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1、AConversationonManagementofDysphagia ASupplementaryTrainingModuleforSwallowingScreeningTeamsbasedonthebooklettitled ManagementofDysphagiaInAcuteStroke AnEducationalManualfortheDysphagiaScreeningProfessional Acknowledgements RosemaryMartino MA MSc PhDAssociateProfessor UniversityofTorontoDoneldaMoscr
2、ip MScRegionalStrokeRehabilitationCoordinatorCentralEastStrokeNetworkAlaneWitt Lajeunesse MS MScDysphagiaEducator CoordinatorChinookRehabilitationProgramPatriciaKnutson MASpeechLanguagePathologist HuronPerthHealthcareAlliance TheHeartandStrokeFoundationofOntarioisgratefultothefollowingprofessionalsf
3、ortheirworkindevelopingthisCD BeckyFrench MScSpeechLanguagePathologist SouthlakeRegionalHealthCentreAudreyBrown MScSpeechLanguagePathologist ProvidenceCare St Mary softheLakeHospitalLauraMacIsaac BScN MScStrokeSpecialistCaseManagerStrokeStrategySoutheasternOntarioAnnaMascitelli MASpeechLanguagePatho
4、logist NiagaraHealthSystem Agenda DysphagiaandStrokeCareBestPracticeGuidelinesforManagingDysphagiaSwallowing Anatomy Physiology PathophysiologyClinicalApproachtoDysphagiaCaseStudies Source Heart StrokeFoundation 2006 ManagementofDysphagiainAcuteStroke AnEducationalManualfortheDysphagiaScreeningProfe
5、ssional 18 BestPracticeGuidelinesforManagingDysphagia MaintainallacutestrokesurvivorsNPOuntilswallowingabilityhasbeendetermined Screenallstrokesurvivorsforswallowingdifficultiesassoonastheyareawakeandalert Screenallstrokesurvivorsforriskfactorsforpoornutritionalstatuswithin48hoursofadmission BestPra
6、cticeGuidelinesforManagingDysphagia Assesstheswallowingabilityofallstrokesurvivorswhofailtheswallowingscreening Providefeedingassistanceormealtimesupervisiontoallstrokesurvivorswhopassthescreening Assessthenutritionandhydrationstatusofallstrokesurvivorswhofailthescreening BestPracticeGuidelinesforMa
7、nagingDysphagia Reassessallstrokesurvivorsreceivingmodifiedtexturedietsorenteralfeedingforalterationsinswallowingstatusregularly Explainthenatureofthedysphagiaandrecommendationsformanagement follow upandreassessmentupondischargetoallstrokesurvivors familymembersandcareproviders BestPracticeGuideline
8、sforManagingDysphagia Providethestrokesurvivororsubstitutedecisionmakerwithsufficientinformationtoallowinformeddecisionmakingaboutnutritionaloptions AnatomyandPhysiologyofSwallowing Source Heart StrokeFoundation 2006 Managementofdysphagiainacutestroke aneducationalmanualforthedysphagiascreeningprofe
9、ssional p 8 4StagesofSwallowing OralPreparatoryStage Source Heart StrokeFoundation 2002 ImprovingRecognitionandManagementofDysphagiainAcuteStroke aVisionforOntario p 9 4StagesofSwallowing OralPropulsiveStage Source Heart StrokeFoundation 2002 ImprovingRecognitionandManagementofDysphagiainAcuteStroke
10、 aVisionforOntairo p 9 4StagesofSwallowing 3 PharyngealStage Source Heart StrokeFoundation 2002 ImprovingRecognitionandManagementofDysphagiainAcuteStroke aVisionforOntairo p 9 4StagesofSwallowing 4 EsophagealStage Source Heart StrokeFoundation 2002 ImprovingRecognitionandManagementofDysphagiainAcute
11、Stroke aVisionforOntairo p 9 NormalSwallowingChangesintheElderly NormalChangesReductioninmuscletoneLossofelasticityofconnectivetissueDecreasedsalivaproductionChangesinsensoryfunctionDecreasedsensitivityofmucosaHealthyelderlyindividualscancompensateCompoundedbyfatigueorweaknessfromdiseaseprocesses e
12、g stroke leadingtodysphagia WhatisDysphagia DifficultyordiscomfortinswallowingCanoccurwithanymotor sensoryorstructuralchangestotheswallowingmechanismDysphagiaaffectsaperson sabilitytoeatordrinksafely TypesofDysphagia OralDysphagiaPharyngealDysphagiaEsophagealDysphagia ComplicationsofDysphagia Health
13、Issues AspirationpneumoniaMalnutritionDehydrationMortalityHealthCareCosts LengthofStayIncreasedworkloadforstaff DysphagiaRiskFactors StrokelocationCerebralhemisphereBrainstemComorbidconditionsProgressiveNeurologicNeuromusculardisorderRespiratorydisorderSystemicdisorder MedicationsSideeffectsTardived
14、yskinesiaXerostomiaTracheotomyandVentilation InterdisciplinaryTeam Speech LanguagePathologistRegisteredDietitianPhysicianRegisteredNurse RegisteredPracticalNurseOccupationalTherapistPhysiotherapistPharmacistStrokeSurvivor FamilyandCareProviders DysphagiaScreeningTool Identifiespatientsatriskfordysph
15、agiaPass FailmeasureMustbeprovenreliableandvalidInitiatesearlyreferralforassessment managementortreatmentforthoseathigherrisk DysphagiaAssessment CompletedbySLPdysphagiaexpertDeterminesthestructure function anddegreeofimpairmentVarioustypesofassessment ClinicalBedsideInstrumentalDirectstreatmentplan
16、 NutritionScreeningandAssessment BestPracticeGuidelinesrecommend Nutritionscreeningwithin48hoursofadmissionThosewhofailarereferredtoanRDSeebookletfromHeart StrokeFoundationofOntario 2005 ManagementofDysphagiainAcuteStroke NutritionScreeningforStrokeSurvivors OngoingMonitoring ClinicalindicatorsofpossibledysphagiaPoordentitionDroolingAsymmetricfacialandlipweaknessChangesinvoiceDysarthria slurredspeechReducedtonguemovementCoughingorchokingPleaseseepage24ofmanualforcompletelist DysphagiaManagement
