Clinicians modify bolus size particularly for patients that require a greater volume to adequately stimulate a swallow response (increase bolus size) or for patients that require multiple swallows per bolus (decrease bolus size). https://doi.org/10.1016/j.jcomdis.2013.04.001, Fujiu-Kurachi, M. (2002). Miles, A., McFarlane, M., Scott, S., & Hunting, A. Tongue pressure generation during tongue-hold swallows in young healthy adults measured with different tongue positions. The SLP educates involved parties on possible health consequences and documents all communication with the patient and caretakers (Horner et al., 2016). Swallowing-induced changes in heart rate have been recently reported. https://doi.org/10.1007/s12603-019-1191-0, Balzer, K. (2000). American Journal of Speech-Language Pathology, 29(2S), 919933. Agency for Health Care Policy and Research. The exact epidemiological numbers by condition or disease also remain poorly defined. https://doi.org/10.1056/NEJM199104253241703, Spechler, S. (1999). Thickened liquids for children and adults with oropharyngeal dysphagia: The complexity of rheological considerations. The decision to recommend use of a feeding tube is made in collaboration with the medical team. Dysphagia, 36(2), 303315. https://doi.org/10.1007/s40141-014-0061-2, Westby, C., Burda, A., & Mehta, Z. As with any treatment, if it is powerful . https://doi.org/10.1016/j.jmu.2013.10.008, Huckabee, M. L., & Steele, C. M. (2006). ), Normal and abnormal swallowing (pp. How to Perform: While dry swallowing, squeeze all of the muscles associated with swallowing as hard as possible. 119138). Kawashima, K., Motohashi, Y., & Fujishima, I. polymyositis and dermatomyositis (Gonzlez-Fernndez & Daniels, 2008). Utility of clinical swallowing examination measures for detecting aspiration post-stroke. European Neurology, 38, 4952. See the Service Delivery section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Dysphagia, 29(1), 1724. An example of a compensatory technique includes a head rotation, which is used during the swallow to direct the bolus toward one of the lateral channels of the pharyngeal cavity. Aspiration pneumonia: A review of modern trends. https://doi.org/10.1016/S0303-8467(02)00053-7, DePippo, K. L., Holas, M. A., & Reding, M. J. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 11(1), 911. (1993). Logemann, J. The causes and consequences of dysphagia cross traditional boundaries between professional disciplines. To PEG or not to PEG. Decision making must take into account many factors about each individuals overall status and prognosis. Journal of Hospital Medicine, 10(4), 256265. For further information please see ASHAs resource on the Videofluroscopic Swallowing Study. Presence and severity of co-morbidities (e.g., dehydration, renal disease, respiratory infections). Gastroenterology & Hepatology, 9(5), 311313. Comprehensive assessment includes non-instrumental and instrumental procedures. Biofeedback incorporates the patients ability to sense changes and aids in the treatment of feeding or swallowing disorders. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: Observational prospective study. Visualize the presence, location, and amount of secretions in the hypopharynx and larynx the patients sensitivity to the secretions; and the ability of spontaneous or facilitated efforts to clear the secretions. (2007). The first pro-posed instruction for the effortful swallow, "as you swal- (2017). . https://doi.org/10.1044/1058-0360(2011/10-0067), Donzelli, J., & Brady, S. (2004). Electrical stimulation uses an electrical current in order to stimulate the peripheral nerve. Increased risk of dehydration and associated conditions (e.g., renal failure, gastroparesis, constipation, urinary tract infections, confusion/delirium, and poor recovery from illness (Cichero & Lam, 2014; Leibovitz et al., 2007; Murray et al., 2016, Wheelan, 2001). https://doi.org/10.1097/MCG.0000000000000624, Bahat, G., Yilmaz, O., Durmazoglu, S., Kilic, C., Tascioglu, C., & Karan, M. A. In B. Jones (Ed. International Journal of Otolaryngology, 2012, Article 157630. https://doi.org/10.1155/2012/157630. Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia. A. (1997). https://doi.org/10.1007/BF02407401. Otolaryngologic Clinics of North America, 46(6), 10591071. identifying core team members and support services. Thieme. A review of medical/clinical records, including the potential impact of medications and treatment of other medical diagnoses such as. Rehabilitative techniques, such as exercises, are designed to create lasting change in an individuals swallowing over time by improving underlying physiological function. Instrumental procedures may not be indicated in select patients (e.g., a patient with ill-fitting dentures resulting in oral dysphagia or some patients with low levels of alertness who are unable to participate in the study). choking. Keep your shoulders flat. Bedside diagnosis of dysphagia: A systematic review. INTRODUCTION. Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. The effortful swallow is designed to improve posterior tongue-base movement, in that way improving clearance of the bolus from the valleculae. PEG insertion in patients with dementia does not improve nutritional status and has worse outcomes as compared with PEG insertion for other indications. Screening identifies the need for further assessment and may be completed prior to a comprehensive evaluation. Consent, refusal, and waivers in patient-centered dysphagia care: Using law, ethics, and evidence to guide clinical practice. Logemann, J. The standards for ASHA certification effective in 2020 require competence in dysphagia. Ultrasound imaging and swallowing. (2016). Management of GERD-related chronic cough. https://doi.org/10.1002/lary.26854, Brodsky, M. B., Huang, M., Shanholtz, C., Mendez-Tellez, P. A., Palmer, J. (n.d.). The Ampcare ES unit is a portable, non-invasive, dual-channel . This study was performed on 34 healthy wo The Journal of Nutrition, Health & Aging, 23(6), 571577. For further information on the modified Evans blue dye test, please see the, recommendations for additional assessment to determine whether, and the degree to which, swallowing anatomy and/or physiology may be impaired; and. Although effortful swallowing would appear to be, at first inspection, a fairly benign intervention, a recognition of the delicate balance of biomechanical movements underlying swallowing suggests that there is the potential for unanticipated adverse outcomes. Prevalence refers to the number of people who are living with dysphagia in a given time period. Journal of Rehabilitation Research & Development, 46(2), 205214. Objective data highlights progress for patients and therapists to see while also guiding treatment plans. Dysphagia, 31(6), 721729. A., & Lam, P. (2014). The purpose of the screening is to determine the likelihood that dysphagia exists and the need for further swallowing assessment (see ASHAs resource on Swallowing Screening). Examples of exercises include the following: Specific bolus volumes per swallow may result in faster pharyngeal swallow responses (Barikroo et al., 2015). Oropharyngeal function may be potentially affected in some patients with esophageal motility issues. https://doi.org/10.1111/ane.12136, Saconato, M., Chiari, B. M., Lederman, H. M., & Gonalves, M. I. https://doi.org/10.1016/0003-9993(93)90035-9, Shiga, H., Kobayashi, Y., Katsuyama, H., Yokoyama, M., & Arakawa, I. Part IVImpact of dysphagia treatment on individuals postcancer treatments. https://doi.org/10.1007/s00455-015-9657-7. Various pressure measures can be calculated and compared to normative data (Omari & Schar, 2018). Wirth, R., Dziewas, R., Beck, A. M., Clav, P., Hamdy, S., Heppner, H. J., Langmore, S., Leischker, A. H., Martino, R., Pluschinski, P., Rsler, A., Shaker, R., Warnecke, T., Sieber, C. C., & Volkert, D. (2016). intake. McGraw Hill. Steadman, K. J., Weng, M. T., Malouh, M. A., Symons, K., & Cichero, J. https://doi.org/10.1111/j.1468-3148.2005.00250.x, Cheney, D., Siddigui, M., Litts, J., Kuhn, M., & Belafsky, P. (2015). https://doi.org/10.1016/j.apmr.2006.04.019, Humbert, I. 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. The presence of the two abnormalities indicated that this young patient had cricopharyngeal hypertonicity. 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). The effects of lingual exercise in stroke patients with dysphagia. Gerontology,53(4), 179-183. Treatment of dysphagia may include restoration of normal swallow function (rehabilitative) and/or modifications to diet consistency and patient behavior (compensatory). Journal of Applied Research in Intellectual Disabilities, 19(2), 153162. https://doi.org/10.1136/jnnp.2004.038430, Loeb, M., McGeer, A., McArthur, M., Walter, S., & Simor, A. E. (1999). Precautions: May increase nasal regurgitation. Indications for rehabilitative exercises -appropriate etiology of the dysphagic physiology -cognitively able -motivation to perform exercises independently -good support systems Oral rehab exercises: hypertonicity -slow, progressive stretching exercises to relieve spasms or hyperfunction https://doi.org/10.1016/j.clnu.2007.08.006, Gonzlez-Fernndez, M., & Daniels, S. K. (2008). https://doi.org/10.1589/jpts.27.3631, Patel, D. A., Krishnaswami, S., Steger, E., Conver, E., Vaezi, M. F., Ciucci, M. R., & Francis, D. O. Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting. Whiplash-associated dysphagia and dysphonia: A scoping review. (2013). Effortful Swallow . Advanced age is a risk factor for aspiration pneumonia (Loeb et al., 1999). Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. See the Treatment section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. develop a treatment plan to improve the safety and efficiency of the swallow. https://doi.org/10.7224/1537-2073-2.1.40, Barczi, S. R., Sullivan, P. A., & Robbins, J. Supportive Care in Cancer, 27, 36813700. The Ampcare's Effective Swallowing Protocol (ESP) is a therapeutic intervention FDA-cleared for the treatment of dysphagia. (2018). A randomized controlled trial. OtolaryngologyHead and Neck Surgery, 151(5), 765769. Alterations to swallowing physiology as the result of effortful swallowing in healthy seniors. Oral-motor treatments range from passive to active (e.g., range-of-motion activities, resistance exercises, or chewing and swallowing exercises). Timing refers to the timing of rehabilitation relative to the onset of dysphagia. 2. Please see ASHAs Practice Portal page on Telepractice for further detail. Physical Medicine and Rehabilitation Clinics of North America, 19(4), 867888. SLPs may encounter patients approaching the end of life. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. (2001). Patients were asked to "swallow hard" using a "lingual focus" to maximize the oropharyngeal effect of the maneuver [ 14 ]. Parkinsonism & Related Disorders, 18(4), 311315. Acta Gastroenterologica Latinoamericana, 40(2), 156158. Techniques and exercises: Maneuvers: Chin tug and turn. SLPs help guide medical decision making regarding the appropriateness of these procedures given the severity and nature of the patients swallowing deficits. Bend your head forward so that your chin tucks. (2005). 2200 Research Blvd., Rockville, MD 20850 Although the body of literature concerning the value of electrical stimulation for swallowing is large, the benefits remain unclear (Carnaby-Mann & Crary, 2007; Clark et al., 2009; Humbert et al., 2012; Sun et al., 2020). Lindgren, S., & Janzon, L. (1991). Diseases of the Esophagus, 31(1), 17. Mendelsohn maneuver (Lift larynx, Increase UES opening time) Showa maneuver (Reduce Valleculae residue) Supraglottic swallow (Contraindications: CAD, arrhythmias and stroke) Exercises: A. Prosthetics (e.g., palatal obturator, palatal lift prosthesis) can be used to normalize pressure and movement in the intraoral cavity by providing compensation or physical support for patients with structural deficits/damage to the oropharyngeal mechanism. (2012). A., Hewitt, A. L., Gentry, L. R., & Taylor, A. J. (2001). Causes of dysphagia among different age groups: A systematic review of the literature. SLPs also have expertise in communication disorders that may affect the diagnosis and management of swallowing disorders. https://doi.org/10.1001/archotol.130.2.208, Elvevi, A., Bravi, I., Mauro, A., Pugliese, D., Tenca, A., Cortinovis, I., Milani, S., Conte, D., & Penagini, R. (2014). As indicated in the ASHA Code of Ethics (American Speech-Language-Hearing Association [ASHA], 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so. https://doi.org/10.1016/j.apmr.2006.11.002. Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. Please see ASHAs resource on Flexible Endoscopic Evaluation of Swallowing for further information on the FEES. American Journal of Speech-Language Pathology, 20(2), 124130. The patient is severely agitated, unable to remain alert, or unable to follow simple commands. The natural history and functional consequences of dysphagia after hemispheric stroke. Dysphagia, 30(5), 558564. It is not contraindicated for patients with cardiovascular disease or stroke. supraglottic swallow, super supraglottic swallow, effortful swallow/Valsalva maneuver, mendelsohn maneuver. 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. Systematic review and meta-analysis of the association between sarcopenia and dysphagia. Treatment targeting a specific function or structure may also affect function in other structures. https://doi.org/10.1007/s00455-001-0065-9, Cabr, M., Serra-Prat, M., Force, L., Almirall, J., Palomera, E., & Clav, P. (2014). Effortful Swallow Purpose: Improve the contact and coordination between the different muscles used while swallowing. Monitoring the presence of the signs and symptoms of oropharyngeal and/or esophageal swallowing dysfunction. See the Dysphagia Evidence Map for summaries of the available research on this topic. Cognitive deficits (e.g., impulsivity, decreased initiation) may affect a patients pace during meals. An SLPs roles include. A later study by Falsetti et al. Chin tuck for prevention of aspiration: Effectiveness and appropriate posture. Additional systematic reviews and studies have reported varied estimates of dysphagia prevalence in the following: drooling and poor oral management of secretions and/or bolus; ineffective chewing, in consideration of the individual variability in mastication cycles and time (Shiga et al., 2012); food or liquid remaining in the oral cavity after the swallow (oral residue); inability to maintain lip closure, leading to food and/or liquids leaking from the oral cavity (anterior loss of bolus); food and/or liquids leaking from the nasal cavity (nasopharyngeal regurgitation); complaints of food sticking or complaints of a fullness in the neck (globus sensation); complaints of pain when swallowing (odynophagia); changes in vocal quality (e.g., wet or gurgly sounding voice) during or after eating or drinking; coughing or throat clearing during or after eating or drinking; difficulty coordinating breathing and swallowing; acute or recurring aspiration pneumonia/respiratory infection and/or fever (Bock et al., 2017; DiBardino & Wunderink, 2015; Marik, 2010); changes in eating habits, for example, avoidance of certain foods/drinks (Sura et al., 2012); weight loss, malnutrition, or dehydration from not being able to eat enough (Saito et al., 2017; Via & Mechanick, 2013); and, complaints of discomfort related to suspected esophageal dysphagia (e.g., globus sensation, regurgitation). Stroke, 36(12), 27562763. 6. One model for ethical decision making includes consideration of the following (Jonsen et al., 1992): Clinicians provide information regarding these considerations without factoring in their own personal beliefs. Dysphagia in amyotrophic lateral sclerosis: Prevalence and clinical findings. Treatment options should be selected on a case-by-case basis as there are many etiologies of dysphagia. Disfagia como nica manifestacin de miastenia gravis [Dysphagia as the sole manifestation of myasthenia gravis]. https://doi.org/10.1007/s00520-019-04920-z, Ra, J. Y., Hyun, J. K., Ko, K. R., & Lee, S. J. Please see ASHAs Dysphagia Evidence Map. Swallowing function after stroke: Prognosis and prognostic factors at 6 months. Scientific Reports,13(1), 2626. It is important to consider signs and symptoms of dysphagia in the context of other clinical indicators such as the etiology of the dysphagia and the overall health of the patient, rather than relying on a single sign or symptom. https://doi.org/10.1111/joor.12461. 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. (2003). https://doi.org/10.1682/JRRD.2008.08.0092, McCullough, G., Rosenbek, J., Wertz, R., McCoy, S., Mann, G., & McCullough, K. (2005). With this support, swallowing efficiency and function may be improved. Due to the interprofessional nature of dysphagia management, clinicians should be aware of multiple options for dysphagia intervention, including medical, surgical, and behavioral treatment. Archives of Physical Medicine and Rehabilitation, 82(12), 16611665. Other studies have such findings as follows: Not all signs and symptoms are seen in all types of dysphagia, and the evidence supporting the predictive value of these signs and symptoms is mixed. Dysphagia, 19(4), 266271. Seminars in Speech and Language, 33(3), 203216. Neurogastroenterology & Motility, 30(4), Article e13251. (1992). https://www.asha.org/policy/. See the Assessment section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. https://doi.org/10.1001/archinte.159.17.2058. https://doi.org/10.1044/leader.FTR3.08082003.4. https://doi.org/10.1136/bmj.295.6595.411, Granell, J., Garrido, L., Millas, T., & Gutierrez-Fonseca, R. (2012). https://doi.org/10.1001/archotol.133.6.564, Chadwick, D. D., & Jolliffe, J. typical and atypical parameters of structures and functions affecting swallowing; effects of swallowing impairments on the individuals capacity for, performance in, and participation in activities; and. Current Opinion in Otolaryngology & Head and Neck Surgery, 26(6), 382391. Determine with specificity the relative safety and efficiency of various bolus consistencies and volumes. A systematic review and meta-analysis of pneumonia associated with thin liquid vs. thickened liquid intake in patients who aspirate. radiation treatment protocols in head and neck cancer; psychosocial, environmental, and behavioral factors. Archives of OtolaryngologyHead & Neck Surgery, 131(9), 762770. Clinical presentation of swallowing difficulties. Only saliva swallow Food/Liquid swallow . https://doi.org/10.1002/hed.24713, Carnaby-Mann, G. D., & Crary, M. A. The purpose of a non-instrumental swallowing assessment is to determine the presence (or absence) of signs and symptoms of dysphagia, with consideration for factors such as fatigue during a meal, posture, positioning, and environmental conditions. Many facilities have an ethics consultation service that can help clinicians, patients, and families address challenges when an ethical issue arises. No contraindications for this technique; do not use with patients with generalized bilateral weakness. (2004). Investigation of compensatory postures with videofluoromanometry in dysphagia patients. During any screening process, the members of the patient care team may note proper posture and positioning for eating, as well as any potential sensory deficits that may affect swallowing. Validation of the 3-oz water swallow test for aspiration following stroke. Deglutition disorders as a consequence of head and neck cancer therapies: A systematic review and meta-analysis. Extend your lower jaw above your upper jaw (like a bull dog). Swallow hard. Prevalence of dysphagia in multiple sclerosis and its related factors: Systematic review and meta-analysis. Using ethnographic interviewing strategies during the assessment process is an excellent way to gather information about an individuals specific needs (Westby et al., 2003). Patients may also require cuing and assistance to maintain an appropriate rate during meals. Dysphagia as the sole manifestation of myasthenia gravis. Evolution of tracheal aspiration in severe traumatic brain injury-related oropharyngeal dysphagia: 1-year longitudinal follow-up study. After swallowing, residual food and liquid in the mouth and throat are likely to overflow into the unprotected airway and cause what is known as aspiration. Clinical interventions in aging, 11, 189-208. Therapeutic exercises. The New England Journal of Medicine, 324(17), 11621167. Effortful swallowThe effortful swallow is known to increase orolingual pressure (Fukuoka et al., 2013) increase pressure in the upper pharynx (Huckabee & Steele, 2006) and to improve tongue base retraction. Oropharyngeal dysphagia in older personsfrom pathophysiology to adequate intervention: A review and summary of an international expert meeting. Mold, J., Reed, L., Davis, A., Allen, M., Decktor, D., & Robinson, M. (1991). SLPs interpret and apply the results of imaging to dysphagia treatment plans and make recommendations and referrals as appropriate. Journal of Intellectual Disability Research, 53(1), 2943. Effortful Swallow Indications: Useful in treated head and neck cancer patients with reduced tongue strength, reduced laryngeal elevation, reduced pharyngeal contraction, reduced laryngeal vestibule closure, and cricopharyngeal dysmotility. Patients who exhibit residue in the valleculae after the swallow. OtolaryngologyHead and Neck Surgery, 160(6), 955964. https://doi.org/10.1007/s00455-015-9637-y, Bchet, S., Hill, F., Gilheaney, ., & Walshe, M. (2016). (2007). https://doi.org/10.1007/s00455-017-9863-6. Gender difference in masticatory performance in dentate adults. Swallow hard. Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities. The manometric examination revealed a markedly elevated resting peak UES pressure and greatly elevated pharyngeal pressures (approximately 250 mmHg). the Yale Swallow Protocol (Suiter et al., 2014). Swallow while keeping your tongue gently between your teeth. Alternative feeding does not preclude the need for rehabilitative techniques to facilitate sensory and motor capabilities necessary for oral feeding. Each year, approximately one in 25 adults will experience a swallowing problem in the United States (Bhattacharyya, 2014). Thickening agents used for dysphagia management: Effect on bioavailability of water, medication and feelings of satiety. Verification of aspiration and thorough assessment of impairments in swallowing physiology or laryngeal/pharyngeal/upper esophageal anatomy require instrumental assessment. The prevalence of dysphagia in community-dwelling adults over the age of 50 years is estimated to be somewhere between 15% and 22% (Aslam & Vaezi, 2013; Barczi et al., 2000), and in skilled nursing facilities, the prevalence rises to over 60% (Steele et al., 1997; Suiter & Gosa, 2019). Acta Neurologica Scandinavica, 128(6), 397401. Plonk, W. M. (2005). Some maneuvers require following multistep directions and may not be appropriate for patients with cognitive impairments. Directions 1. American Journal of Speech-Language Pathology, 25(4), 453469. Gastroenterology & Hepatology, 9(12), 784795. Dysphagia management in acute and sub-acute stroke. AGA technical review on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Assessment and treatment of swallowing and swallowing disorders includes consideration of infection control and personal protective equipment (PPE) as necessary. For further information see ASHAs resource on Aerosol Generating Procedures. The number of repetitions is patient specific. For example, patients with sufficient cognitive skills can be taught to interpret the visual information provided by these assessments (e.g., surface electromyography, ultrasound, flexible endoscopic evaluation of swallowing [FEES], manometry, Iowa Oral Performance Instrument [IOPI], or mirror) and to make physiological changes during the swallowing process.
effortful swallow contraindications
effortful swallow contraindications
effortful swallow contraindications