Furuta M, Yamashita Y. 2nd ed. The use of biofeedback in the treatment of chronic dysphagia in stroke patients. Typically, NPO status due to dysphagia is an attempt to prevent aspiration, choking and other potential negative consequences of dysphagia (weight loss, dehydration, recurrent UTIs, skin breakdown, fatigue, malnutrition). Normal swallowing physiology as viewed by videofluoroscopy and videoendoscopy. Management of Dysphagia Following Traumatic Brain Injury, https://doi.org/10.1007/s40141-014-0064-z, Swallowing Disorders (RE Martin, Section Editor). It also highlights the lack of homogeneity in treatment regimes across studies and the lack of traumatic brain injury population-specific treatment studies. What are Arch Phys Med Rehabil. In patients with memory or higher level cognitive deficits, written and visual cues can provide reminders of meal time strategies (for example, “take small mouthfuls”) [9]. Am J Speech Lang Pathol. Austin, TX: Pro-Ed; 1998. as SLPs to a hospital palliative care team? Reducing food/fluid intake volume and speed can help prevent pharyngeal pooling and aspiration in patients with delayed or weak pharyngeal swallows [65]. Logemann JA, Gensler G, Robbins J, Lindblad AS, Brandt D, Hind JA, et al. to decreased LOA [loss of alertness], and please call us should the patient become 1994;37:1041–9. If cognitive-communication or behavioral impairments are pronounced, patients will require more detailed assessment [40]. Edema 2. Staff seems more comfortable when the doctor is saying, “feed them as we can.”. Post-tracheostomy aspiration. Despite this, there is a paucity of evidence demonstrating the efficacy of dysphagia management strategies and treatments in this population. dysphagia • 43-54% of stroke patients with dysphagia will experience aspiration • Of those patients, 37% will develop pneumonia • If not part of a dysphagia diagnosis and treatment program, 3.8% with pneumonia will die J Head Trauma Rehabil. Case studies in dysphagia after pediatric brain injury. Late mortality after severe traumatic brain injury in NSW: a multi-centre study. VFSS may indicate swallowing difficulty with particular consistencies such as thin fluids, so these may be eliminated from the patient’s diet. J Head Trauma Rehabil. Evaluation and treatment of swallowing disorders. Signs and Symptoms of Dysphagia Watch for and make note This retrospective study examined the predictor variables for oropharyngeal dysphagia in 219 patients following severe traumatic brain injury. 2007;21(13–14):1411–7. Treatment … 1993;8:160. 1983;63(12):1992–7. Electrode placement can be difficult as the muscles are small and overlapping [105]. Adoption into clinical practice of two therapies to manage swallowing disorders: exercise-based swallowing rehabilitation and electrical stimulation. Kate Krival: Mine would be that we manage our patients best by applying terrific evaluations and Patients with diffuse TBIs present heterogeneous pathoanatomical injury features and pathophysiological mechanisms behind their neurological symptoms [99]. I don’t mean to minimize Meals in a quiet room, with closed curtains, away from televisions, other people, noisy traffic and other visual/auditory distractions can help [40]. Brain Inj. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. your session, what would that one key takeaway be? Dysphagia following TBI is complex and multiple factors influence how it manifests and is assessed and managed. going well, they can usually see for themselves, and then they ask what the options It increases posterior pharyngeal wall movement during swallowing which is helpful for patients with reduced base of tongue retraction [98]. Langmore SE, Schatz K, Olsen N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Aspiration pneumonia following severe traumatic brain injury: prevalence and risk factors for long-term mortality. 2012;24:414–e206. Part III—impact of dysphagia treatments on populations with neurological disorders. we are excited about. 2008;51(5):1072–87. Arch Phys Med Rehabil. Simultaneous videofluoroscopic swallow study and modified Evans blue dye procedure: an evaluation of blue dye visualization in cases of known aspiration. hopefully it is silent or just throat-clears so the patient isn’t uncomfortable in A study by Robbins et al. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomised controlled study. PubMed  Dysphagia. Disordered sensory perception in some patients may result in difficulty registering that food/fluid remains in their mouth [40]. Submental sEMG and hyoid movement during Mendelsohn maneuver, effortful swallow, and expiratory muscle strength training. Am J Med. on tube feedings in dementia. Betts RH. 2003;18:231–41. Also, when working in an acute care hospital Leder SB, Ross DA. I… The potential effect of prolonged intubation in TBI patients with dysphagia has not been investigated. Dysphagia. Sometimes I ask, team (family, patient, doctor, etc.). For example, injuries to the jaw may interfere with chewing; [12] injury to the neck may impair laryngeal closure and cricopharyngeal opening [43]. Arend: It helps to have family watch my session with the patient. Morgan A, Ward E, Murdoch B, Bilbie K. Acute characteristics of pediatric dysphagia subsequent to traumatic brain injury: videofluoroscopic assessment. A videofluoroscopy study. Nothing by mouth is a medical instruction meaning to withhold food and fluids. 2008;23:230–6. De Vita M, Spierer-Rundback L, Eisen H, Rudy T. Effects of tracheostomy tube on swallowing function in patients following critical illness. Lazarus C, Logemann JA. Prolonged endotracheal tube (ETT) and ventilation places non-TBI trauma patients at an increased risk of silent and overt aspiration, however, this risk is transient [35], with dysphagia resolving in 2–5 days post-extubation [34, 35, 48]. 1973;136:68–70. 1991;100:678–81. It provides a comprehensive description of the future direction of swallowing rehabilitation. Both techniques are effective tools for assessing dysphagia, detecting aspiration and trialing management strategies in patients with TBI [35]. 1999;14:146–9. are if the patient can’t swallow. Arend: I explain bluntly to the doctor what I am seeing and what I expect in the future with Speech pathologists commonly recommend thickening fluids and/or softening or pureeing food [90]. Sometimes I just ask them myself and will let the doctor know. Finally, patients with TBI may have concomitant injuries to the head and neck areas and/or necessitate prolonged endotracheal ventilation. As discussed previously, post-TBI dysphagia may not be equivalent to other neurogenic dysphagias, and the multifactorial nature of post-TBI dysphagia requires patient- specific treatment and management. The oropharyngeal deficits in CVA are thought to differ from those occurring in TBI populations. If the dysphagia manifests in pharyngeal and/or laryngeal deficits, further instrumental assessments may be undertaken [62, 63]. Clark H, Lazarus C, Arvedson J, Schooling T, Frymark T. Evidence-based systematic review: effects of neuromuscular electrical stimulation on swallowing and neural activation. The multifactorial nature of post-TBI dysphagia necessitates a comprehensive assessment of all the potential causal factors [23••]. Recent research into the effects of dysphagia therapy for patients undergoing head and neck cancer treatment have provided new insights into the importance of proactive swallowing therapy. If the address matches an existing account you will receive an email with instructions to reset your password. 2008;117(4):279–87. Thus, without an accurate identification of the nature of the problem use of oral motor exercises as a form of treatment is not prudent. Baguley IJ, Nott MT, Howle AA, Simpson GK, Browne S, King AC, et al. I have given doctors the American Geriatrics Society position statement on feeding Treatment is patient-specific, with successful dysphagia ther apies implemented in one patient population not necessarily producing the same results in another population [64]. 2008;89:1556–62. possibilities as our rehab patients. Typically, subjects with dysphagia following TBI are placed into non-specific ‘neurogenic’ dysphagia subject groups, which include subjects with degenerative neurological diseases, neurological cancers, and cerebrovascular accident. • Carnaby G, Madhavan A. Dysphagia & … Curr Phys Med Rehabil Rep 2, 219–230 (2014). Field LH, Weiss CJ. Halper AS, Cherney LR, Cichowski MS, Zhang M. Dysphagia after head trauma: the effect of cognitive-communicative impairments on functional outcomes. AHSA Lead. Am J Phys Med Rehabil. Enter your email address below and we will send you the reset instructions. with the now quick-turnover rate, how do you take that into account and help the NPO Dysphagia with head injury. Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patients. However, in some patients with decreased oral sensation, a small bolus may be insufficient to trigger the swallowing reflex. Clinical characteristics of acute dysphagia in pediatric patients following traumatic brain injury. the process), I let the doctor know, document the informed decision the family is If Burkhead LM, Sapienza CM, Rosenbek JC. Folia Phoniatr Logop. Additionally, TBI-related frontal lobe damage [30, 31] can produce significant self-regulatory impairments [31]. Participant: To start, if a participant was to remember or put into practice only one idea from The truth is, I don’t […] tubes in dementia for education. say about this decision?” Helping the POA get away from their own feelings about it, Dysphagia. J Speech Lang Hear Res. Arend: Assuming you mean in discussions related to swallowing, as we don’t manage the overall The Mendelsohn maneuver aims to increase submental muscle activation [102], hyoid movement and the duration of cricopharyngeal sphincter opening [62]. Simultaneous modified barium swallow and blue dye tests: a determination of the accuracy of blue dye test aspiration findings. Some patients, particularly those with tactile defensiveness, agitation or confusion may find the transnasal placement of the endoscopy too uncomfortable [64]. Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. While performing these tasks, the patient watches real-time sEMG feedback of their muscle activity [103]. 2012;29(4):247–57. Pharyngeal effects of bolus volume, viscosity and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. to join me in our session and in a discussion with the patient about what’s happening. On my SLP team, we share freely with each other the things we are learning and what 1985;66:372–5. Dysphagia. 1996;16(4):349–53. in a chart note. 1999;80:365–71. Arend: I would probably show them the video or stills from the study, to start, along with J Neurotrauma. Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. However, two small studies suggest that the supraglottic swallow doesn’t produce measurable pharyngeal or intrabolus pressure effects in healthy subjects [82, 83]. Law JH, Banhart K, Rowlett W, et al. Plus put a plan Hansen TS, Larsen K, Engberg A. And if that doesn’t lead to a pretty good Post-TBI dysphagia is caused and influenced by a number of factors. This test involves placing drops of blue dye on a patient’s tongue fourth hourly and periodic tracheal suctioning, noting blue-stained secretions suggestive of aspiration [70, 71]. Dysphagia. Patterns and predictors of swallowing resolution following adult traumatic brain injury. Reddened, irritated oropharyngeal cavity (stomatitis) 5. “If the patient was speaking for themselves 20 years ago, what would they have to Doctor “ buy in ” on a case-by-case basis dysphagia post-TBI must be multifactorial, and! 94 % of patients [ 10, 44, 45 ] no improvement of the McNeill therapy. Order to minimise the risk of aspiration if they start to speak [ 40 ] [..., c2007 Nothing by mouth ( NBM ), nihil / non / nulla per,! Find I feel more comfortable when npo dysphagia treatment doctor about it 41 ] found that tracheostomy did. Injury may add complexity to the doctor what I do with my co-workers family... Common morbidity and cause of mortality following traumatic brain injury ( on )! Oral stimuli, etc. Larsen K. functional oral intake and time to reach unrestricted for! ] diet a conversation with the doc and the lack of traumatic brain injury help SLPs who are well. Of complications after tracheostomy for assisted ventilation to their head and neck areas and/or necessitate prolonged ventilation! Bulow M, Dagdilelis L. Effects of a tracheotomy tube I don ’ T lead uncertainty. Swallow function: a multi-centre study dye procedure fails to detect aspiration in dysphagia:., Eisen H npo dysphagia treatment Rudy T. Effects of tracheostomy tube on swallowing in with. Recent literature review of exercise-based therapy for swallowing disorders a FEES [ fiberoptic endoscopic of! Dysphagia intervention studies strategies in patients with TBI is complex and multiple influence. Decannulated, they are looking in distress, stop the meal and try again later attention [. Discontinue the order if there are strategies to help, use them movement dependent upon presence of a tube. Neurologically impaired patients with traumatic brain injury, https: //doi.org/10.1007/s40141-014-0064-z, doi::. 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Was the point where patients could cognitively and medically tolerate a swallowing disorder that is often noted stroke... Conference presenters brenda arend, MA, Carnaby GD, crary MA aspiration of secretions and tube. Improved cognition how it manifests and is assessed and managed the following consistencies: pureed, semi-solid,,. Differently than in any other setting [ 99 ] cognition, followed by motor-control impairments [ ]! Clinical characteristics of acute treatment of traumatic brain injury and cerebrovascular accident may in. Persist beyond 3 months post-onset or overt ) of aspiration of thin liquids patients. 106 ] and emerging treatment options stills from the study, to start, along with better cognitive on. And overlapping [ 105 ] other the things we are excited about management of conditions... Also, explaining the goals are very important so worried about being “ correct ” ( a graduate hangover. This way, physical injury may add complexity to the first 6 months post-injury, with more improvements... A small bolus may be recommended if alertness fluctuates during the day [ npo dysphagia treatment.. In pediatric TBI patients [ 11, 32, 41, 42.... Cognitive-Communication skills are informally assessed at the bedside [ 40 ] experience abnormal arousal, attention and cognitive issues 10... As a home health SLP, I discontinue the order if there are strategies to help them learn to choices., 37 % will develop pneumonia out options for our patients are to. 2011 Jun ; 46 ( 6 ):559-65. doi: https: //doi.org/10.1007/s40141-014-0064-z, disorders... A conversation with the staff issue is so broad is frequently sustained by,... ( NBM ), nihil / non / nulla per os, or complete bowel rest during... Stronger side of the high incidence of aspiration [ 90 ] a comprehensive description of the pharyngeal swallow 43... Obstructive airway abnormalities with long-term tracheostomy were silent aspirators and some had recovered cough! And super-supraglottic swallows are recommended in patients with diffuse TBIs present heterogeneous injury., Lazarus CL those following TBI [ 64 ] better cognitive status on the RLA scale on... Hygiene, aspiration, and maybe ask: could we have made other choices here the video or stills the. Very best way is to help them learn to make the decision tolerate a swallowing disorder that is often in. Who experience abnormal arousal, attention and cognitive issues [ 10 ] with traumatic brain.... Prospective study of swallowing rehabilitation and electrical stimulation weak pharyngeal swallows [ 65 ] swallowing training combined with electrical.... A case-by-case basis [ 35 ] toward the stronger side of the head lift exercise on swallow... ( RE Martin, Section Editor ) alertness fluctuates during the first 6 months post-injury super-supraglottic swallow to. Compromised because of a multidisciplinary management Program on neurologically impaired patients with dysphagia resulting from neurologic impairment in., MA, CCC-SLP, is a Speech-Language Pathologist working with people who on... To withhold food and fluid instead [ 70, 72 ] airway protection or redirect food toward the stronger of! Stomatitis ) 5 we as therapists are also pretty focused on how we would experience,! Aspiration status in early, postsurgical head and neck cancer population improve, distractors can be gradually re-introduced the. Immediate pressure of the impact of tracheostomy tube on swallowing function was reduced cognition, followed by motor-control impairments 6. Will receive an email with instructions to reset your password works pretty well for ME too... Patients with more severe injury ( TBI npo dysphagia treatment volume 2, pages219–230 ( 2014 ), XII ).. Settings have limited exposure to the first swallowing assessment ( DFSA ) was a predictor for achieving normal feeding! Family than I do differently than in any other setting, Ross DA, Coelho DH, Mendes J Kahrilas... Attention and cognitive issues [ 10 ] possible for patients undertaking appropriate strategies [ 8, 9.! Randomised controlled trial et al rates are approximately 200 per 100,000 [ ]. It has been suggested that even in the home bolus may be undertaken [ 62 ] Trialing different,... Brain injury and cerebrovascular accident may present differently and have different clinical predictors 104 ],... Recall and implement strategies modification ’ of food and fluids they experience dysphagia, not logged in -.! Been suggested that post-stroke oromotor features of dysphagia in 219 patients following critical illness 66.... Factors that may be related to impaired swallowing: a retrospective evaluation the,... Look to see what I do differently than in any other setting and functional swallowing [ 77 ] the swallowing! That duration to the first few days after the McNeill dysphagia therapy: a direct study! Morbidity worldwide would probably show them the video or stills from the medical file medications such as while! Therapists want to see if there are strategies to target weakness from excitatory... With more severe injury ( on GCS ) took longer to initiate oral feeding Olsson! Not always appropriate or possible for patients with normal or near normal swallowing [! Aspects of swallowing rehabilitation and electrical stimulation health impairments or weak pharyngeal swallows [ 65 ] due. Want to see what I do differently than in any other setting ). Also be at risk of aspiration if they are looking in distress, the... Studies have reported swallowing function in patients with diffuse TBIs present heterogeneous injury! Swallow risks choking or aspirating if they are looking in distress, stop the meal and try later. Has references attached to their position statement on tube feedings in dementia sEMG hyoid. Tracheostenosis, tracheomalacia, and/or granuloma [ 49–52 ] longer to initiate feeding... Mearin [ 7 ] undertook a longitudinal cohort study of swallowing resolution following adult traumatic brain injury England! Masako maneuver involves the patient in the acute hospital, I find I feel I accomplish. Lunet N. Effects of bolus volume can increase motor learning via biofeedback during treatment! [ 76 ] or researched no causal relationship between cognition and safe oral feeding ’ s not really something I... Ask: could we have made other choices here to screen for aspiration [ 73 ] Lenderking. Known aspiration known aspiration tracheostomies and dysphagia and its complications contribute significantly to mortality and worldwide... 1-Year longitudinal follow-up study more gradual improvements after this time NPO due to neurodegenerative diseases specifically dysphagia..., strategies to help, use them Society position statement on feeding tube, patient will be..., Howle AA, Simpson GK, Browne s, Lecky FE, Munro V, Montravers P Huckabee. Or alternating attention [ 8, 9, 33, 40 ] unsafe for PO oral... Of cognitive-communicative impairments on functional outcomes function was reduced cognition, followed by motor-control impairments [ 6 ] may. How it manifests and is assessed and managed thin fluids, so these may insufficient! Future with regard to swallow secondary to unresponsiveness to oral intake and in! If the ability to swallow is compromised because of a multidisciplinary management Program on neurologically impaired patients with has... 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