HC 1 General framework

Question 1

What’s the importance of getting the whole ICF picture in treating dysphagia?

Answer 1

Because of the great importance for the patient of the unobservable aspects of the dysphagia: the embarrasment, not having fun eating, the effort,…

=> so you need to work on this in therapy as well!

Question 2

What do we understand in “body functions and structures”? Which team member could be involved here?

Answer 2

• structure of the tongue
• esophagus
• vocal folds
• sucking, biting, chewing, manipulation of food in mouth
• consciousness & attention
• taste & smell function
• …

==> SLP, doctors, phsyical therapist,…

Question 3

What do we understand in “activity”. Which team member could be involved here?

Answer 3

• eating
• drinking
• meal preparing
• coughing, choking
• consistencies
• reflexes, habits

==> SLP, doctors, dietitian,…

Question 4

What do we understand in “participation”? Which team member could be involved here?

Answer 4

• family at the dinner table
• going to a restaurant
• have/attend a birthday party
• weddingcake
• …

==> patients associations

Question 5

What do we understand in “environmental factors”? Which team member could be involved here?

Answer 5

• availability of aids
• food adjustments
• medication
• other treatments
• …

==> SLP, social worker, psychologist, nurse, occupational therapist,…

Question 6

What do we understand in “personal factors”? Which team member could be involved here?

Answer 6

• patients preferences in food and drinks
• cultural or religious food choices
• …

==> psychologist, social worker, dietitian,…

Question 7

Why do we use - besides ICF - EBP as a frame of reference?

Answer 7

Because it leads to the

• best assessment
• best treatment
• best advice

for your patient

Question 8

Explain the 5 steps of EBP

Answer 8

1. ASK: convert the need for information into an aswerable clinical question
2. ACQUIRE: track down the best evidence for answering your question
3. APPRAISE: critically appraise the evidence for validity, impact and applicability
4. APPLY: integrate the evidence into your clinical decision making
5. AUDIT: evaluatie steps 1-4 and seek ways to improve next time

Question 9

We set SMART goals and will achieve it by a SMARTER process. Explain

Answer 9

• SMART: specific, measurable, achievable, realistic and time-bound
• SMARTER: shared, monitored, accessible, relevant, transparent, evolving and relationship-centered

Question 10

What elements are mandatory to talk about dysphagia?

Answer 10

• structures critical for swallowing are involved: abnormalities in the structures or in their movements
• transport/movement is involved: from mouth to stomach
• safety is involved: (risk of) choking, undernutrition or aspiration pneumonia

Question 11

How can we classify dysphagia?

Answer 11

1. by age:

• pediatric - adults - presbyphagia

2. by stage:

• oropharyngeal dysphagia: preparation phase, transport phase, pharyngeal phase (mouth & throat)
• esophageal dysphagia: esphageal phase (disturbed peristalsis or obstruction)

3. by etiology:

• neurologic (acute, chronic, degenerative)
• structural (pathology [congenital or acquired] or therapy)
• iatrogenic
• presbyphagia (primary or secondary)
• psychogenic

Question 12

In which groups is there a high prevalence of dysphagia?

Answer 12

• stroke (acute & chronic)
• stroke brainstem
• TBI (= traumatic brain injury)
• progressive diseases
• head-neck carcinoma
• dementia
• elderly

Question 13

What are the main medical consequences of dysphagia? Why?

Answer 13

• undernutrition: lower energy levels (important to sustain a swallow), negative effect on immune system => infection, sepsis, death
• aspiration pneumonia: treatment is costly, increased lenght of stay in hospital, greater disability, poorer nutritional status
• dehydration: increase mental confusion + organ system failure => negative effect on swallowing (vicious circle)

==> higher morbidity, higher mortality

Question 14

What does a SLP have to think about when treating dysphagia?

Answer 14

• is it safe? Airway protection
• is it adequate? Nutrition, hydration
• quality of life

Question 15

What psychosocial consequences come with dysphagia?

Answer 15

• social interactions: limitations
• affects spouses and family too
• stress when preparing special meals
• increased cost for dietary supplements

Question 16

Which team members could be involved?

Answer 16

• Speech-language pathologist
• Otolaryngologist (ENT)
• Gastroenterologist
• Radiologist
• Neurologist
• Dentist
• Nurse
• Dietitian
• Occupational Therapist
• Pulmonologist and Respiratory Therapist (= Physical therapist)
• Social worker

Question 17

What is nasal regurgitation?

Answer 17

Bolus goes partially or fully upwards into the nasopharynx because the soft palate is not entirely closed

Question 18

Wat is odynophagia

Answer 18

painfull swallowing

Question 19

What is drooling?

Answer 19

involuntary loss of saliva

Question 20

Explain the penetration-aspirationscale.

Answer 20

• score 1: no entry of materials into the larynx or trachea
• score 2-5: laryngeal penetration: entry of material into the larynx, but it stays above the vocal cords
• score 6-7: aspiration: bolus passes the vocal cords and enters the trachea
• score 8: silent aspiration: no attempt to clear the trachea

Question 21

What is aspiration pneumonia?

Answer 21

Infection of the lungs due to aspiration

Question 22

What is residue?

Answer 22

part of the bolus stays in the back of the mouth after the swallow.

Question 23

What is premature spillage?

Answer 23

Bolus is going too early from mouth to throat, before swallow is in the pharyngeal fase (dangerous, because the airway is not protected yet and esophagus isn’t opened yet)

• either during preparatory or oral phase
• either prior to onset of pharyngeal swallow