Dysphagia Awareness Month

I was beyond excited that June is Dysphagia Awareness Month.  I have been planning this post for weeks in my head and then life stepped in and said, “not today.”  That “not today” lasted over a week.

To begin the summer, I ended up getting really sick.  In fact, I was sick to the point the thought of food made me worse.  Needless to say, to write about swallowing and food was not my top priority at that time!!

How are you celebrating dysphagia?  To me, the best way to celebrate is to educate.

So many people have no idea what dysphagia is.  It is imperative that we educate the public.  You never know when that ONE person you talk to may need the information.  When I check into a hotel for a continuing education event and they ask me why I’m staying, you’d better believe I tell them what I’m there for and then tell them a little about dysphagia.  People ask all the time what I do for a living.  Take that moment to tell them a little about dysphagia.

Request to speak at a local health fair.  People are there for health information.  Take advantage of educating the people regarding dysphagia, what is it, who it can affect, signs and symptoms.  The presentation can be as little as five minutes.  You can also provide information about dysphagia at the health fair.  Some county fairs will have hospital booths providing information.  Ask if you can provide information about dysphagia.

Ask to write a guest blog post or start your own blog.  When I started blogging, there were basically no dysphagia blogs.  There are plenty of speech blogs but the dysphagia blogs tend to be on the low side.  You can use a blog to share information about therapy, review journal articles or just to educate the public.

Start a journal club.  Let’s face it, we live in an evidence-based world.  Embrace it.  Learn as much as you can from the evidence to make educated decisions for your patients with dysphagia.

Take a good quality course this month.  Ianessa Humbert has a new course coming in September.  This promises to be a challenging course allowing SLPs to become better at critical thinking in dysphagia assessment and treatment.  Northern Speech Services has great courses available.  Courses are also on sale through June 14!  SpeechPathology.com also offers a wide variety of courses.  CIAO is another company offering some good, quality continuing education courses.  What courses would you recommend for a GREAT quality learning experience?

Make the most of Dysphagia Awareness Month, not just in June, but all year long!

Course Alert-Head and Neck Cancer

head and neck cancder

Northern Speech Services is offering a new course on head and neck cancer entitled:  Head and Neck Cancer Across the Continuum of Care: Addressing Swallowing Challenges.  The course is taught by Paula Sullivan who is an expert in dysphagia in the cancer population.

Per the NSS website:

This comprehensive online course will provide the participant an in-depth examination of head and neck cancer, its presentation, functional sequelae, evaluation approaches, treatment options, and provide an evidence-based approach of optimal patterns of care for head and neck patients with swallowing dysfunction.  Types of treatment for head and neck cancer and their impact on swallowing and communication function will be described, including both surgical and organ preservation. 

Assessment and evidence-based practice relevant to the head and neck cancer population will provide support for the practitioner in developing a holistic approach to rehabilitation which will optimize functional outcomes and, most importantly, quality-of-life.  Video presentation will be an integral part of this course.  By the completion of this course, the participant will possess a comprehensive understanding of dysphagia management in this challenging and rewarding population. Offered for 0.9 ASHA CEUs – 9 contact hours. 

This is definitely a course on my to-take list!

Has anyone taken this course yet?  If so, let us know what you thought!

Oral Care

Aspiration is defined as the inhalation of either oropharyngeal or gastric contents into the lower airways, that is, the act of taking foreign material into the lungs.  (http://emedicine.medscape.com/article/296198-overview)

lungs

At one time, we thought the food/liquid that was aspirated was the most important factor in those who end up with aspiration pneumonia.  I remember being told early in my career to avoid foods/drinks with high sugar content because they will cause the person to develop pneumonia.

There are many factors in developing aspiration pneumonia.  There are people walking around that aspirate on a daily basis that never develop pneumonia.  Others simply look at a  piece of pizza and bam, pneumonia.  Health status, respiratory status, activity level, medications can all play a factor in the development of aspiration pneumonia.  A major factor is oral care.

Bacteria from the oral cavity and nares are the main culprits in causing aspiration pneumonia including:  Streptococus pneumoniae,Haemophilus influenza, Staphlococcus aureus, and gram-negative bacteria (Bacteroides, Prevotella, Fusobacterium).

Oral colonization of bacteria worsens with (Gomes et al 2003, Wan et al 2003):

  • Antibiotic use
  • Oral disease
  • Xerostomia
  • Malnutrition
  • Presence of teeth
Patients at Risk for Aspiration Pneumonia
 
  • Patients who are dependent for oral care
  • Have large numbers of missing teeth
  • Dentures
  • Have limited hand dexterity Decreased mental capacity Multiple medical co-morbidities Immunosuppressed
  • Ventilator dependant
  • Receive non-prandial feedings Have had a stroke
  • Neurologically impaired Xerostomia
  • Known dysphagia
  • Poor access to professional dental care
  • Active smoking
  • Depression
  • Use of sedative medicine
  • Use of gastric acid-reducing medication
  • Use of ACE inhibitor
  • Poor feeding position

 Aspiration pneumonia is a 3 phase process:

  • Colonizes pathogenic bacteria in the oropharynx
  • Aspirates the bacteria into the airway
  • Unable to clear the material and then develops a bacterial infection in the respiratory system

 (Langmore S, Terpenning M., Schork A., Chen Y., Murray J., Lopatin D., Loesche W.  Predictors of aspiration pneumonia:  How important is dysphagia? Dysphagia 1998; 13: 69-81)

 

Proper oral care is essential in the elimination/reduction in this harmful bacteria.  Oral care consists of brushing with a toothbrush and a toothpaste containing fluoride.  Rinsing with a non-alcohol based mouthwash may also help with oral care.

Lemon glycerine swabs are not made for oral care and can, in fact, be very drying to the oral mucosa.

lemon glycerin swabs

toothettes

Toothette swabs do not create adequate friction to clean the oral cavity.

Improper oral care can be linked to increased risk of stroke.

Oral Care Assessment:

oral cavity

The Sage Oral Cavity Assessment is a tool that allows you to rate the oral cavity and assign a severity to oral care or lack of.  

The Oral Health Assessment Tool (OHAT) is a tool that is great for use in the SNF setting.  It is much like the Sage in that you rate the oral cavity condition and assign severity to oral care or lack of.  It also prompts for an admission rating and quarterly ratings.  There are even educational slides to use in facility training.

Oral care is an absolute necessity during a bedside evaluation.  Have you ever tried to chew and swallow a cracker with a severely dry mouth or after you have not brushed your teeth for days?  It’s not easy.  While helping the patient or performing oral care, you have a great opportunity to educate the patient/family member/caregivers on oral care and its importance.  Oral care is a great tool for patients that refuse an NPO status or for patients that are not compliant with diet recommendations.  It’s an absolute essential for everyone.

The Dysphagia Game

Maybe you’ve heard of The Dysphagia Game. Maybe you’ve played it?

dysphagia game 2

The Dysphagia Game is an online game and a board game that’s similar to Chutes and Ladders. It’s a game that can be used to educate patients, clients, families and colleagues.

                            dysphagia game 1

Do you know what’s great? The Dysphagia Game US version will be released soon!

Check out the online version at Dysphagia Game.

dysphagia game 3