Post Stroke Dysphagia
Post Stroke Dysphagia
This is a Learning in 10 voice annotated presentation (VAP) on Post Stroke Dysphagia
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Content
0 ->
0.82 -> Hi.
1.32 -> This presentation will be
2.67 -> narrated by me, Elysia speech
4.74 -> therapist from Sengkang Health--
6.54 -> And me, Jodi from Changi General
8.25 -> Hospital.
9.14 -> We'll be touching
9.9 -> on post-stroke dysphagia.
11.43 ->
14.41 -> By the end of this presentation,
15.847 -> you should be able to meet
16.93 -> these four objectives--
18.61 -> one, understand
19.73 -> normal swallowing; two,
21.88 -> the oral and pharyngeal changes
23.41 -> post-stroke; three,
25.36 -> be aware of the signs
26.53 -> of dysphagia, which might lead
27.91 -> to aspiration;
29.5 -> and four, the ST's role
31.63 -> in dysphagia management.
32.99 ->
36.03 -> This chart gives an overview
37.74 -> of the areas
38.52 -> that a speech therapist covers
40.11 -> for stroke patients.
41.73 -> But this presentation will focus
43.95 -> on swallowing.
44.76 ->
47.92 -> Pre-oral phase-- swallowing
50.01 -> actually starts before food
51.75 -> and drink enters your mouth.
53.97 -> Your sense of smell
54.96 -> picks up the aromas of the food.
57.27 -> An element of cognition
58.65 -> is involved because need
59.91 -> to be aware and recognize
61.44 -> that it's a smell of food.
64.15 -> The salivary glands gets
65.6 -> activated.
66.907 -> And you also prepare
67.74 -> the position of your mouth
69.01 -> and tongue to receive the food.
71.6 -> Therefore, elements of smell,
73.94 -> sight, and cognition
75.7 -> are required
76.54 -> for the pre-oral phase.
78.04 ->
81.26 -> Now, we're going to talk
82.26 -> about when food enters
83.55 -> the mouth.
84.67 -> This is an image
85.65 -> of the lateral view of the head
87.15 -> and neck region.
89.21 -> Here are the lips, teeth,
91.89 -> tongue, soft palate, epiglottis.
95.61 -> This is down towards the lungs.
97.86 -> And this is the esophagus
99.24 -> at the back.
100.68 -> The first phase
101.64 -> is the oral phase.
104.19 -> This stage is where food is
105.69 -> broken down.
107.62 -> Lip closure will stop the food
109.37 -> from spilling out.
111.05 -> And the tongue
111.71 -> is an important muscle, as it
113.6 -> helps move the food
114.86 -> between the teeth
116.03 -> where mastication takes place.
118.44 -> It also prevents food and drink
120.05 -> from spilling
120.74 -> backwards into the pharynx.
123.86 -> Buccal muscles and muscles
125.23 -> of the jaw will help break down
126.64 -> the food.
127.572 -> There's a lot of muscle
128.53 -> recruitment
129.34 -> within the oral cavity, which we
130.72 -> don't think about every time we
132.25 -> eat or drink.
133.15 ->
136.23 -> Then the tongue forms
137.88 -> a cohesive bolus.
139.59 -> And the soft palate stops food
142.26 -> and drinks from going
143.21 -> into the nasal cavity.
145.17 -> The bolus then enters
146.28 -> the pharynx, travels to the back
148.23 -> of the mouth.
149.73 -> The epiglottis flexes downwards
151.67 -> to seal off the entrance
153 -> to the airways.
154.2 -> This consequently results
156.12 -> in a period of apnea.
158.54 -> The bolus gets directed straight
160.07 -> down to the esophagus.
162.399 -> With the help
162.94 -> of the esophageal muscle,
164.3 -> peristalsis occurs directing
166.72 -> the bolus all the way down
168.59 -> to the stomach, as you can see
170.06 -> here.
173.06 -> Dysphagia is a medical term
174.74 -> for having difficulties
175.78 -> in swallowing.
176.83 -> Some stroke patients might find
178.7 -> eating, drinking, and taking
180.38 -> medications difficult.
184.62 -> OK, I'm going to introduce you
186.21 -> to some terms that we use.
188.24 -> Penetration is when food goes
189.77 -> down the wrong way,
191.18 -> meaning it enters the airways
193.03 -> but does not
193.61 -> go past the vocal folds.
195.44 -> As you can see in this picture,
196.88 -> the bolus sits on top
198.35 -> of the vocal folds.
199.47 ->
202.54 -> Aspiration is the term we use
204.1 -> when food goes past the point
205.72 -> of the vocal folds.
207.22 -> As you can see, the red circle
209.32 -> is now below the line
210.97 -> of the vocal folds.
212.6 -> For a normal swallow,
213.85 -> a cough reflex will kick in
215.92 -> and expel the bolus out.
218.2 -> However, sudden aspiration
219.94 -> occurs when there isn't a cough
221.59 -> reflex present.
223.21 -> In such instances, we cannot be
225.7 -> sure if aspiration has taken
227.53 -> place.
228.7 -> For example, medullary strokes
230.65 -> put the patient at high risk
232.04 -> of sudden aspiration.
233.71 ->
236.76 -> Stroke can give rise to motor
238.2 -> difficulties.
239.31 -> For example, those who have
240.897 -> suffered from a cerebellar
241.98 -> stroke may have difficulties
243.66 -> coordinating their muscles.
245.222 -> And those who have been
246.18 -> diagnosed with pure motor
247.38 -> strokes may have decreased
248.76 -> muscle movements or muscle
250.43 -> paralysis.
252 -> This will affect their chewing,
253.602 -> and they may have
254.31 -> poor oral control
255.39 -> and affect their swallowing.
257.354 ->
259.959 -> We also know that a stroke can
261.49 -> affect cognition.
262.96 -> Cognitive deficits can also
264.58 -> contribute to dysphagia.
266.53 -> The patient may have
267.43 -> poor attention
268.36 -> and get easily distracted.
270.44 -> They may have reduced awareness
272.08 -> of food and drink in the mouth
273.76 -> and may not be but to sustain
275.2 -> attention during their meals.
276.605 ->
279.93 -> Here are some common signs
281.43 -> and symptoms of oral dysphasia
283.56 -> or difficulties
284.34 -> in the oral phase--
285.96 -> food loss from mouth,
287.76 -> unable to chew, pocketing
289.74 -> of food in the sides
290.73 -> of the mouth, and bits a food
292.782 -> left in the mouth
293.49 -> of the swallowing.
297.32 -> For pharyngeal phase
298.48 -> difficulties,
299.17 -> you may see nasal regurgitation,
301.62 -> which is food and drink coming
303.13 -> out of nose;
304.39 -> complaints of food being stuck
306.13 -> in the throat;
307.45 -> repetitive swallowing
308.62 -> on a single spoonful; coughs
310.69 -> before, during,
311.93 -> or after swallow;
313.42 -> throat clearing before, during,
315.41 -> or after swallow;
316.84 -> changes in voice quality;
318.79 -> and shortness of breath.
319.96 ->
322.97 -> Consequences of dysphagia--
325.55 -> you can get aspiration
326.75 -> pneumonia, which is a chest
328.07 -> infection as a result of food
329.93 -> and fluid entering the lungs;
332.42 -> malnutrition or dehydration;
334.89 -> the inability to take required
336.98 -> medications;
338.54 -> and some psychosocial
339.68 -> consequences as well--
341.1 -> for example, the fear of eating
342.89 -> out and social isolation.
345.08 ->
348.06 -> Signs of dysphasia
349.16 -> can occur in up to 78%
351.23 -> of patients with stroke.
352.83 -> Ideally, a formal swallowing
354.53 -> evaluation should be performed
356.03 -> by speech therapist.
357.56 -> But this can be impeded
358.61 -> by a lack of resources and time
360.71 -> conflicts,
361.67 -> making it difficult for a speech
363.15 -> therapist
363.65 -> to assess each and every patient
365.57 -> prior to allowing them diet.
367.83 -> Nurses then play a part
369.08 -> by helping to conduct
370.16 -> a simple, routine, bedside
371.72 -> swallowing test for patients who
373.32 -> have been admitted
374.07 -> for acute stroke.
375.74 -> All water swallowing tests
377.28 -> aim to capture patients at risk
379.06 -> for dysphagia
380.03 -> by either passing or failing
381.3 -> them.
381.8 ->
384.79 -> Before they can assess patients
386.38 -> themselves, nurses have to be
388.33 -> trained and assessed
389.29 -> by the speech therapist as well.
391.362 -> There are various water
392.32 -> swallowing test protocols
393.49 -> available.
394.33 -> And different institutions
395.77 -> use different protocols.
397.39 -> Each water swallowing test has
398.86 -> its own exclusion criteria
400.96 -> of patients whom nurses are not
402.43 -> allowed to perform
403.3 -> the swallowing test on--
404.65 -> for example, patients
406.21 -> with brainstem strokes, tongue
408.04 -> deviation, prior history
409.75 -> of dysphasia, and so on.
411.82 -> For patients who pass
413.11 -> the swallowing test,
414.37 -> nurses still have to watch
415.78 -> for signs of aspiration,
417.7 -> especially during mealtimes.
419.8 -> Patients who have failed
420.82 -> the swallowing test
422.05 -> would be kept nil by mouth
423.397 -> and referred to the speech
424.48 -> therapist for a more
425.74 -> formal swallowing evaluation.
427.36 ->
430.41 -> What can STs do?
432.59 -> Adjust the environment
433.9 -> to facilitate a safe swallow.
436.72 -> We also modify fluid
438.07 -> consistencies and dietary
439.57 -> texture to reduce and prevent
441.67 -> incidences of aspiration.
444.19 -> We can give inputs on the need
445.69 -> for enteral feeding.
447.45 -> And we can teach patients
449.41 -> swallow rehab.
451.44 -> The top picture shows the motor
453.25 -> tactile stimulation using
454.74 -> a cold spoon--
455.85 -> one of the swallow rehab
457.02 -> techniques we do.
457.89 ->
460.912 -> We are, of course, part
461.87 -> of a multidisciplinary team.
463.741 -> And we work
464.24 -> with other professionals
465.26 -> to provide better care.
467.54 -> Just for example, we work
468.89 -> closely with dietitians
470.6 -> to discuss nutritional intake.
472.82 -> OTs can provide information
474.59 -> on the patient's
475.36 -> cognitive function,
476.76 -> PTs for patients chest status,
479.42 -> and so on.
480.24 ->
483.3 -> In conclusion, stroke can result
485.49 -> in swallowing and communication
487.08 -> difficulties.
488.25 -> Speech therapists help to manage
489.96 -> patients with dysphagia
491.37 -> and improve their quality
492.66 -> of life.
493.68 -> If you recognize any
494.73 -> of the signs and symptoms
496.2 -> as mentioned earlier,
497.64 -> please consult the speech
498.9 -> therapist for assessment.
500.731 ->
503.247 -> That's the end
503.83 -> of our presentation
504.97 -> on post-stroke dysphagia.
506.71 -> Thank you for listening.
509.01 ->
Source: https://www.youtube.com/watch?v=INq6Ezg4kks