Pediatric Swallowing Assessment and Treatment.pptx

Transcription

By Jennifer Dahms, MS, CCC-SLP, BRS-S
  To
identify the cranial nerve innervation
for swallowing
  To identify the muscle functioning for
normal swallowing
  To identify the aspects of normal
swallowing function
Jennifer Dahms, MS/CCC-SLP, BRS-S
  To
identify abnormal muscle and
movement patterns that inhibit functional
swallowing
  To identify 3 assessment procedures for
objectifying abnormal swallowing
  To list 5 treatment techniques for treating
pediatric swallowing disorders
  Cranial
Nerves associated with
swallowing function
-Cranial Nerve V – elevates the hyoid, nasopharyngeal
closure
-Cranial Nerve VII – some functioning with elevating the
larynx and the hyoid
-Cranial Nerve IX – palatal movement, pharyngeal
constriction
-Cranial Nerve X – mostly responsible for laryngeal
closure
-Cranial Nerve XI – has some innervation with laryngeal
elevation
-Cranial Nerve XII – some impact on hyoid movement
  Muscles
for tongue elevation
-intrinsic vs. extrinsic
  Muscles
for hyolaryngeal excursion
-anterior belly of the digastric, mylohyoid, geniohyoid
  Muscles
for nasopharyngeal closure
-palatal levator, palatal tensor
  Muscles
for pharyngeal contraction
-superior/medial/inferior constrictors
  Muscles
for epiglottic inversion
-secondary to hyolaryngeal excursion and tongue
movements
  Muscles
for laryngeal elevation
-stylopharyngeus
-salpingopharyngeus
-palatopharyngeus
  Muscles
for airway closure
-lateral cricoarytenoid, interarytenoids
  Muscles
for PE segment opening
-inferior pharyngeal constrictor, cricopharyngeus
  The
tongue (tip, blade, tongue root)
-tip elevation, squeezing bolus, bolus transport
  The
nasopharynx
-elevates for closure
  The
pharynx
-squeezing motion
  The
epiglottis
-airway closure
-impacted by tongue movement
  The
airway
-larynx elevates
-vocal folds approximate
  The
hyoid
-elevates and pulls forward
  The
esophagus
-peristaltic waves
  Adult
versus Pediatric
-adult (more space between structures)
-pediatric (closeness of structures)
  Drinking
style
-Gulping
-Piecemeal deglutition
  The
tongue
-Tightness
-Decreased tongue cupping
-Decreased tongue elevation
-Decreased posterior tongue strength
-Decreased range of motion
-Decreased oral containment
  The
nasopharynx
-Nasal regurgitation / backsplash
-Forced nasal emissions
  The
pharynx
-residue
  The
epiglottis
-incomplete inversion
-hitting posterior pharyngeal wall
  The
airway
-Laryngeal cleft
-decreased hyoid excursion
-decreased laryngeal elevation
-tracheostomy
  Torticollis
  Tonsils
-speed bumps
  The
esophagus
-decreased PE segment opening
-TE fistula
-GERD
-Eosinophilic Esophagitis
  Video
Fluoroscopic Swallow Study /
Modified Barium Swallow
-the “gold standard”
-radiation exposure
-looks at the full phases of swallowing
  FEES
-no view of oral phase; may give some information about
the posterior tongue
-best look at what happens to a bolus post-swallow in
terms of residue
  Manometry
-measures strength of contractions, pressure changes
  Lipid
Laden Macrophage
-measures the fat content of aspirate
  Ultrasound
-primarily for identifying oral dysphagia
-could reveal information on oral bolus control that may
be affecting the pharyngeal phase
  O2
Saturation Levels
-looking for desaturations during swallowing
-not a lot of research on this technique, especially with
pediatrics
  Cervical Auscultation
-listening for changes in pharyngeal sounds related to
swallowing
-screening
  Clinical
Observation
-vocal quality, laryngeal excursion, protective response or
lack there of, overall timeliness of swallow, point of
swallow with breathing
  Postural
Changes
-elevation with bottle feeding, recline in chair/wheel chair
-head position with children with cerebral palsy
  Consistency
Changes
-diet level, thickening liquids
-controversy with thickening
-tube placement
  Utensil
Changes
-bottle systems, cups, straws
  Tongue
/ Hyoid Massage
-use with oral tightness that relates to decreased bolus
control
-aerophagia
  Tongue
Exercises
-tongue elevation
-tongue retraction
-posterior resistive chewing
-tongue lifting
  Thermal
Stimulation
-to improve swallow response
-laryngeal mirror vs. spoon
  Vibratory
Input
-to improve awareness
-oral, pharyngeal
  Shaker
Exercise
-Developed by Reza Shaker
-to improve epiglottic inversion and PE segment opening
-modifications to pediatrics
  Vital
Stimulation
-E stim based
-controversial
-Deep Pharyngeal Neuromuscular Stimulation (DPNS)
  Adult Techniques
-swallow maneuvers
  Behavioral
Strategies
-best if child is being fed vs. self-feeding
  Drooling
-not being able to control secretions posteriorly
  Tongue
Exercises
-Sapienz, et al. (2008)
-Burkhead (2009)
  Thermal
Stimulation
-Miura et al. (2009)
-vibration with children
  Sour
Boluses
-Logemann et al. (1995)
-Miura et al. (2009)
  Vital
Stimulation
-ASHA handout
-Christiaanse et al. (2011)
  How
do we apply research to pediatrics?
-functioning
-plasticity
-habilitative vs. rehabilitative
-Jennifer Dahms has no financial or nonfinancial
relationships related to the content of this continuing
education course other than payment by Gawenda
Seminars & Consulting, Inc. for presentation
 
 
 
 
American Speech-Language-Hearing Association. (2002).
Knowledge and skills for speech-language pathologists performing
endoscopic assessment of swallowing functions [Knowledge and Skills].
Knowledge and skills needed by speech-language pathologists performing
videofluoroscopic swallowing studies [Knowledge and Skills].
Knowledge and skills needed by speech-language pathologists providing
services to individuals with swallowing and/or feeding disorders
[Knowledge and Skills].
American Speech-Language-Hearing Association. (2002). Roles of
speech-language pathologists in swallowing and feeding disorders
[Position Statement].
 
 
 
 
American Speech-Language-Hearing Association. (2001). Roles of
speech-language pathologists in swallowing and feeding disorders:
technical report [Technical Report].
Arvedson, Joan C. and Linda Brodsky. (2002). Pediatric Swallowing
and Feeding: Assessment and Management, Second Edition. Thomson
Delmar Learning.
Burkhead, Lori M. “Applications of Exercise Science in Dysphagia
Rehabilitation”. Swallowing and Swallowing Disorders (Dysphagia),
June 2009; 18: 43-48.
Christiaanse, M.E,. B. Mabe, G. Russell, T.L. Simeone, J. Fortunato, and
B. Rubin. “Neuromuscular electrical stimulation is no more
effective than usual care for the treatment of primary dysphagia in
children”. Pediatric Pulmonology. 2011 June; 46(6):559-65.
 
 
 
 
Dailey Hall, Kelly. (2001). Pediatric Dysphagia Resource Guide.
Singular.
Logemann, Jeri A. (1993). Manual for the Videofluorographic Study
of Swallowing, Second Edition. Pro-Ed.
Logemann, Jeri A., Barbara Roa Pauloski, Laura Colangelo, Cathy
Lazarus, Masako Fujiu, and Peter J. Kahrilas. “Effects of a Sour Bolus
on Oropharyngeal Swallowing Measures in Patients with
Neurogenic Dysphagia”. Journal of Speech and Hearing Research.
June 1995; 38: 556-563.
Miura,Yutaka,Yuji Morita, Hideki Koizumi, and Tomio Shingai.
“Effects of Taste Solutions, Carbonation, and Cold Stimulus on the
Power Frequency Content of Swallowing Submental Surface
Electromyography”. Chemical Senses. May 2009; 34: 325 - 331.
 
 
 
Special Interest Division 13 – Swallowing and Swallowing Disorders
(Dysphagia). “Frequently Asked Questions Regarding the Use of
Electrical Stimulation to Treat Feeding and Swallowing Disorders in
the Pediatric Population”. Division handout.
Sapienz, Christine, Karen Wheeler-Hegland, Kim Stewart, and
Joseph Nocera. “Exercise Prescription for Dysphagia: Intensity and
Duration Manipulation”. Swallowing and Swallowing Disorders
(Dysphagia), June 2008; 17: 50-58.
Swigert, MA, CCC-SLP, Nancy B. (1998). The Source for Pediatric
Dysphagia. Linguisystems.

Pediatric Swallowing Assessment and Treatment.pptx

Transcription

Similar documents

A Cut Above

NEWS FLASH

How Green Is Your Dog? - Eco Touch Premium Car Care

Incoming 4th Summer Reading 2015.pages

Mrs. Callaway`s Super St. Patrick`s Speech/Language Packet

IPAT slides 2

Summer Flyer - National Louis University

“left handed virtuoso of the upright bass”

No Monthly Fees or Contracts Required