Angela Mansolillo – Breathing, Digestion and Swallowing: Best Practices in Dysphagia Management

Outline

RESPIRATORY SYSTEMS: Breathing/swallowing coordination

• Overview of systems – anatomy/physiology
• Breathing/Swallow coordination
• Coordination and aspiration
• Airway protective mechanisms
• Reflexive cough

GASTROESOPHAGEAL SYSTEMS: The impact on feeding and swallowing

• Esophageal function
• Digestive functions
• Reflux mechanisms
• When does GER become GERD?
• GERD signs and symptoms
• GERD and feeding/swallowing difficulties
• Esophageal/Pharyngeal inter-relationships

GI/RESPIRATORY RELATIONSHIPS: What’s the connection?

• Pressure, energy, and innervation
• Extra-esophageal reflux

ASPIRATION: How much is too much?

• Pulmonary Clearance Mechanisms
• Predictors of pneumonia in various populations

RESPIRATORY DISEASE PROCESSES: The impact on feeding/swallowing

• Pediatric:
  • Infant Respiratory Distress Syndrome (IRDS)
  • Bronchopulmonary Dysplasia (BPD)
  • Respiratory Synctial Virus (RSV)
  • Congenital Heart defects
• Adult:
  • Obstructive Sleep Apnea (OSA) and dysphagia
  • Congestive Heart Failure (CHF)
  • Obstructive Conditions
  • Restrictive Conditions

PNEUMONIAS: It’s not all aspiration

• Pneumonia vs Pneumonitis
• Community Acquired Pneumonia
• Healthcare Acquired Pneumonia
• Aspiration Pneumonia

AIRWAY MANAGEMENT: What’s the impact on swallowing?

• Non-invasive positive pressure ventilation
• High flow nasal cannula
• Intubation
• Tracheostomies

ASPIRATION ASSESSMENT: Clinical Assessment – Making the Most of your Bedside Eval

• Cognitive assessment
• Pitch elevation
• Serial swallows
• Oral mechanism
• Respiratory factors
• Cough
• Respiratory muscle strength
• 3 oz water tests
• Understanding lab values
• Pulse Oximetry

Instrumental assessment – Which type and when?

• Modified Barium Swallow studies
• Fiberoptic Endoscopic Evaluation of Swallowing

ASPIRATION MANAGEMENT: Diet modifications – Not such a benign intervention

• Implications of dietary changes
• Compliance issues
• Thick liquids – pros and cons
• Water protocols

Strategies and Exercises – What does the evidence tell us?

• Compensation
• Sensory interventions
• Principles of exercise physiology
• Lingual strengthening
• Pharyngeal strengthening
• Expiratory muscle strength training

REFLUX ASSESSMENT: What do these tests tell me?

• Upper GI studies
• Ph Monitoring
• Esophagoscopy
• Scintigraphy

REFLUX MANAGEMENT: What’s the dysphagia clinician to do?

• Lifestyle modifications
• Positioning
• Diet modifications
• Medications
• Effects of acid suppression
• Surgical interventions
• New directions in reflux management