Angela Mansolillo – Breathing, Digestion and Swallowing: Best Practices in Dysphagia Management

Outline

RESPIRATORY SYSTEMS: Breathing/swallowing coordination RESPIRATORY SYSTEMS: Breathing/swallowing coordination

• Overview of systems – anatomy/physiologyOverview of systems – anatomy/physiology
• Breathing/Swallow coordinationBreathing/Swallow coordination
• Coordination and aspirationCoordination and aspiration
• Airway protective mechanismsAirway protective mechanisms
• Reflexive coughReflexive cough

GASTROESOPHAGEAL SYSTEMS: The impact on feeding and swallowingGASTROESOPHAGEAL SYSTEMS: The impact on feeding and swallowing

• Esophageal functionEsophageal function
• Digestive functionsDigestive functions
• Reflux mechanismsReflux mechanisms
• When does GER become GERD?When does GER become GERD?
• GERD signs and symptomsGERD signs and symptoms
• GERD and feeding/swallowing difficultiesGERD and feeding/swallowing difficulties
• Esophageal/Pharyngeal inter-relationshipsEsophageal/Pharyngeal inter-relationships

GI/RESPIRATORY RELATIONSHIPS: What’s the connection? GI/RESPIRATORY RELATIONSHIPS: What’s the connection?

• Pressure, energy, and innervationPressure, energy, and innervation
• Extra-esophageal refluxExtra-esophageal reflux

ASPIRATION: How much is too much? ASPIRATION: How much is too much?

• Pulmonary Clearance MechanismsPulmonary Clearance Mechanisms
• Predictors of pneumonia in various populationsPredictors of pneumonia in various populations

RESPIRATORY DISEASE PROCESSES: The impact on feeding/swallowing RESPIRATORY DISEASE PROCESSES: The impact on feeding/swallowing

• Pediatric: Pediatric:
  • Infant Respiratory Distress Syndrome (IRDS)Infant Respiratory Distress Syndrome (IRDS)
  • Bronchopulmonary Dysplasia (BPD)Bronchopulmonary Dysplasia (BPD)
  • Respiratory Synctial Virus (RSV)Respiratory Synctial Virus (RSV)
  • Congenital Heart defectsCongenital Heart defects
• Adult: Adult:
  • Obstructive Sleep Apnea (OSA) and dysphagiaObstructive Sleep Apnea (OSA) and dysphagia
  • Congestive Heart Failure (CHF)Congestive Heart Failure (CHF)
  • Obstructive ConditionsObstructive Conditions
  • Restrictive ConditionsRestrictive Conditions

PNEUMONIAS: It’s not all aspiration PNEUMONIAS: It’s not all aspiration

• Pneumonia vs PneumonitisPneumonia vs Pneumonitis
• Community Acquired PneumoniaCommunity Acquired Pneumonia
• Healthcare Acquired PneumoniaHealthcare Acquired Pneumonia
• Aspiration PneumoniaAspiration Pneumonia

AIRWAY MANAGEMENT: What’s the impact on swallowing? AIRWAY MANAGEMENT: What’s the impact on swallowing?

• Non-invasive positive pressure ventilationNon-invasive positive pressure ventilation
• High flow nasal cannulaHigh flow nasal cannula
• IntubationIntubation
• TracheostomiesTracheostomies

ASPIRATION ASSESSMENT: Clinical Assessment – Making the Most of your Bedside Eval ASPIRATION ASSESSMENT: Clinical Assessment – Making the Most of your Bedside Eval

• Cognitive assessmentCognitive assessment
• Pitch elevationPitch elevation
• Serial swallowsSerial swallows
• Oral mechanismOral mechanism
• Respiratory factorsRespiratory factors
• CoughCough
• Respiratory muscle strengthRespiratory muscle strength
• 3 oz water tests3 oz water tests
• Understanding lab valuesUnderstanding lab values
• Pulse OximetryPulse Oximetry

Instrumental assessment – Which type and when? Instrumental assessment – Which type and when?

• Modified Barium Swallow studiesModified Barium Swallow studies
• Fiberoptic Endoscopic Evaluation of SwallowingFiberoptic Endoscopic Evaluation of Swallowing

ASPIRATION MANAGEMENT: Diet modifications – Not such a benign intervention ASPIRATION MANAGEMENT: Diet modifications – Not such a benign intervention

• Implications of dietary changesImplications of dietary changes
• Compliance issuesCompliance issues
• Thick liquids – pros and consThick liquids – pros and cons
• Water protocolsWater protocols

Strategies and Exercises – What does the evidence tell us? Strategies and Exercises – What does the evidence tell us?

• CompensationCompensation
• Sensory interventionsSensory interventions
• Principles of exercise physiologyPrinciples of exercise physiology
• Lingual strengtheningLingual strengthening
• Pharyngeal strengtheningPharyngeal strengthening
• Expiratory muscle strength trainingExpiratory muscle strength training

REFLUX ASSESSMENT: What do these tests tell me? REFLUX ASSESSMENT: What do these tests tell me?

• Upper GI studiesUpper GI studies
• Ph MonitoringPh Monitoring
• EsophagoscopyEsophagoscopy
• ScintigraphyScintigraphy

REFLUX MANAGEMENT: What’s the dysphagia clinician to do? REFLUX MANAGEMENT: What’s the dysphagia clinician to do?

• Lifestyle modificationsLifestyle modifications
• PositioningPositioning
• Diet modificationsDiet modifications
• MedicationsMedications
• Effects of acid suppressionEffects of acid suppression
• Surgical interventionsSurgical interventions
• New directions in reflux managementNew directions in reflux management