AConversationonManagementofDysphagia ASupplementaryTrainingModuleforSwallowingScreeningTeamsbasedonthebooklettitled ManagementofDysphagiaInAcuteStroke AnEducationalManualfortheDysphagiaScreeningProfessional Acknowledgements RosemaryMartino MA MSc PhDAssociateProfessor UniversityofTorontoDoneldaMoscrip MScRegionalStrokeRehabilitationCoordinatorCentralEastStrokeNetworkAlaneWitt Lajeunesse MS MScDysphagiaEducator CoordinatorChinookRehabilitationProgramPatriciaKnutson MASpeechLanguagePathologist HuronPerthHealthcareAlliance TheHeartandStrokeFoundationofOntarioisgratefultothefollowingprofessionalsfortheirworkindevelopingthisCD BeckyFrench MScSpeechLanguagePathologist SouthlakeRegionalHealthCentreAudreyBrown MScSpeechLanguagePathologist ProvidenceCare St Mary softheLakeHospitalLauraMacIsaac BScN MScStrokeSpecialistCaseManagerStrokeStrategySoutheasternOntarioAnnaMascitelli MASpeechLanguagePathologist NiagaraHealthSystem Agenda DysphagiaandStrokeCareBestPracticeGuidelinesforManagingDysphagiaSwallowing Anatomy Physiology PathophysiologyClinicalApproachtoDysphagiaCaseStudies Source Heart StrokeFoundation 2006 ManagementofDysphagiainAcuteStroke AnEducationalManualfortheDysphagiaScreeningProfessional 18 BestPracticeGuidelinesforManagingDysphagia MaintainallacutestrokesurvivorsNPOuntilswallowingabilityhasbeendetermined Screenallstrokesurvivorsforswallowingdifficultiesassoonastheyareawakeandalert Screenallstrokesurvivorsforriskfactorsforpoornutritionalstatuswithin48hoursofadmission BestPracticeGuidelinesforManagingDysphagia Assesstheswallowingabilityofallstrokesurvivorswhofailtheswallowingscreening Providefeedingassistanceormealtimesupervisiontoallstrokesurvivorswhopassthescreening Assessthenutritionandhydrationstatusofallstrokesurvivorswhofailthescreening BestPracticeGuidelinesforManagingDysphagia Reassessallstrokesurvivorsreceivingmodifiedtexturedietsorenteralfeedingforalterationsinswallowingstatusregularly Explainthenatureofthedysphagiaandrecommendationsformanagement follow upandreassessmentupondischargetoallstrokesurvivors familymembersandcareproviders BestPracticeGuidelinesforManagingDysphagia Providethestrokesurvivororsubstitutedecisionmakerwithsufficientinformationtoallowinformeddecisionmakingaboutnutritionaloptions AnatomyandPhysiologyofSwallowing Source Heart StrokeFoundation 2006 Managementofdysphagiainacutestroke aneducationalmanualforthedysphagiascreeningprofessional p 8 4StagesofSwallowing OralPreparatoryStage Source Heart StrokeFoundation 2002 ImprovingRecognitionandManagementofDysphagiainAcuteStroke aVisionforOntario p 9 4StagesofSwallowing OralPropulsiveStage Source Heart StrokeFoundation 2002 ImprovingRecognitionandManagementofDysphagiainAcuteStroke aVisionforOntairo p 9 4StagesofSwallowing 3 PharyngealStage Source Heart StrokeFoundation 2002 ImprovingRecognitionandManagementofDysphagiainAcuteStroke aVisionforOntairo p 9 4StagesofSwallowing 4 EsophagealStage Source Heart StrokeFoundation 2002 ImprovingRecognitionandManagementofDysphagiainAcuteStroke aVisionforOntairo p 9 NormalSwallowingChangesintheElderly NormalChangesReductioninmuscletoneLossofelasticityofconnectivetissueDecreasedsalivaproductionChangesinsensoryfunctionDecreasedsensitivityofmucosaHealthyelderlyindividualscancompensateCompoundedbyfatigueorweaknessfromdiseaseprocesses e g stroke leadingtodysphagia WhatisDysphagia DifficultyordiscomfortinswallowingCanoccurwithanymotor sensoryorstructuralchangestotheswallowingmechanismDysphagiaaffectsaperson sabilitytoeatordrinksafely TypesofDysphagia OralDysphagiaPharyngealDysphagiaEsophagealDysphagia ComplicationsofDysphagia HealthIssues AspirationpneumoniaMalnutritionDehydrationMortalityHealthCareCosts LengthofStayIncreasedworkloadforstaff DysphagiaRiskFactors StrokelocationCerebralhemisphereBrainstemComorbidconditionsProgressiveNeurologicNeuromusculardisorderRespiratorydisorderSystemicdisorder MedicationsSideeffectsTardivedyskinesiaXerostomiaTracheotomyandVentilation InterdisciplinaryTeam Speech LanguagePathologistRegisteredDietitianPhysicianRegisteredNurse RegisteredPracticalNurseOccupationalTherapistPhysiotherapistPharmacistStrokeSurvivor FamilyandCareProviders DysphagiaScreeningTool IdentifiespatientsatriskfordysphagiaPass FailmeasureMustbeprovenreliableandvalidInitiatesearlyreferralforassessment managementortreatmentforthoseathigherrisk DysphagiaAssessment CompletedbySLPdysphagiaexpertDeterminesthestructure function anddegreeofimpairmentVarioustypesofassessment ClinicalBedsideInstrumentalDirectstreatmentplan NutritionScreeningandAssessment BestPracticeGuidelinesrecommend Nutritionscreeningwithin48hoursofadmissionThosewhofailarereferredtoanRDSeebookletfromHeart StrokeFoundationofOntario 2005 ManagementofDysphagiainAcuteStroke NutritionScreeningforStrokeSurvivors OngoingMonitoring ClinicalindicatorsofpossibledysphagiaPoordentitionDroolingAsymmetricfacialandlipweaknessChangesinvoiceDysarthria slurredspeechReducedtonguemovementCoughingorchokingPleaseseepage24ofmanualforcompletelist DysphagiaManagement