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Research Question:

In what ways can speech-language pathologists (SLPs) provide effective treatment for moderate to severe dysphagia?

Foundation Questions:

1. What is dysphagia?

2. What are the effects of dysphagia?

Tentative Points:

I plan to explain the different treatment methods that are used by SLPS for moderate to severe dysphagia. I will discuss what is dysphagia and also the effects of dysphagia. I plan on discussing the effects of dysphagia by exploring the emotional, nutritional, and medical aspects of the disorder.

Genres:

Genre 1: Webliography

Voice: Clinician voice

Audience: General audience

Rationale: The webliography was developed in order for those visiting my site to get a better sense of who I am.

Genre 2: Poem

Voice: Client voice

Audience: Client's Family

Rationale: The poem will be developed to help explain to the client's family what the client is experiencing.

Genre 3: Journal Entry

Voice: Client

Audience: Client, since it is a personal journal

Rationale: The client will discuss his therapy and progress along the course of treatment for dysphagia.

Genre 4: Email Exchange

Voice: Client & Client's Spouse

Audience: Client & Client's Spouse

Rationale: The email exchange will be used to describe what went on in the first day of speech. The client will discuss his dysphagia and the course of treatment that the speech therapist will be using.  

Genre 5: Pamphlet

Voice: Clinician

Audience: General Audience

Rationale: The pamphlet will be developed to allow the general audience to gain a better understanding of dysphagia.

 Genre 6: Powerpoint Presentation

Voice: Clinician voice

Audience: Client & Family

Rationale: The powerpoint presentation will be developed in order to offer basic information about dysphagia treatment to patients and their families.

Genre 7: Observation Report

Voice: Clinician

Audience: Clinician

Rationale: The clinician will observe the client and develop a report of her observations in order to develop an appropriate plan of treatment.

Anticipated Integration of Genres:

I plan to integrate my genres by developing a letter from the client to his wife. The letter will explain the client's feelings and explanation of everything that has gone on since his diagnosis of dysphagia.

Tentative Resources:

Angell, M. E., & Bailey, R. L. (2005). Improving feeding skills and mealtime behaviors in children and youth with disabilities. Education and Training in Developmental Disabilities, 40 (1), 80-96. Retrieved September 29, 2005, from the PsycINFO database.

Arvedson, J.C. (2000). Evaluation of children with feeding and swallowing problems. Language, Speech, and Hearing Services in Schools, 31 (1), 28-41. Retrieved September 29, 2005, from the ERIC database.

Barer, D., Davies, S., MacDonald, A., & Taylor, H. (2001). An inter-disciplinary approach to swallowing problems in acute stroke. International Journal of Language & Communication Disorders, 36, 357-362. Retrieved October 3, 2005, from PsycINFO database.

Chambers, E., Garcia, J.M., & Molander, M. (2005). Thickened liquids: Practice patterns of speech-language pathologists. American Journal of Speech-Language Pathology, 14 (1), 4-13. Retrieved September 29, 2005, from Academic Search Premier database.

Chang, Y.C., Han, D.S., Lu, C.H., & Wang, T. G. (2005). Comparison of disordered swallowing patterns in patients with recurrent cortical/subcortical stroke and first-time brainstem stroke. Journal of Rehabilitation Medicine, 37 (3), 189-191. Retrieved October 3, 2005, from Academic Search Premier database.

Connolly, M. J., & Smith, H.A. (2003). Evaluation and treatment of dysphagia following stroke. Topics in Geriatric Rehabilitation, 19 (1), 43-60. Retrieved October 3, 2005, from the Academic Search Premier database.

Donahue, P.A. (1990). When it’s hard to swallow: Feeding techniques for dysphagia management. Journal of Gerontological Nursing, 16 (4), 6-9. Retrieved October 3, 2005, from the PsycINFO database.

Donaldson, N., Kalra, L., Ramsey, D., & Smithard, D. (2005). Is the gag reflex useful in the management of swallowing problems in acute stroke. Dysphagia, 20 (2), 105-107. Retrieved October 3, 2005, from Medline database.

Douglas, G.R. (1991). Peer-mediated procedures to induce swallowing and food acceptance in young children. Journal of Applied Behavior Analysis, 24 (4), 783-790. Retrieved September 29, 2005, from the ERIC database.

Finestone, H.M., & Green-Finestone, L.S. (2003). Rehabilitation medicine: Diagnosis of dysphagia and its nutritional management for stroke patients. Canadian Medical Association Journal, 169 (10), 1041-1044. Retrieved October 3, 2005, from the Academic Search Premier database.  

Hagg, M., & Larsson, B. (2005). Effects of motor and sensory stimulation in stroke patients with long-lasting dysphagia. Dysphagia, 19 (4), 219-230. Retrieved October 3, 2005, from the Medline database.

Logemann, J. A. (2000). Therapy for children with swallowing disorders in the educational setting. Language, Speech, and Hearing Services in Schools, 31 (1), 50-55. Retrieved September 29, 2005, from the ERIC database.

Love, C.P., & Perry, L. (2001). Screening for dysphagia and aspiration in acute stroke: A systematic review. Dysphagia, 16 (1), 7-18. Retrieved October 3, 2005, from the Medline database.

Diagnosed with a swallowing disorder.

You have to change the way you eat and drink.

Swallowing is no longer easy for me.

Please tell me how to deal with all of this.

Happened to get choked today.

Aspiration is a word they used, but it’s all new to me.

Speech therapists are supposed to help me learn to compensate.

Interesting techniques they are having me to try.

Am I ever going to be the same?

March 1, 2005

Dear Journal,

Today was not the best day for me. I went for some testing with the speech therapist, radiologist, and x-ray technician. They made me do something called a modified barium swallow, and it was not very enjoyable. I had to sit in a special chair and swallow different things coated with barium. First, they had me drink some barium and it looked like a milkshake, but unfortunately for me, it tasted more like chalk and was pretty disgusting. They told me the barium was so they could see my swallowing on the x-ray. I guess the test didn’t last for more than 30 minutes, but it felt like forever. They were changing my position and trying different things so that I wouldn’t get choked and I could maybe swallow different things better. I am at a point now where every time I eat or drink, I am wondering if I will get choked and aspirate (which is my new technical word the speech therapist taught me). Today I was just so nervous and wondering what was going to happen. I think my apprehension was the worst thing of the day. Hopefully that was my first and last modified barium swallow.

October 5, 2005

Dear Journal,

Today was the first time that I have been out to eat since my stroke. My wife finally talked me into it. She said that I need to not be embarrassed about having to do things differently than other people when I eat. I guess she’s right, I just didn’t really want the world to know that I am different now. I have worked for a good while in therapy just to get to this point. It wasn’t too bad I suppose. Not many people were in the restaurant, so I felt more comfortable. I brought my thickener with me and put it in my drink. I still can’t get that stuff exactly right, and I don’t care what they tell me, putting that stuff in your drink makes it taste different. Anyway, I just ordered some mashed potatoes because I didn’t want to try anything too difficult. I used some of my compensatory techniques. Mainly I do the head turn because it’s my favorite. I think it’s pretty simple to do and it’s not that noticeable to others. I am really glad I went because now I know that I can, and I kind of felt like I was a little bit closer to the way my life was before. It made my wife really happy too.       

To: loves2garden@mail.com

From: footballfan@mail.com

Kathy,

Hey honey, how is everything going? I know you wanted me to e-mail you and let you know what went on in therapy today as soon as I could, so here you go.

The therapy is going to take some time, I think. I have been feeling pretty overwhelmed with it all. I know that I am just starting my therapy, but this is going to take some effort on my behalf. Since this was only my first day in therapy, the speech therapist began talking about what all we are going to be working on. I think I understood most of it. She told me that I have a moderate swallowing disorder, which is called dysphagia. We already knew that, though. She then told me that two of the biggest problems with me is that I have what they call a delayed swallow and also poor laryngeal closure. I think we’ve talked about all of this before with her, but I actually understood what was going on this time. The delayed swallow is exactly how it sounds. It is just that for some reason I am taking more time than normal to actually swallow. It should be a natural reflex, but mine is no longer quick and natural. The poor laryngeal closure is a little more difficult to explain, but I’ll try. My vocal folds are what helps me make voice, but they also close to help stop food from going into my airway and then into my lungs. Mine are not closing all the way anymore. So, when I swallow things can go down into my airway and I will get choked, and the food and drink can go down into my lungs. If it goes into my lungs, then there will be a big problem because I will most likely get pneumonia. None of that sounded very good to me, but it was good to know.

So, after telling me about my problem, the speech therapist went over some things that we are going to do to try and help my delayed swallow and also my poor laryngeal closure. We even tried a few things today, but we just did a sort of dry run without any food. She told me that in order to help close my vocal folds and protect my airway, there are some things I can do that are really simple. One of them was called the chin tuck. You basically put your chin down while you swallow and it is supposed to make it harder for food or drink to get into your airway. She also did a pretty neat thing to help with my delayed swallow. She had an ice cold little mirror with a long arm on it and she put it in my mouth and sort of stroked a place towards the back of my mouth. It made me swallow automatically, it was pretty neat.

Well, this was a long e-mail, but I think I covered a lot of went on today. I hope you have a good day at work. I’ll see you at home.

Love you,

Mark

To: footballfan@mail.com

From: loves2garden@mail.com

Mark,

I’m glad that your day wasn’t too bad. I know that therapy is going to be really tiresome and hard on you. I just want you to get better, and I know that the speech therapist can help you. I have been so worried about you since you were diagnosed with this, but for the first time I am starting to feel more comfortable with it all. The fact that you are already working on things to help you is simply amazing to me. Hopefully I will get to go with you next time to your session with the speech therapist so I can see what all you guys are working on. If I know what you are supposed to be doing, I will be able to watch you more and make sure you are following your orders =)

I can’t wait to get home this evening so you can show me the things you learned in therapy today. Your explanation of your problem really helped me to understand it. I think when they told us all of this before, we were just so upset and overwhelmed that everything didn’t sink in. I’m glad that she took the time to go over it all with you again. This is all so exciting!

I have to get back to work, but everything sounds wonderful. I am so glad that everything is working out for us. I really feel like everything is going to be okay. I will see you soon!

Love,

Kathy  

To: loves2garden@mail.com

From: footballfan@mail.com

Hey Honey,

I’m so glad that you are excited about all of this. I was kind of worried that you would still be worrying yourself sick about everything. It makes me feel much better knowing that you are starting to relax a little! You are as much a part of this as I am. I think everything that has happened has possibly affected you even more than it has me. It’s good to see you happy again.

The more I thought about it, the more excited I got to go back to therapy again. Isn’t that funny? I thought you would have to drag me to therapy every week kicking and screaming, but I might be more of an adult than either of us imagined.

Oh, I forgot to tell you one other thing that the speech therapist mentioned. She said that I need to have liquids that have a sort of thick consistency because that will help the liquid from going into my airway. That made a lot of sense, I guess. She showed me how thick it needed to be, and called it honey thick, or about the consistency of honey. She gave me a thickener that is a powder that you can put into your drinks to make it thick like that. I didn’t like it at all, but it wasn’t too big of a deal. So, I can’t drink water or anything without putting that stuff in it. I’m sure you’ll always be there to remind me =)

I hope the rest of your day is wonderful. I know that I will enjoy the rest of mine. I love you!

Love,

Mark

What is dysphagia?

Dysphagia is when the action of swallowing is difficult to perform. Occasional difficulty swallowing usually does not require any sort of remediation, but persistent difficulty may be indicative of a serious medical condition. Dysphagia is most common in older adults, but can occur at any age.

Signs and symptoms of dysphagia:

Swallowing repeatedly

Coughing or choking while eating

Pocketing of food or food is kept in the mouth unintentionally

“Wet” quality of voice while eating

Sensation of food being stuck in your throat

Not being able to swallow at all

Recurring pneumonia

Weight loss or dehydration

Causes of dysphagia:

Dysphagia can be caused by any condition that weakens or damages the muscles or nerves that are involved in swallowing. Some of these conditions include:

Stroke

Old Age

Multiple sclerosis

Parkinson’s disease

Alzheimer’s disease

Motor Neurone Disease

Cancer of mouth and/or throat

Head and neck injuries

Cerebral palsy

Muscular dystrophy

Amyotrophic lateral sclerosis (Lou Gehrig’s disease)

Treatment for dysphagia:

After dysphagia is diagnosed, a speech-language pathologist will often help to remediate the swallowing process. There are several forms of treatment for dysphagia, depending on the cause, symptoms, and type of swallowing problem. Treatment may be compensatory, which is used to eliminate the symptoms of dysphagia with little change to the actual process of swallowing. Treatment may also involve active swallowing therapy that will change how the patient swallows and the muscle function. Compensatory techniques are generally tried first because they do not require extra muscle effort and patients do not fatigue easily.

Compensatory techniques can include changing the head or body position of the patient, increasing sensory information, changing the food amount or thickness, and making changes to the patient’s eating strategy. The speech-language pathologist will try different techniques and decide which is best for the patient.

Swallowing therapy includes exercising the muscles that are used during swallowing. This therapy will change the way a person swallows. These techniques may include exercising the lips, tongue, jaw, and vocal folds. Chewing exercises may also be used to improve coordination of the tongue and jaw while eating. Other techniques include swallowing maneuvers that help the patient to gain better control over particular areas of their swallow.

Where to go for help:

If you believe that you or a loved one is suffering from dysphagia, contact your doctor immediately. Your doctor will discuss the possible medical causes of the dysphagia with you. A speech-language pathologist may then perform an evaluation and begin providing treatment if necessary. Other medical specialists may also be involved to help evaluate and treat the dysphagia.

Resources:

Bloom, R. L., & Ferrand, C. T. (1997). Introduction to organic and neurogenic disorders of communication. Needham Heights, MA: Allyn and Bacon.

Difficulty swallowing. (2005, October 12). Retrieved October 22, 2005, from http://www.mayoclinic.com/invoke.cfm?id=DS00523

Swallowing problems in adults. (2005). Retrieved October 23, 2005, from http://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Adults.htm

Go to the following URL to view my PowerPoint presentation on dysphagia...

http://mupfc.marshall.edu/~sirk4/Dysphagia%20Treatment.ppt

Click on the page to transition between slides.