https://doi.org/10.5056/jnm.2014.20.1.79, Falsetti, P., Caterina, A., Palilla, R., Bosi, M., Carpinteri, F., Zingarelli, A., Pedace, C., & Lenzi, L. (2009). Porto de Toledo, I., Lopes Quirino Pantoja, L., Fontes Luchesi, K., Assad, D. X., De Luca Canto, G., & Neves Silva Guerra, E. (2019). Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. https://doi.org/10.1002/(SICI)1097-0347(199709)19:6<535::AID-HED11>3.0.CO;2-4, Macht, M., Wimbish, T., Bodine, C., & Moss, M. (2013). https://doi.org/10.1002/hed.24713, Carnaby-Mann, G. D., & Crary, M. A. Using the Fleming index of dysphagia to establish prevalence. Dysphagia, 6(4), 187192. 1997- American Speech-Language-Hearing Association. A systematic review by Martino et al. intake. A Systematic Review of the Physiological Effects of the Effortful Mendelsohn maneuver (Lift larynx, Increase UES opening time) Showa maneuver (Reduce Valleculae residue) Supraglottic swallow (Contraindications: CAD, arrhythmias and stroke) Exercises: A patient with decision-making capacity, the patients family, or other established decision-maker has the right to accept or refuse such recommendations (Krekeler et al., 2018). (2013). https://doi.org/10.1044/leader.FTR3.08082003.4. Recently, the addition of high-resolution manometry (HRM) has enabled the SLP to evaluate In studies in which improvement in swallowing has been identified [90], VitalStimTM was paired with effortful swallow for 1 h sessions completed 5 days per week for 3 weeks. Swallowing Exercises Flashcards | Quizlet Signs and symptoms of dysphagia include. (2012). (2019). https://doi.org/10.1007/s12603-019-1191-0, Balzer, K. (2000). Consideration of the underlying neurophysiological impairment is necessary for understanding swallow function and deficits. Dysphagia, 29(5), 603609. Squeeze their muscles with their chin tucked down 2. Stroke, 30, 744748. American Journal of Gastroenterology, 86(8), 965970. In addition to determining the type of assessment and treatment that is optimal for adults with dysphagia, SLPs consider other service delivery variables that may affect swallowing outcomesvariables such as format, provider, dosage, and timing. (1991). Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. You can either: Hold this position for 1 minute, and then lower your head and rest for 1 minute. https://doi.org/10.1001/archinte.159.17.2058. Dysphagia, 4(1), 3942. Practical Gastroenterology, 29(7), 1631. Mosby. Parkinsonism & Related Disorders, 18(4), 311315. (2016). Individuals of all ages are screened as needed, requested, or mandated or when presenting medical conditions (e.g., neurological or structural deficits) suggest that they are at risk for dysphagia. Effortful swallow enhances vertical hyolaryngeal movement and - PubMed Acta Gastroenterologica Latinoamericana, 40(2), 156158. Some maneuvers require following multistep directions and may not be appropriate for patients with cognitive impairments. overall physical, social, behavioral, and cognitive/communicative status; the patients perception of function, severity, change in functional status, and quality of life; physiological status and vital signs, including heart rate, oxygen saturation, and respiratory rate as well as respiratory/swallowing pattern, which may vary across individuals and across the life span (Martin-Harris et al., 2005); secretion management skills, which might include frequency and adequacy of spontaneous saliva swallowing and the ability to swallow voluntarily; labial seal, anterior spillage and evidence of oral control, including mastication and transit, manipulation of the bolus, presence of hyolaryngeal excursion as observed externally or to palpation, and time required to complete the swallow sequence; behavioral signs and symptoms, such as throat clearing or coughing before/during/after the swallow, which may not always be indicators of penetration and/or aspiration; the impact of fatigue and/or respiratory function on swallowing; changes to physiological status/vital signs/voice quality; and. For example, the super-supraglottic swallow is a rehabilitative technique that increases closure at the entrance to the airway and may also serve as a compensation to protect the airway (McCabe et al., 2009). Korkmaz, M. ., Eilmez, O. K., zelik, M. A., & Gven, M. (2020). Examining the evidence on neuromuscular electrical stimulation for swallowing: A meta-analysis. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Adult Dysphagia page: The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association. Swallowing disorders in Sjgrens syndrome: Prevalence, risk factors, and effects on quality of life. Sapienza: The studies have shown that during EMST, not IMST, the suprahyoid muscles are co-contracting and generating greater muscle activity than that exhibited during normal dry or wet swallow, and that the muscle force produced is on par with effortful swallow exercises. PDF Efficacy of exercises to rehabilitate dysphagia: A critique of the Journal of Neurology, Neurosurgery & Psychiatry, 76(9), 12971300. https://doi.org/10.1007/BF02493526, Via, M. A., & Mechanick, J. I. World Health Organization. Rehabilitative Therapy | SpringerLink concerns regarding the safety and efficiency of swallow function, contribution of dysphagia to nutritional compromise, contribution of dysphagia to pulmonary compromise, contribution of dysphagia to concerns for airway safety (e.g., choking), the need to identify disordered swallowing physiology to guide management and treatment, the need to assist in the determination of a differential medical diagnosis related to the presence of dysphagia, the presence of a medical condition or diagnosis associated with a high risk of dysphagia, previously identified dysphagia with a suspected change in swallow function; and, the presence of a chronic degenerative condition with a known progression or the recovery from a condition that may require further information for the management of oropharyngeal function. As indicated in the ASHA Code of Ethics (American Speech-Language-Hearing Association [ASHA], 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so. In clinical settings, SLPs typically use one of two types of instrumental evaluation: the videofluoroscopic swallowing study (VFSS) or the flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing. https://doi.org/10.1016/j.pmr.2008.07.001, Gordon, C., Hewer, R. L., & Wade, D. T. (1987). Effortful Swallow ACTIVITY: SWALLOW WITH AS MUCH EFFORT AS POSSIBLE. http://europepmc.org/abstract/MED/20645565, Ruoppolo, G., Schettino, I., Frasca, V., Giacomelli, E., Prosperini, L., Cambieri, C., Roma, R., Greco, A., Mancini, P., De Vincentiis, M., Silani, V., & Inghilleri, M. (2013). Systematic review and meta-analysis of the association between sarcopenia and dysphagia. polymyositis and dermatomyositis (Gonzlez-Fernndez & Daniels, 2008). Therefore future studies are needed to examine these factors. Otolaryngologic Clinics of North America, 46(6), 10591071. Or hold this position for 1 minute, and then lower your head and . https://doi.org/10.1056/NEJM199104253241703, Spechler, S. (1999). American Journal of Speech-Language Pathology, 18(4), 361375. 99-E024). ASHA does not require any additional certifications. Increased risk of dehydration and associated conditions (e.g., renal failure, gastroparesis, constipation, urinary tract infections, confusion/delirium, and poor recovery from illness (Cichero & Lam, 2014; Leibovitz et al., 2007; Murray et al., 2016, Wheelan, 2001). Dysphagia in amyotrophic lateral sclerosis: Prevalence and clinical findings. Management of oropharyngeal dysphagia in laryngeal and hypopharyngeal cancer. Suiter, D. et al. Prevalence of oropharyngeal dysphagia and impaired safety and efficacy of swallow in independently living older persons. Don't lift your shoulders. SLPs may encounter patients approaching the end of life. The medical team may make temporary recommendations (e.g., no oral intake, stipulation of specific dietary precautions) while the patient is awaiting further assessment. Dysphagia, 19(4), 266271. Dysphagia in the elderly. https://doi.org/10.3109/17549507.2015.1024171, Layne, K. A., Losinski, D. S., Zenner, P. M., & Ament, J. Dysphagia in multiple sclerosisPrevalence and prognostic factors. Conflict may occur when medical recommendations do not match patient preferences. The effortful swallow maneu-ver was first introduced to improve the contact between the base of the tongue (BOT) and the posterior pharyngeal wall (PPW) during swallowing, thus increasing pressure on the bolus (Pouderoux & Kahrilas, 1995). European Neurology, 38, 4952. Full article: Effect of effortful swallow on pharyngeal pressures Hold this posture for 3-5 seconds. European Archives of Oto-Rhino-Laryngology. Bend your head forward so that your chin tucks. Part IVImpact of dysphagia treatment on individuals postcancer treatments. A later study by Falsetti et al. Dysphagia may increase caregiver costs and burden and may require significant lifestyle alterations for the patient and the patients family. American Speech-Language-Hearing Association, preferred providers of dysphagia services, Flexible Endoscopic Evaluation of Swallowing, International Dysphagia Diet Standardisation Initiative [IDDSI], Alternative Nutrition and Hydration in Dysphagia Care, ASHA Guidance to SLPs Regarding Aerosol Generating Procedures, End-of-Life Issues in Speech-Language Pathology, Flexible Endoscopic Evaluation of Swallowing (FEES), International Dysphagia Diet Standardisation Initiative (IDDSI), Perspectives of the ASHA Special Interest Groups, Royal College of Speech and Language Therapists: Statement on Thickened Fluids, The Impact of Prescribed Medication on Swallowing: An Overview, Videofluoroscopic Swallowing Study (VFSS), https://doi.org/10.1016/j.archger.2012.04.011, https://doi.org/10.1097/MCG.0000000000000624, https://doi.org/10.1007/s12603-019-1191-0, https://doi.org/10.1007/s00455-015-9637-y, https://doi.org/10.1007/s00455-016-9737-3, https://doi.org/10.1513/AnnalsATS.201606-455OC, https://doi.org/10.1007/s00455-001-0065-9, https://doi.org/10.1034/j.1600-0404.2002.10062.x, https://doi.org/10.1001/archotol.133.6.564, https://doi.org/10.1111/j.1365-2788.2008.01115.x, https://doi.org/10.1111/j.1468-3148.2005.00250.x, https://doi.org/10.1191/0961203302lu195cr, https://doi.org/10.1044/1058-0360(2009/08-0088), https://doi.org/10.1016/S0303-8467(02)00053-7, https://doi.org/10.1001/archneur.1992.00530360057018, https://doi.org/10.1016/j.jcrc.2014.07.011, https://doi.org/10.1044/1058-0360(2011/10-0067), https://doi.org/10.1001/archotol.130.2.208, https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.01.009, https://doi.org/10.1016/j.jcomdis.2013.04.001, https://doi.org/10.1007/s00455-013-9471-z, https://doi.org/10.1007/s00455-013-9464-y, https://doi.org/10.1044/2020_AJSLP-19-00063, https://doi.org/10.1016/j.clnu.2007.08.006, https://doi.org/10.1016/j.pmr.2008.07.001, https://doi.org/10.1016/j.physbeh.2017.03.018, https://doi.org/10.1044/2016_AJSLP-15-0041, https://doi.org/10.1016/j.jmu.2013.10.008, https://doi.org/10.1016/j.apmr.2006.04.019, https://doi.org/10.1016/j.parkreldis.2011.11.006, https://doi.org/10.1007/s00455-004-0013-6, https://doi.org/10.1007/s00455-017-9852-9, https://doi.org/10.3109/17549507.2015.1024171, https://doi.org/10.1001/archinte.159.17.2058, https://doi.org/10.1002/(SICI)1097-0347(199709)19:6<535::AID-HED11>3.0.CO;2-4, https://doi.org/10.1097/CCM.0b013e31829caf33, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740808/, https://doi.org/10.1001/archotol.131.9.762, https://doi.org/10.1161/01.STR.0000190056.76543.eb, https://doi.org/10.1682/JRRD.2008.08.0092, https://doi.org/10.1044/1092-4388(2005/089), https://doi.org/10.1007/978-0-387-22434-3_13, https://doi.org/10.1007/s00455-017-9863-6, https://www.swallowingdisorderfoundation.com/about/swallowing-disorder-basics/, https://www.nidcd.nih.gov/health/statistics/quick-statistics-voice-speech-language, https://doi.org/10.1097/MOO.0000000000000491, https://doi.org/10.1007/s00455-015-9657-7, https://doi.org/10.1007/s00520-019-04920-z, https://doi.org/10.1007/s00455-014-9551-8, https://doi.org/10.1044/leader.FTR5.09072004.8, https://doi.org/10.1016/j.apmr.2006.11.002, https://doi.org/10.1016/j.otc.2013.08.008, http://europepmc.org/abstract/MED/20645565, https://doi.org/10.1007/s00455-017-9855-6, https://doi.org/10.1111/j.1532-5415.2010.03227.x, https://doi.org/10.1016/0003-9993(93)90035-9, https://doi.org/10.1016/j.jpor.2012.02.001, https://doi.org/10.1007/978-0-387-22434-3_8, https://doi.org/10.1056/NEJM199104253241703, https://doi.org/10.1016/S0016-5085(99)70573-1, https://doi.org/10.1007/s00455-020-10137-8, https://doi.org/10.1007/s00455-013-9488-3, https://doi.org/10.1097/PHM.0000000000001397, https://doi.org/10.1592/phco.19.11.974.31575, https://doi.org/10.1111/j.1365-2982.2008.01208.x, https://doi.org/10.1016/j.otc.2013.08.002, https://doi.org/10.1007/s40141-014-0061-2, https://doi.org/10.1044/leader.FTR3.08082003.4, www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/, Connect with your colleagues in the ASHA Community. assessment of respiratory status, cough, and throat clearing abilities. https://doi.org/10.1007/s00455-004-0013-6, Kim, H. D., Choi, J. (2018). https://doi.org/10.1044/sasd11.1.9, Fujiu-Kurachi, M., Fujiwara, S., Tamine, K., Kondo, J., Minagi, Y., Maeda, Y., Hori, K., & Ono, T. (2014). Swallowing function after stroke: Prognosis and prognostic factors at 6 months. Does a water protocol improve the hydration and health status of individuals with thin liquid aspiration following stroke? ICU-acquired swallowing disorders. Deglutition disorders as a consequence of head and neck cancer therapies: A systematic review and meta-analysis. Please see ASHAs resource on the Videofluroscopic Swallowing Study for further information on the VFSS. Critical Care Medicine, 41(10), 23962405. Tongue pressure generation during tongue-hold swallows in young healthy adults measured with different tongue positions. identifying core team members and support services. Diagnostic accuracy of the modified Evans blue dye test in detecting aspiration in patients with tracheostomy: A systematic review of the evidence. Evaluation of the natural history of patients who aspirate. The role of the SLP in treating individuals with progressive neurological disorders is designed to maximize current function, compensate for irreversible loss of function, assess and reassess changes in status, and educate and counsel patients regarding the progression of the disorder and potential options, including non-oral means of nutrition. (1992). Patient adherence to dysphagia recommendations: A systematic review [published correction appears in Dysphagia, May 4, 2018]. Rehabilitative techniques, such as exercises, are designed to create lasting change in an individuals swallowing over time by improving underlying physiological function. Alternative feeding does not preclude the need for rehabilitative techniques to facilitate sensory and motor capabilities necessary for oral feeding. The Journal of Nutrition, Health & Aging, 23(6), 571577. Do 5 reps 2 times per day. Effortful Swallow . Robbins, J., Gensler, G., Hind, J., Logemann, J. An example of a compensatory technique includes a head rotation, which is used during the swallow to direct the bolus toward one of the lateral channels of the pharyngeal cavity. Such knowledge increases pertinent communication with other health care providers and facilitates selection of the best treatment options for individual patients (Groher & Crary, 2010). contextual factors that serve as barriers to or facilitators of successful swallowing and participation for individuals with swallowing impairments. Instrumental procedures are the only method that provides visualization of swallowing physiology and laryngeal, pharyngeal, and upper esophageal anatomy, which help diagnose dysphagia. Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.
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