Before writing any vowel or consonant give credit to my teacher degree in Kinesiology Claudia Delpodio, which in my opinion and I think also that of many, is what is eminence in the field of action of physical therapists in the Respiratory and Cardiovascular Area. Week ago a reader asked me a training input MMII, sorry for the delay, but these days I will publish it, I have not forgotten the request. Having said that I proceed to develop the theme, today is a cloudy, rainy, means "depression", so 0 introduction, little inspiration.
Swallowing is the business of transporting solids, liquids and saliva from the mouth into the esophagus. When this activity, loss of coordination, synchronization and effectiveness in one of their trips is presented dysphagia caused by structural abnormalities, anatomical or physiological.
neurogenic dysphagia predisposes to poor management of secretions and aspiration pneumonia, the main complication and is responsible for significant morbidity and mortality.
swallowing participate in the cortex, brainstem and cranial nerves as follows:
- trigeminal sensory and motor
- Facial: motor, sensory and parasympathetic
- Glossopharyngeal: sensory, motor, sensory and secretory taste vasodilator
- Vago: motor, sensory and vegetative life
- Espinal
- Hypoglossal motor: motor
Swallowing involves the following steps:
- school
- Oral Oral pharyngeal
- Esophageal
Swallowing Clinic works in an interdisciplinary way in the study, diagnosis , prevention and treatment of swallowing disorders. It is worth mentioning that today is interdisciplinary artillery many but few use it in their patients, sometimes for personal reasons and others for lack of hierarchical organization in hospitals and health centers.
With this interdisciplinary approach is achieved in our patient continuing medical education for the prevention of aspiration in patients fed by mouth and maintain an artificial airway: tracheostomy based on sound management of the upper airway. Also be weekly meetings for the group's membership Prevalence exchange of views and / or development of treatment guidelines and protocols.
Outcomes are the following:
- aphagia
- Weak
- language impairment of the oral stage
- Aspiration swallowing apraxia
- Condition of the pharyngeal phase
- oropharyngeal muscles atrophy Weakness
- m.
- Impaired pharyngeal phase of swallowing esophageal
- premature food drop
- Retention of food in places of stagnation as vallecula and pyriform sinuses.
For the prevention and treatment of swallowing disorders is needed:
- Power characteristics and consistency.
- Sound Management respiratory secretions.
- proper posture of the head and body during feeding.
- techniques Using multiple swallows.
Grades of dysphagia:
- Normal: safe chewing and swallowing.
- Mild: occasionally present difficulties. Management of specific techniques.
- Moderate: reliable soft diet. Difficulty with solids and liquids. Requires supervision.
- Moderately Severe: oral intake is not successful. Primary method of ensuring food and eat only in the presence of the therapist.
- Severe: nutrition is performed by alternative methods. Do not eat food by mouth.
dysphagia assessment is done at the bedside of the patient, x-ray with barium swallow, videofluoroscopy and videofibrolaringoscopía.
Evaluation "Bed Side"
Evaluation I:
- Level of consciousness
- cranial nerves V, VII, IX, X, XI, XII
- head control, mobility
cervical - motility:
; facial lingual
lingual and nasal pharyngeal
Assessment II - oropharyngeal sensitivity
- phonation
- Lake pharyngeal
- voluntary cough
- laryngeal ascent
- tracheostomy
Evaluation III
- means of artificial feeding (enteral, parenteral, nasogastric tube, gastrostomy, yeyunostomía)
- reflujo gastroesophageal
- Opening and closing valves
- trigger reflex swallowing
- coordination (power, valves, RDD, respiration).
Evaluation IV
- protective reflex cough and gag
- swallowing reflexes, and pharyngeal palatoamigdalino
other publication Hare soon treatment.
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