“The best practice for swallowing is swallowing” – Dysphagia in Children and Adults

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Swallowing Evaluation and Rehabilitation

Check my other post:
Dysphagia - Feeding & Swallowing Disorders in Infants & Children

http://slpzone.blogspot.com/2012/05/feeding-and-swallowing-disorders-in.html    

Dysphagia and Swallowing Therapy and Treatment, Diet and Liquid Consistency

http://slpzone.blogspot.com/2012/04/dysphagia-and-swallowing-therapy-and.html

 

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I refreshed my knowledge about Dysphagia by viewing ASHA webinars:

“Elements of a Comprehensive Clinical Dysphagia Evaluation presented” by Joseph Murray, PhD, CCC-SLP

“Impact of Impaired Antomy and Physiology on Treatment of Dysphagia in Adults” presented by Nancy B. Swigeret, MA CCC-SLP, BCS-S

“Dysphagia Intervention: Planning and Implementation” presented by Nancy B. Swigeret, MA CCC-SLP, BCS-S

“Theoretical Basis of Exercise and Treatment of Dysphagia” Nancy B. Swigeret, MA CCC-SLP, BCS-S

 

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What is normal swallowing?

Normal swallowing consists of a set of physiologic behaviors which result in food, liquid or other substances moving from the mouth to the pharynx and esophagus while protecting and closing the airway to the stomach. Swallowing is an important part of eating and drinking.

What is swallowing dysfunction?

When the process fails and the bolus is aspirated, this is called swallowing dysfunction or dysphagia. Dysphagic patients may have difficulty with any one or more of the anatomic or physiologic components of the oral, pharyngeal or esophageal stages of the swallow.

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What is a role of swallowing evaluation?

Evaluation of the patient with dysphagia should identify the anatomic or physiologic abnormalities characterizing the patient's swallow and include introduction and assessment of the efficacy of treatment strategies.

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What is the primary goal in the management of swallowing disorders?

The primary goal in the management of swallowing disorders is to ensure safe swallowing. For determination of the appropriate rehabilitative approaches, clinicians should consider the assessment of all symptoms and problems causing dysphagia.

What are tree types of management?

The management of swallowing disorders:

• medical management
• surgical approaches
• rehabilitative approaches.

What are the types of treatment?

Treatment may involve:

• compensatory management, such as postural changes or enhancing sensory input
• rehabilitative management, such as active muscle exercise with or without the introduction of food.

Sensory Diet Activities

The sensory diet, a term originally developed by Occupational Therapist and Sensory Processing Disorder research pioneer Patricia Wilbarger, is a carefully designed, personalized activity schedule that provides the sensory input a person's nervous system needs to stay focused and organized throughout the day. A person whose nervous system is on "high trigger" will need more calming input, while someone who is more "sluggish" will need more arousing input to "jazz" up her nervous system. Infants, young children, teens, and adults can all benefit from a well-designed sensory diet.

http://www.amazon.com/Raising-Sensory-Smart-Child-SensoryProcessing/dp/0143115340/ref=sr_1_fkmr0_1?s=books&ie=UTF8&qid=1336190524&sr=1-1-fkmr0

References: 

Raising a Sensory Smart Child, By Lindsey Biel, OTR/L and Nancy Peske, with a foreword by Dr. Temple Grandin 

More Sensory Resources (Including Sensorimotor, Movement & Self-Regulatory Titles) you will find at

http://www.parentbooks.ca/Autism_Sensory_&_Sensorimotor.html 

  

Tactile

Tactile input is the sense of touch and includes texture, temperature, pressure, and more. Don't forget that the tactile system includes not only the skin covering your body but also inner skin linings such as inside the mouth.

        

Toddlers and Preschoolers

Let her drink plain seltzer or carbonated mineral water to experience bubbles in her mouth (you can flavor with lemon, lime, etc.). Play with foamy soap or shaving cream, add sand for extra texture, use fingerpaint, play with glitter glue, mix cookie dough and cake batter, and so on. Let your child use the playground sandbox or create your own at home, filling a bin with dry beans and rice or other materials. Use clay such as Play-Doh (the classic Play-Doh Fun Factory provides excellent proprioceptive input as well). Don't force a child who is unwilling to touch all these "yucky" substances. Let her use a paintbrush, stick, or even a toy for cautious exploration.

      

Schoolage kids

Eat frozen foods (popsicles, frozen fruit or vegetables), dress up in fun costumes to get used to the feel of unfamiliar clothing, garden and repot indoor plants, play with make-up and face painting.

Smell

If your child has sensory problems, certain odors can stimulate, calm, or send him into sensory overload.

• Explore scents with your child to find the ones that work best to meet your goal (either to calm or to wake up). While everyone has different preferences, lavender, vanilla, and rose are generally calming. Peppermint and lemon are usually invigorating. Let's say your child needs help staying calm and loves lavender. You can use lavender soaps and bath oils to ease bath time, lavender candles or oils in an aromatherapy burner or machine at bedtime, and lavender body lotion. 
• If your child is overtired at the mall and you know scents help, have her smell her favorite scent or stop into a strongly-smelling store that sells candles and soaps. 
• Play a smelling game with your SI child. Have her close her eyes or wear a blindfold and try to identify smells such as maple syrup, apple, peanut butter, and soap. 
• Life stinks sometimes. Accept your child's opinion about something she thinks smells "gross." Then help her find something that smells nice.

Taste

Taste input is strongly influenced by smell (e.g.: chew gum until the flavor is gone, then hold a lemon under your nose; the gum will taste like lemon). 

• Strong tastes can stimulate the mouth of a child with SI and make him more willing to try new foods. Before presenting new foods, let the child have one peppermint, sour gummy bear, or other strong-flavored food. 
•  If your child does not have a strong negative reaction to refined sugar (becomes very "hyper" or gets very sleepy), get an assortment of flavored jellybeans. Eat one at a time, and have her guess which flavor it is. 
• Children will be more likely to taste something if they help make it. Let him help you select foods. For example, let him choose between chicken or fish, string beans or sugar snaps, and potato or rice. Then let your child arrange the meat in the baking pan, break off vegetable tips and dump in water, and so on. Let him help you arrange food on each plate into a pleasing presentation. 
• Don't forget to play with your food. A so-called picky eater may be more willing to eat "rocks and trees" than meatballs and broccoli.

Sample Sensory Diet

Here is a sample sensory diet, created for a second grade child whose sensory seeking behavior interfered with his attention and learning. We've used the annoying term, "as directed," to avoid providing a cookbook recipe. Activities should be individualized for each child and modified frequently to meet changing needs. A separate program was worked out for this child with the school, including frequent movement breaks, an inflatable seat cushion for wiggling while remaining seated, and providing crunchy/chewy oral comfort snacks at handwriting time. 

Morning Routine Massage feet and back to help wake up   Listen to therapeutic listening CD  Use vibrating toothbrush and vibrating hairbrush  Crunchy cereal with fruit and some protein   Spin on Dizzy Disc Jr. as directed  Jump on mini-trampoline as directed

After school Go to playground for at least 20 minutes Push grocery cart or sister's stroller Spinning as directed  Mini Tramp — add some variety: have him play catch or toss toys into a basket while jumping Massage feet to "reorganize," use theraputty, body sox, make body sandwiches, wheelbarrow walk Do ball exercises as directed Listen to therapeutic listening CD  Oral work — sucking thick liquids through a straw (smoothies, etc.), crunchy and chewy snacks (to give input into jaws and teeth) prior to and/or during homework

Dinner Time Help with cooking, mixing, chopping, etc.   Help set table, using two hands to carry and balance a tray  Provide crunchy and chewy foods

Night time Family time: clay projects, painting projects, etc.  Warm bath with bubbles and calming essential oil  Massage during reading time

Sensory Problems - Management Tips

Tips adopted from a book, Raising a Sensory Smart Child, by Lindsey Biel, OTR/L and Nancy Peske

http://www.amazon.com/Raising-Sensory-Smart-Child-SensoryProcessing/dp/0143115340/ref=sr_1_fkmr0_1?s=books&ie=UTF8&qid=1336064418&sr=1-1-fkmr0

You can find more interesting books placed under each section. Enjoy.

Toothbrushing

·   To desensitize gums, provide tactile input. Wear a rubber finger cot, swipe with a washcloth, or use an Infadent finger cot or Toothettes (available from Achievement Productsfor Children)

·   If your child can't tolerate foamy toothpaste, try Orajel toddler toothpaste, which does not foam.

·   Develop a predictable routine for when and how to brush. Help your child choose the brushing pattern which will always be used. For example, she could decide to always start with the top teeth and to brush from left to right, front to back. A consistent brushing pattern will help your child motor plan this complex activity, learn to predict when and where she will feel various sensations (rather than be a "victim" of horrible sensations), and help your child feel proud about keeping her mouth and teeth nice and clean.

http://www.amazon.com/Brushing-Your-Teeth-Can-Fun/dp/0789315947/ref=sr_1_1?s=books&ie=UTF8&qid=1336065098&sr=1-1

Bathing

·   If your child doesn't like "slimy" soap or shampoo, try foamy soap (also good for tactile play—unlike shaving cream, it doesn't have a strong smell).

·   Try using a large container of water for rinsing since the extra weight of the water might feel soothing. Alternately, your child might be more comfortable if he simply feels in control of the water. In this case, provide a sprinkling can (beach or garden toy) or a hand-held shower attachment. Count together to rinsing: "1, 2, 3, rinse."

·   Use a foam visor or a washrag held over the face when rinsing. This is good for a child who hates water on his face or who hates tilting his head back for rinsing. You might also have him dry his face immediately after washing it even if he's still in the shower or bath.

·   If toweling dry is a problem, experiment with softer (or harder) towel textures. You can also try pre-warming the towel in the dryer for a few minutes.

http://www.amazon.com/Bathing-Without-Battle-Person-Directed-Individuals/dp/0826101240/ref=sr_1_fkmr0_2?ie=UTF8&qid=1336063948&sr=8-2-fkmr0  

Going to Bed

·   Make sure the room is dark enough (or light enough) for your child to sleep. A small amount of light might comfort one child, while light creeping in through the curtains or under the door might disturb another.

·   Try a white noise machine, fan, aquarium, or even a radio set on static to create white noise to block out sleep-disturbing sounds. Some children fall asleep more easily listening to gentle clasical music or CDs specifically designed to promote sleep. Check out Baby Go to Sleep sleep CDs.

·   Give calming deep pressure input via a backrub or massage using long, firm strokes. Even just squeezing her feet, legs, hands, and arms, can be very soothing at bedtime. You can also try using a weighted blanket (available from SouthpawEnterprises and Abilitations.)

http://www.amazon.com/Theres-Monster-Under-My-Bed/dp/0689714092

Getting a Haircut

·   Massage your child's scalp before a haircut using your hands or a vibrating hairbrush (available from Abilitations).

·   Go to a kid-friendly haircutting place or create your own at home with candy and an absorbing video to watch.

·   Have the barber or stylist give the child a big soft brush or a dry washrag with baby powder on it to brush off stray hair as it is cut. Use baby powder on irritated skin afterward.

http://www.amazon.com/Its-Haircut-Time-overcame-haircut/dp/1935567330/ref=sr_1_fkmr0_1?s=books&ie=UTF8&qid=1336065471&sr=1-1-fkmr0

Clothing

·   Some tactile-defensive kids insist on supersoft, all-cotton clothing (think: pre-worn = pre-softened).

·   Some children are more comfortable wearing snug clothing or tight clothing worn beneath their other clothes. Try bicycle shorts, tights, "too small" t-shirts, etc.

·   When buying clothes for a tactile-sensitive child, avoid scratchy nylon threads and items made of polyester blends which can pill and cause discomfort.

·   Buy seamless socks.

http://www.amazon.com/Animals-Should-Definitely-Wear-Clothing/dp/0689708076/ref=sr_1_1?s=books&ie=UTF8&qid=1336067715&sr=1-1

Shopping

·   Avoid shopping during peak hours when stores are most crowded and noisy.

·   Let your child push the grocery cart for sensory input. Many grocery stores have junior carts for smaller children. Also, pushing a stroller can help a toddler or preschooler get calming input. Add packages for extra weight.

·   Give your child some control and a sense of predictability. Young children can help find groceries on the shelf, match groceries to a picture list, or follow a picture list of chores you will be doing that day. Older kids can help you write lists, find items, pull out coupons, or check items off your to-do list.

http://www.amazon.com/Possum-Child-Shopping-Little-Critter/dp/0590328069/ref=sr_1_1?s=books&ie=UTF8&qid=1336066530&sr=1-1

Potty Training

·   Some children are disturbed by the size and feel of a large toilet seat. Bring your child to the store and help her to pick out a potty chair or a small, cushioned vinyl ring that fits onto an adult toilet seat.

·   Some children are frightening by the sound of flushing. A sense of control might help: together, count off to the flush, for example: "1, 2, 3, FLUSH!" Make lots of noise as the toilet is flushing, shouting "hooray!"

·   Sometimes, tight clothes provide sensory input that distracts a child from the sensation of needing to use the potty. Loose clothing such as boxer shorts may help him recognize when he has the urge to go.

http://www.amazon.com/It-Hurts-When-Poop-Children/dp/1433801302/ref=sr_1_1?s=books&ie=UTF8&qid=1336067283&sr=1-1

See all 15 Favorite Potty Training Books

http://www.parents.com/toddlers-preschoolers/potty-training/gear/15-favorite-potty-training-books/