effortful swallow contraindications

OtolaryngologyHead and Neck Surgery, 160(6), 955964. A descriptive investigation of dysphagia in adults with intellectual disabilities. https://doi.org/10.1007/s00455-013-9471-z, Fukuoka, T., Ono, T., Hori, K., Tamine, K., Nozaki, S., Shimada, K., Yamamoto, N., Fukuda, Y., & Domen, K. (2013). Kawashima, K., Motohashi, Y., & Fujishima, I. Inadequate fluid intakes in dysphagic acute stroke. Dysphagia cuts across so many diseases and age groups that its true prevalence in adult populations is not fully known and is often underestimated. Various neurological diseases are known to be associated with dysphagia. A systematic review by Martino et al. The prevalence of dysphagia among adults in the United States. SLPs also have expertise in communication disorders that may affect the diagnosis and management of swallowing disorders. Investigation of compensatory postures with videofluoromanometry in dysphagia patients. recurring pneumonia. SLPs may make recommendations for modifications of texture and viscosity and discuss their implications with other team members (e.g., dietary team, the patient). 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. Part IVImpact of dysphagia treatment on individuals postcancer treatments. https://doi.org/10.1097/CCM.0b013e31829caf33, Madanick, R. D. (2013). Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients (Evidence Report/Technology Assessment No. Zhou, D., Jafri, M., & Husain, I. Barriers to caregiver compliance with eating and drinking recommendations for adults with intellectual disabilities and dysphagia. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: Impact on quality of life. ), Normal and abnormal swallowing (pp. Prevalence of gastroesophageal reflux in elderly patients in a primary care setting. Examining the evidence on neuromuscular electrical stimulation for swallowing: A meta-analysis. (2001). Interprofessional practice (IPP) is critical to successfully achieving the desired improvements and outcomes due to complexities of assessment and treatment of swallowing disorders. Oropharyngeal function may be potentially affected in some patients with esophageal motility issues. Swallow hard. Oropharyngeal dysphagia in older personsfrom pathophysiology to adequate intervention: A review and summary of an international expert meeting. (2023). Effectiveness of chin-tuck maneuver to facilitate swallowing in neurologic dysphagia. Dysphagia, 12(1), 4350. Dosage primarily refers to the amount of treatment provided (e.g., the frequency, intensity, and duration of service). Archives of Physical Medicine and Rehabilitation, 88(2), 150158. Repeat this up to 10 times in a single session. Other instrumental procedures are used primarily in research at this time but may develop into clinical diagnostic tools. https://doi.org/10.1007/978-0-387-22434-3_13. Consent, refusal, and waivers in patient-centered dysphagia care: Using law, ethics, and evidence to guide clinical practice. Impact of the modified consistency/viscosity on the individuals swallowing physiology. Super-supraglottic swallow in irradiated head and neck cancer patients. In these instances, team members consider whether the individual will need the alternative source for a short or an extended period of time. Archives of OtolaryngologyHead & Neck Surgery, 131(9), 762770. The Laryngoscope, 127(Suppl. In clinical settings, SLPs typically use one of two types of instrumental evaluation: the videofluoroscopic swallowing study (VFSS) or the flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing. Keep your shoulders flat. https://doi.org/10.1016/j.clnu.2007.08.006, Gonzlez-Fernndez, M., & Daniels, S. K. (2008). https://doi.org/10.1007/s00455-013-9464-y. Miles, A., McFarlane, M., Scott, S., & Hunting, A. Knowledge, skills, and clinical experience related to the evaluation and management of individuals with swallowing and swallowing problems may be acquired on the graduate or postgraduate level, in formal coursework, and/or via continuing education. The natural history and functional consequences of dysphagia after hemispheric stroke. It is valuable to first discuss how the neuroplasticity prin-ciples apply to each. Ongoing assessment can also include evaluation of changes in patients swallow function as a result of intervention, including diet modification, while implementing a plan of care. The intent of many exercises is to provide lasting functional improvement. description of the characteristics of suspected swallowing status, recommendations to support oral and non-oral nutrition and hydration identification of the need for intervention and support, recommendations for intervention and support, prognosis for improvement or maintenance of function and identification of relevant factors, referral for other services or professionals, counseling, education, and training to the patient, health care providers, and caregivers. Prevalence of oropharyngeal dysphagia in Parkinsons disease: A meta-analysis. Annals of Otology, Rhinology & Laryngology, 124(5), 351354. Zhao, W. T., Yang, M., Wu, H. M., Yang, L., Zhang, X. M., & Huang, Y. Treatment options for patients with dysphagia are selected on the basis of evidence-based practice, which includes a combination of the best available internal and external evidence. The Synchrony Dysphagia Solutions by ACP combines sEMG with a virtual environment to engage patients in fun, interactive swallowing and speech exercises. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. polymyositis and dermatomyositis (Gonzlez-Fernndez & Daniels, 2008). Evaluation and management of oropharyngeal dysphagia in different types of dementia: A systematic review. An analysis of lingual contribution to submental surface electromyographic measures and pharyngeal pressure during effortful swallow. Internal and external evidence may come from. Archer, S. K., Smith, C. H., & Newham, D. J. (2001). Dysphagia, 18:284-292. (1991). Journal of Neurology, Neurosurgery & Psychiatry, 52(2), 236241. assessment of respiratory status, cough, and throat clearing abilities. Patients who exhibit residue in the valleculae after the swallow. SLPs have knowledge of the anatomy, physiology, and functional aspects of the upper aerodigestive tract as they relate to swallowing and speech. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.01.009, Flowers, H. L., Silver, F. L., Fang, J., Rochon, E., & Martino, R. (2013). A. A report by the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) estimates that approximately one third of patients with dysphagia develop pneumonia and that 60,000 individuals die each year from such complications (Agency for Health Care Policy and Research, 1999). (2009) found that dysphagia occurs in over one third of patients admitted to stroke rehabilitation units. (2013). Assessment across the life span: The clinical swallow evaluation. 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. American Journal of Speech-Language Pathology, 18(4), 361375. Management of individuals with dysphagia should be based on results of comprehensive assessment, including both instrumental and non-instrumental assessments as applicable. Ask the client to: 1. This study examined how high-effort sips from small-diameter straws influenced linguapalatal swallow pressures. Gather saliva in your mouth or take a sip of water. Journal of Speech, Language, and Hearing Research, 48(6), 12801293. Validation of the 3-oz water swallow test for aspiration following stroke. Evolution of tracheal aspiration in severe traumatic brain injury-related oropharyngeal dysphagia: 1-year longitudinal follow-up study. https://doi.org/10.1592/phco.19.11.974.31575, Terr, R., & Mearin, F. (2009). A review of medical/clinical records, including the potential impact of medications and treatment of other medical diagnoses such as. Ultrasonography in assessing oropharyngeal dysphagia. (2016). Cichero, J. https://doi.org/10.1016/j.parkreldis.2011.11.006. Roden, D. F., & Altman, K. W. (2013). Iranian Journal of Neurology, 17(4), 180188. Journal of Neurogastroenterology and Motility, 20(1), 7986. Aspiration pneumonia: A review of modern trends. support adequate nutrition and hydration and return to oral intake (including incorporating the patients dietary preferences and consulting with family members/caregivers to ensure that the patients daily living activities are being considered); determine the optimum supports (e.g., posture, or assistance) to reduce patient and caregiver burden while maximizing the patients quality of life; and. https://doi.org/10.1111/ane.12136, Saconato, M., Chiari, B. M., Lederman, H. M., & Gonalves, M. I. Dysphagia in multiple sclerosisPrevalence and prognostic factors. https://doi.org/10.1007/s00455-017-9855-6, Serra-Prat, M., Hinojosa, G., Lpez, D., Juan, M., Fabr, E., Voss, D. S., Calvo, M., Marta, V., Rib, L., Palomera, E., Arreola, V., & Clav, P. (2011). Percutaneous endoscopic gastrostomy (PEG) tubes may not be appropriate in all populations and may not necessarily improve outcomes or quality of life (Ayman et al., 2016; Plonk, 2005). https://doi.org/10.1111/j.1468-3148.2005.00250.x, Cheney, D., Siddigui, M., Litts, J., Kuhn, M., & Belafsky, P. (2015). The effortful swallow was designed as a compensatory strategy to improve BOT retraction and thereby decrease vallecular residue [13, 76], . See the Treatment section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. INSTRUCTIONS https://doi.org/10.1007/BF02414429, Langmore, S. E., & Pisegna, J. M. (2015). B., Yoo, S. J., Chang, M. Y., Lee, S. W., & Park, J. S. (2017). 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). Logemann, J. Dysphagia, 30(5), 558564. specifying diagnostic questions to be answered by instrumental evaluations. In conclusion, the EFS manoeuver facilitates vertical speed and distance of hyolaryngeal excursion and epiglottic tilt and extends the duration of excursion and the epiglottic tilt, especially after reaching maximal . https://doi.org/10.3748/wjg.v18.i23.2973, Sonies, B. C., Chi-Fishman, G., & Miller, J. L. (2003). https://doi.org/10.1007/s00455-014-9551-8, Riquelme, L. F. (2004). American Journal of Speech-Language Pathology, 25(4), 453469. Dysphagia, 16(3), 190195. 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). https://doi.org/10.1136/jnnp.52.2.236, Barikroo, A., Carnaby, G., & Crary, M. (2015). SLPs use instrumental techniques to evaluate oral, pharyngeal, laryngeal, upper esophageal, and respiratory function as they apply to normal and abnormal swallowing. Dysphagia, 33(2), 173184. Effortful Swallow . Dysphagia, 31(3), 424433. Implementation of a free water protocol at a long term acute care hospital. Deglutition disorders as a consequence of head and neck cancer therapies: A systematic review and meta-analysis. (2019). Some factors to consider while evaluating diet texture modifications for patients with dysphagia include: Despite the risk of aspiration, alternatives to liquid consistency modifications may support overall health of persons with dysphagia when pristine oral health can be maintained (e.g., Frazier Free Water Protocol; Gaidos et al., 2023; Kaneoka et al., 2017; Murray et al., 2016). With this support, swallowing efficiency and function may be improved. Monitoring the presence of the signs and symptoms of oropharyngeal and/or esophageal swallowing dysfunction. Effects of cuff deflation and one way speaking valve placement on swallow physiology. Diver - Effortful Swallow & Tongue Against Resistance. Patients may benefit from the use of adaptive equipment or environmental modifications to more effectively manage the bolus (Granell et al., 2012). Relative contraindications for PEG are aspiration pneumonia due to gastroesophageal reflux, significant ascites, and morbid obesity. https://doi.org/10.1002/lary.26854, Brodsky, M. B., Huang, M., Shanholtz, C., Mendez-Tellez, P. A., Palmer, J. The ability of the 10-item Eating Assessment Tool (EAT-10) to predict aspiration risk in persons with dysphagia. Objective data highlights progress for patients and therapists to see while also guiding treatment plans. Dysphagia management in acute and sub-acute stroke. International Classification of Functioning, Disability and Health. Physical Medicine and Rehabilitation Clinics of North America, 19(4), 867888. A. Assessment and treatment of swallowing and swallowing disorders includes consideration of infection control and personal protective equipment (PPE) as necessary. 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. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Adult Dysphagia page: The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association. You do not have JavaScript Enabled on this browser. (2007). https://doi.org/10.1002/(SICI)1097-0347(199709)19:6<535::AID-HED11>3.0.CO;2-4, Macht, M., Wimbish, T., Bodine, C., & Moss, M. (2013). (2009). Agency for Health Care Policy and Research. Swallow as hard as you can. Dysphagia, 28(4), 539547. See the Service Delivery section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Modifications to diet texture may include changing the viscosity of liquids and/or altering the texture of solid foods using standardized criteria (e.g., International Dysphagia Diet Standardisation Initiative [IDDSI]). Disfagia como nica manifestacin de miastenia gravis [Dysphagia as the sole manifestation of myasthenia gravis]. Clinical Neurology & Neurosurgery, 104(4), 345351. 1997- American Speech-Language-Hearing Association. Effortful Swallow Purpose: Improve the contact and coordination between the different muscles used while swallowing. Efficacy of exercises to rehabilitate dysphagia: A critique of the literature. Steadman, K. J., Weng, M. T., Malouh, M. A., Symons, K., & Cichero, J. Instrumental procedures are also used to determine appropriateness and effectiveness of treatment strategies. When considering end-of-life issues, it is important for clinicians to respect the patients wishes, including social and cultural considerations. https://doi.org/10.1007/BF02493526, Via, M. A., & Mechanick, J. I. American Journal of Speech-Language Pathology, 29(2S), 919933. Effortful Swallow ACTIVITY: SWALLOW WITH AS MUCH EFFORT AS POSSIBLE. Bend your head forward so that your chin tucks. Maintenance and/or maximization of an individuals health status is a primary concern. Consistent with the World Health Organizations (2001) International Classification of Functioning, Disability and Health framework, the purpose of assessment is to identify and describe. It is important to note that, currently, no bedside screening protocol has been shown to provide adequate predictive value for the presence of aspiration. Plonk, W. M. (2005). https://doi.org/10.1044/sasd11.1.9, Fujiu-Kurachi, M., Fujiwara, S., Tamine, K., Kondo, J., Minagi, Y., Maeda, Y., Hori, K., & Ono, T. (2014). 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). Screening identifies the need for further assessment and may be completed prior to a comprehensive evaluation. Dysphagia, 6(4), 187192. Lupus, 11(5), 322324. Archives of Internal Medicine, 159(17), 20582064. Other studies suggest that dysphagia occurs in 29%64% of stroke patients (Barer, 1989; Flowers et al., 2013; Gordon et al., 1987; Mann et al., 1999). Journal of Rehabilitation Research & Development, 46(2), 205214. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740808/, Mann, G., Hankey, G., & Cameron, D. (1999). Many facilities have an ethics consultation service that can help clinicians, patients, and families address challenges when an ethical issue arises. https://doi.org/10.7224/1537-2073-2.1.40, Barczi, S. R., Sullivan, P. A., & Robbins, J. Code of ethics [Ethics]. https://doi.org/10.1044/1058-0360(2011/10-0067), Donzelli, J., & Brady, S. (2004). Recovery from dysphagia symptoms after oral endotracheal intubation in acute respiratory distress syndrome survivors. (1989). Different management approaches may be necessary for individuals with dysphagia that has resulted from an acute event, a chronic/stable condition, or a progressive neurological disorder. https://doi.org/10.1055/s-2000-8387, Barer, D. (1989). Ayman, A. R., Khoury, T., Cohen, J., Chen S., Yaari, S., Daher, S., Benson, A. Swallowing is a sub maximal event as a whole, but when the patient focuses and purposefully uses a more effortful swallow, there is an increase in the muscle contraction of the entire swallowing mechanism. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. PEG insertion in patients with dementia does not improve nutritional status and has worse outcomes as compared with PEG insertion for other indications. https://doi.org/10.1007/s00455-016-9737-3, Bhattacharyya, N. (2014). Thickening agents used for dysphagia management: Effect on bioavailability of water, medication and feelings of satiety. Neck Exercises Neck Stretch: Extend your chin up towards the ceiling. Preferred practice patterns for the profession of speech-language pathology [Preferred practice patterns]. Decision making must take into account many factors about each individuals overall status and prognosis. Patients may also require further assessment or reassessment depending on changes in functional or medical status. 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).

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