallowing efficiency and function may be improved. SLPs interpret and apply the results of imaging to dysphagia treatment plans and make recommendations and referrals as appropriate. https://doi.org/10.1056/NEJM199104253241703, Spechler, S. (1999). Patient will complete daily oral-motor exercise to increase oral sensitivity to a functional level forbolus formation and optimum safety with (min/mod/max) verbal, tactile and visual cues with ___% effectiveness Consistent with the World Health Organizations (2001) International Classification of Functioning, Disability and Health framework, the purpose of assessment is to identify and describe. https://doi.org/10.1007/BF02493524, Llabrs, M., Molina-Martinez, F. J., & Miralles, F. (2005). Code of ethics [Ethics]. (2014). Cichero, J. Preferences of the person with dysphagia and their care partners, related cultural and/or religious considerations and the impact on the patients overall quality of life. Lingual Coordination/Sensation Short-Term Goals #1.0 Patient will . A randomized controlled trial. side effects of some medications (e.g., Balzer, 2000); metabolic disturbances (e.g., hyperthyroidism); infectious diseases (e.g., COVID-19, sepsis, acquired immune deficiency syndrome [AIDS]); Meux & Wall, 2003); pulmonary diseases (e.g., chronic obstructive pulmonary disease [COPD]); identifying signs and symptoms of dysphagia; identifying normal and abnormal swallowing anatomy and physiology supported by imaging; identifying indications and contraindications specific to each patient for various assessment procedures; identifying signs of potential disorders in the upper aerodigestive and/or digestive tracts and making referrals to appropriate medical personnel; assessing swallow function as well as analyzing and integrating information from such assessments collaboratively with medical professionals, as appropriate; providing treatment for swallowing disorders, documenting progress, adapting and adjusting treatment plans based on patient performance, and determining appropriate discharge criteria; identifying and using appropriate functional outcome measures; understanding a variety of medical diagnoses and their potential impact(s) on swallowing; recognizing possible contraindications to clinical decisions and/or treatment; being aware of typical age-related changes in swallow function; providing education and counseling to individuals and caregivers; incorporating the clients/patients dietary preferences and personal/cultural practices as they relate to food choices during evaluation and treatment services; respecting issues related to quality of life for individuals and/or caregivers; practicing interprofessional collaboration; educating and consulting with other professionals on the needs of individuals with swallowing and feeding disorders and the SLPs role in the diagnosis and management of swallowing and feeding disorders; advocating for services for individuals with swallowing and feeding disorders; performing research to advance the clinical knowledge base; and.