Dysphagia Causes, Symptoms, Treatment - What Are the Signs and Symptoms of Dysphagia? Dysphagia (Swallowing Problems) (cont.)What Are the Signs and Symptoms of Dysphagia? Depending upon the cause of the dysphagia, the difficulty swallowing can be mild or severe. Some affected individuals may have trouble swallowing both solids and liquids, while others may experience problems only when attempting to swallow solid foods.
Information about managing dysphagia in patients with dementia.
Occasionally, there is more trouble with liquid than solid food. If there is aspiration of food (most common with liquids), swallows may induce coughing due to entrance of the liquid into the voice box (larynx) at the top of the trachea or into the lungs. If solid food becomes lodged in the lower throat, it may induce choking and gagging and interfere with breathing. If solid food lodges in the esophagus, it may be felt as severe chest discomfort. If food stuck in the lower esophagus regurgitates at night, individuals may awaken coughing and choking due to food entering the throat, larynx, or lungs. Less commonly, swallowed food may regurgitate effortlessly into the mouth immediately after it is swallowed. If dysphagia is associated with aspiration of food into the lungs, aspiration pneumonia may occur with all of the symptoms of pneumonia (fever, chills, and respiratory distress).
This is a particular danger in individuals who have had a stroke. Dysphagia is present in approximately 5. Other symptoms associated with dysphagia depend upon its exact cause and are specific to the condition that results in dysphagia, such as stroke, cancer, etc. When to Seek Medical Care for Dysphagia. If you are experiencing difficulty swallowing, you should contact your health care professional for an evaluation. Medically Reviewed by a Doctor on 5/2.
Patient Comments & Reviews. The e. Medicine. Health doctors ask about Dysphagia.
TBI info, traumatic brain injury (TBI) is sudden damage to the brain caused by a blow or jolt to the head. Injuries can range from mild concussions to severe. The Modified Barium Swallow Impairment Profile: MBSImP
TBI, Traumatic brain injury (TBI), brain injury. Overview. Traumatic brain injury (TBI) is sudden damage to the brain caused by a blow or jolt to the head. Common causes include car or motorcycle crashes, falls, sports injuries, and assaults. TBI is the leading cause of death and disability among people aged 1 to 4.
- Myotonic dystrophy is an inherited disease where a change, called a mutation, has occurred in a gene required for normal muscle function. The mutation prevents the.
- Modified Barium Swallow Impairment Profile
Injuries can range from mild concussions to severe permanent brain damage. The consequences of a brain injury can affect all aspects of a person's life, including physical and mental abilities as well as emotions and personality. While treatment for mild TBI may include rest and medication, severe TBI may require intensive care and life- saving emergency surgery. Most people who suffer moderate to severe TBI will need rehabilitation to recover and relearn skills. What is a traumatic brain injury? TBI is an injury to the brain caused by a blow or jolt to the head from blunt or penetrating trauma. The injury that occurs at the moment of impact is known as the primary injury.
Primary injuries can involve a specific lobe of the brain or can involve the entire brain. Sometimes the skull may be fractured, but not always. During the impact of an accident, the brain crashes back and forth inside the skull causing bruising, bleeding, and tearing of nerve fibers (Fig. Immediately after the accident the person may be confused, not remember what happened, have blurry vision and dizziness, or lose consciousness. At first the person may appear fine, but their condition can decline rapidly. After the initial impact occurs, the brain undergoes a delayed trauma – it swells – pushing itself against the skull and reducing the flow of oxygen- rich blood. This is called secondary injury, which is often more damaging than the primary injury.
Traumatic brain injuries are classified according to the severity and mechanism of injury: Mild: person is awake; eyes open. Symptoms can include confusion, disorientation, memory loss, headache, and brief loss of consciousness.
Moderate: person is lethargic; eyes open to stimulation. Loss of consciousness lasting 2. Some brain swelling or bleeding causing sleepiness, but still arousable.
Severe: person is unconscious; eyes do not open, even with stimulation. Loss of consciousness lasting more than 6 hours. Types of traumatic brain injuries.
Injuries involving the entire brain are called diffuse: Concussion is a mild head injury that can cause a brief loss of consciousness and usually does not cause permanent brain injury. Diffuse axonal injury (DAI) is a shearing and stretching of the nerve cells at the cellular level. It occurs when the brain quickly moves back and forth inside the skull, tearing and damaging the nerve axons. Axons connect one nerve cell to another throughout the brain, like telephone wires. Widespread axonal injury disrupts the brain's normal transmission of information and can result in substantial changes in a person's wakefulness. Traumatic Subarachnoid Hemorrhage (t.
SAH) is bleeding into the space that surrounds the brain. This space is normally filled with cerebrospinal fluid (CSF), which acts as a floating cushion to protect the brain. Traumatic SAH occurs when small arteries tear during the initial injury. The blood spreads over the surface of the brain causing widespread effects.
Injuries involving specific areas of the brain are called focal: Contusion is a bruise to a specific area of the brain caused by an impact to the head; also called coup or contrecoup injuries. In coup injuries, the brain is injured directly under the area of impact, while in contrecoup injuries it is injured on the side opposite the impact. Hematoma is a blood clot that forms when a blood vessel ruptures. Blood that escapes the normal bloodstream starts to thicken and clot. Clotting is the body's natural way to stop the bleeding. A hematoma may be small or it may grow large and compress the brain.
Symptoms vary depending on the location of the clot. A clot that forms between the skull and the dura lining of the brain is called an epidural hematoma.
A clot that forms between the brain and the dura is called a subdural hematoma. A clot that forms deep within the brain tissue itself is called an intracerebral hematoma. Over time the body reabsorbs the clot. Sometimes surgery is performed to remove large clots.
Although described as individual injuries, a person who has suffered a TBI is more likely to have a combination of injuries, each of which may have a different level of severity. This makes answering questions like “what part of the brain is hurt?” difficult, as more than one area is usually involved. Secondary brain injury occurs as a result of the body's inflammatory response to the primary injury. Extra fluid and nutrients accumulate in an attempt to heal the injury. In other areas of the body, this is a good and expected result that helps the body heal. However, brain inflammation can be dangerous because the rigid skull limits the space available for the extra fluid and nutrients.
Brain swelling increases pressure within the head, which. The swelling happens gradually and can occur up to 5 days after the injury. What are the. symptoms? Depending on the type and location of the injury, the person's symptoms may include: Loss of consciousness Confusion and disorientation.
Memory loss / amnesia Fatigue Headaches Visual problems Poor attention / concentration Sleep disturbances Dizziness / loss of balance Irritability / emotional disturbances Feelings of depression Seizures. Vomiting. Diffuse injuries (such as a concussion or diffuse axonal injury) will typically cause an overall decreased level of consciousness. Whereas, focal injuries (such as an ICH or a contusion) will have symptoms based on the brain area affected (Fig. The brain is composed of three parts: the brainstem, cerebellum, and cerebrum. The cerebrum is divided into four lobes: frontal, parietal, temporal. The table lists the lobes of the brain and their normal functions as well as problems that may occur when injured.
While an injury may occur in a specific area, it is important to understand that the brain functions as a whole by interrelating its component parts. Every patient is unique and some injuries can involve more than one area or a partial section, making it difficult to predict which specific symptoms the patient will experience.
What are the causes? Common causes include falls, car or motorcycle crashes, vehicular accidents involving pedestrians, athletics, and assaults with or without a weapon. Who is affected? Approximately 1. TBI) each year in the United States. Most people who experience a head injury, about 1.
Another 2. 35,0. 00 individuals will be hospitalized with a moderate to severe head injury, and approximately 5. How is a diagnosis made?
When a person is brought to the emergency room with a head injury, doctors will learn as much as possible about his or her symptoms and how the injury occurred. The person's condition is assessed quickly to determine the extent of injury.
The Glasgow Coma Score (GCS) is a 1. Doctors assess the patient's ability to 1) open his or her eyes, 2) ability to respond appropriately to orientation questions, (“What is your name? What is the date today?”), and 3) ability to follow commands (“Hold up two fingers, or give a thumbs up”).
If unconscious or unable to follow commands, his or her response to painful stimulation is checked. A number is taken from each category and added together to get the total GCS score. The score ranges from 3 to 1. Mild TBI has a score of 1.
Moderate TBI has a score of 9- 1. TBI has a score of 8 and below. Diagnostic imaging tests will be performed: Computed Tomography (CT) is a noninvasive X- ray that provides detailed images of anatomical structures within the brain.
A CT scan of the head is taken at the time of injury to quickly identify fractures, bleeding in the brain, blood clots (hematomas) and the extent of injury (Fig. CT scans are used throughout recovery to evaluate the evolution of the injury and to help guide decision- making about the patient's care.
Magnetic Resonance Imaging (MRI) is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of the brain. A dye (contrast agent) may be injected into the patient's bloodstream.
MRI can detect subtle changes in the brain that cannot be seen on a CT scan. Magnetic Resonance Spectroscopy (MRS) gives information about the metabolism of the brain. The numbers generated from this scan provide a general prognosis about the patient's ability to recover from the injury. What treatments. are available? Mild TBI usually requires rest and medication to relieve headache.
Moderate to severe TBI require intensive care in a hospital. Bleeding and swelling in the brain can become an emergency that requires surgery. However, there are times when a patient does not require surgery and can be safely monitored by nurses and physicians in the neuroscience intensive care unit (NSICU). The goals of treatment are to resuscitate and support the critically ill patient, minimize secondary brain injury and complications, and facilitate the patient's transition to a recovery environment. Despite significant research, doctors only have measures to control brain swelling, but do not have a way to eliminate swelling from occurring.
Neurocritical care. Neurocritical care is the intensive care of patients who have suffered a life- threatening brain injury. Many patients with severe TBI are comatose or paralyzed; they also may have suffered injuries in other parts of the body. Their care is overseen by a neurointensivist, a specialty- trained physician who coordinates the patient's complex neurological and medical care. Patients are monitored and awakened every hour for nursing assessments of their mental status or brain function. Click to view larger image with labels. Figure 4. In the NSICU, the patient is connected to numerous machines, tubes, and monitors.
MANAGING DYSPHAGIA IN RESIDENTS WITH DEMENTIASKILLED INTERVENTION FOR A COMMON—AND TROUBLING—DISORDERBY SUE CURFMAN, MA, CCCSource of article: Nursing Homes/Long Term Care Management. Adapted with permission from an original article published at www. Research and statistics clearly indicate that dehydration and malnutrition are prevalent and serious concerns with skilled nursing facility (SNF) residents. Studies indicate that 5. SNF residents are malnourished; the prevalence of malnourished elderly in SNFs has been reported to range from 2.
In addition, 6. 0% of all residents experience an initial weight loss following admission. Many of the residents in these statistics had a dementia diagnosis, which places them at higher risk for weight loss and dehydration. In addition, current statistics estimate that 6. Thus, adequate nutrition and hydration in a resident with dementia is a central concern for all members of the family and healthcare team. The effect of dementia on nutrition and hydration changes throughout the course of the degenerative disease process. In the early stage, the individual with dementia may forget to eat, may become depressed and not want to eat, or may become distracted and leave the table without eating. In the middle stage, the individual with dementia may be unable to sit long enough to eat, yet at this stage may require an additional 6.
In the late stage, the individual with dementia does not have intact oral motor skills for chewing and swallowing, thus becoming subject to malnourishment and “wasting away.”This is one reason a facility can benefit from the involvement of a speech- language pathologist (SLP). The role of the SLP will change over time because of the progressive nature of the dementia disease process and its effect on swallowing function and nutrition. The SLP’s goal is the same as Medicare’s number one goal in these residents: “facilitating and maintaining safety for the resident during swallowing and p. Medicare Hospital Manual). It is imperative that the SLP, as well as the director of nursing and other key members of the caregiving team, have a solid understanding of dysphagia and appropriate treatment and management techniques specific to the disorder. Administrators and other nursing home professionals will also benefit from a general understanding of the complexities of caring for these residents. The Family Guide to Alzheimer's Disease Video Series provides an indispensable resource offering encouragement and instruction to those affected by Alzheimer’s Disease.
The goal of assessment for an individual with dysphagia and dementia is to identify the nature of the dysphagia, identify the contributing factors, differentiate the physiologic impairment and/or cognitive dysfunction aspects, identify capacity for improved safety, and identify the potential benefit from skilled intervention. Specific components of the initial assessment include chart review, resident/caregiver/nursing interview, sensory function, head and neck positioning, oral motor skills, pattern of mastication, salivation, and laryngeal elevation.
Each of the swallow assessment components are individually reviewed below. Chart review. The course of recovery or progressive decline found in the diseases and surgical procedures linked to dysphagia vary widely. Once the disease process contributing to the dysphagia is identified, the clinician should determine the resident’s course of anticipated recovery or decline. Fortunately, the effect of progressive dementia on swallow function can be fairly predictable. Chart review takes on an even more primary role when the resident’s recall or ability to provide information is limited because of memory impairment, dementia, or other language deficits. Therefore, the following information in the medical record should be sought: (1) diagnoses; (2) current weight; (3) recent weight changes; (4) current and historic therapeutic/altered diets; (5) current eating habits, including food types and amounts consumed at scheduled and unscheduled times; (6) self- feeding skills throughout the course of the meal; (7) eating and chewing difficulties; (8) signs/symptoms (from nursing notes) of congestion, coughing, choking with drinking or taking medications, fever, and lethargy; (9) x- ray results (e. Resident/caregiver/nursing interview.
Two key questions for the resident are: (1) “What are your problems with eating, drinking, and swallowing?” and (2) “Why do you think you are having a problem with swallowing?” Besides valuable information about the resident’s perception of the illness, you can get a sense of the resident’s overall cognitive status and ability to attend to and follow directions and learn new information. This will influence the nature of the treatment program. Many residents with dysphagia as a result of neurologic impairment will be unable to participate in the interview process because of expressive and/or receptive communication problems or cognitive dysfunction. If so, the necessary information can be obtained from a caregiver or family member who is familiar with the resident. Sensory function. It is important to determine whether the resident’s sensory pathways are intact, intermittently intact, or absent.
The following six anatomic sites are assessed to determine this, in this order: - tongue (anterior two- thirds); - tongue (posterior one- third); - hard palate; - soft palate; - posterior pharyngeal wall; and - laryngeal region. Sample sensory deficits that may be discovered include decreased p. Note whether the resident is able to complete independent positioning on instruction or is at least able to assist in positioning. Three common head/neck positions occur in the later stages of dementia: chronic head/neck flexion, variable head/neck flexion/extension caused by a lack of positioning management, and chronic head/neck hyperextension. The only appropriate goal of intervention at this late stage is to improve the resident’s functional behaviors through the use of adaptive equipment or assistive devices; no rehab potential remains because of the bilateral brain destruction.
The Crescent Pillow Mate cervical pillow gently cradles the neck. Crescent shape provides support for cervical alignment without forward flexion.
Oral motor skills. The clinician will: (1) visually inspect and assess ROM, strength, and coordination of individual oral structures, including lips, tongue (anterior, middle, and posterior), and soft palate; and (2) assess the functional movement patterns required for the oral stage of swallowing, including food bolus manipulation during chewing, cohesive food bolus formation, anterior- to- posterior transit of cohesive food bolus, and transfer or dropping of food bolus into pharynx. Pattern of mastication. The clinician will assess both the muscles associated with mastication and the pattern of mastication. The oral motor function will determine the pattern of mastication, which deteriorates in a predictable fashion with the progression of dementia. The progressive deterioration in the mastication patterns below reflects a transition from higher level reflex integration to lower level reflex integration during the course of dementia: (1) rotary chew pattern; (2) lateral chew/chomping pattern and jaw- jerk reflex; (3) suck- swallow pattern and(4) absent oral motor function for chewing. Salivation. Assessment of salivary function includes three components: (1) visual inspection of the oral mucosa to determine adequacy of salivary flow, (2) medication review, and (3) medical history review.
Common drug classes that reduce salivation include anticholinergic, antidepressant, and antipsychotic drugs. If salivary flow is adequate, the oral cavity will appear wet; if hyposalivation is present, the oral cavity will become dry. Symptoms of dry mouth (xerostomia) include mouth pain; difficulty chewing; difficulty swallowing; weight loss; mouth infections; tooth decay; a dry, cracked tongue; bleeding gums; cracked corners of the mouth; badly fitting dentures; and dryness in the eyes, nose, skin, and throat. If complaints or visual inspection indicate a dry mouth, the resident should be assessed for other signs/symptoms of dehydration, including dry mucous membranes; loss of skin turgor; intense thirst; flushed skin; oliguria (decreased urine output in relation to fluid intake); dark, yellow urine; and/or possible elevated temperature. Analyzing volitional swallows and laryngeal elevation. Once initiated, the swallow should occur briskly. The clinician will also assess laryngeal elevation during dry and/or bolus swallows.
The components of laryngeal elevation would include the speed of laryngeal elevation, the movement of the structures involved, and the integrity of their movement. Assessment Analysis. The information from the chart review, interview, clinical swallow assessment, and instrumental assessment is reviewed and analyzed to determine the presence of dysphagia, as well as level, severity, and primary etiology of contributing factors. The question then is whether the resident demonstrates dysphagia secondary to a physiologic deficit and/or a cognitive deficit.
Many swallowing and eating impairments are secondary to the primary dementia diagnosis, which is the focus of the remainder of this article. Dysphagia of Dementia. The resident may demonstrate the following secondary conditions related to the primary dementia diagnosis: - absent oral motor pattern for mastication; - poor sensory awareness/integration; - negative reaction to food textures and consistencies; - suck- swallow mastication pattern; - significant irreversible pharyngeal dysphagia; and - reduced p. In direct treatment, the clinician works directly with the resident, teaching him or her compensatory strategies. Examples of direct dysphagia treatment interventions include sensory stimulation, diet modification, muscle strengthening, ROM exercises, and caregiver training in feeding assistance.