2011 annual membership meeting speech & swallowing anne g. lefton, m.a. / ccc-slp nancy sedat...
TRANSCRIPT
2011 Annual Membership Meeting
SPEECH & SWALLOWINGAnne G. Lefton, M.A. / CCC-SLPNancy Sedat & Associates
“It feels like there’s something stuck in my throat!”
Swallowing
Transference of material from:
3 Phases of Swallowing
Oral Pharyngeal Esophageal
Normal Swallow Sequence
Normal Swallow Sequence
In the mouth: lips, teeth and tongue
help prepare bolus (food mass) for further stages of swallowing.
LipsTeeth
TongueBolus
Normal Swallow Sequence
Access between the nasal cavity and mouth closes as bolus moves into pharynx (throat).
Nasal CavityPharynx
Bolus
Normal Swallow Sequence
Bolus is propelled esophagus
As esophagus entrance opens: Epiglottis helps guard against access to the lungs.Epiglottis
Vocal CordsTrachea/Airway to the
LungsEsophagus Entrance
Normal Swallow Sequence
The airway reopens and the esophagus entrance closes as muscle contractions move bolus toward stomach.
To the Stomach
Swallowing Disorders
Swallowing Disorders / Dysphagia Oral Stage
Difficulty controlling, forming, or transporting a cohesive bolus
Swallowing Disorders / Dysphagia Pharyngeal Stage
Pooling or Stasis Aspiration
Illustrations by Elliot Sheltman from Follow the Swallow by Jo Puntil-Sheltman
Evaluation of Swallowing Function Non-instrumental clinical evaluation Instrumental assessment
Modified Barium Swallowing Study (MBSS) aka: Videofluoroscopic Swallowing Examination
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Thin Liquid Swallows
Puree Swallows
Cookie Swallows
Complications from Dysphagia Pneumonia
Risk increases as dysphagia worsens Choking Longer Meal Times Malnutrition Dehydration Weight Loss Quality of Life
Loss of social interaction associated w/ eating
Treatment
What to Do?
Immediate remedies:1. If coughing/choking, never inhibit cough2. Heimlich Maneuver3. Stack breathing4. Portable suction5. CoughAssist device
[www.respironics.com]
CoughAssist™Mechanical In-
Exsufflator
Safe Swallowing Strategies
Swallowing techniques Don’t talk with mouth full Repeat swallows Alternate solids and liquids
One sip at a time Sip ‘n’ tip straws Smaller bites Slowed rate Supervision and cueing Smaller, more frequent meals per day
Safe Swallowing Strategies [cont.] Changes in food & liquid consistencies
Avoid problem textures and consistencies Gel/powder liquid thickener
Diet Hierarchy Steak consistency diet Pot roast consistency diet Meat loaf consistency diet Pudding consistency diet Cream consistency diet (tube feedings)
Safe Swallowing Strategies [cont.] Positioning
Chin tuck Behavioral changes
Reduce distractions Eat more calories early in the day or when
there is less fatigue
Safe Swallowing Strategies [cont.] Pill management
Take with applesauce, yogurt, pudding, ice cream, or any other slippery medium Cool Whip! Long-necked bottles Carbonated beverages
Crush with pharmacist’s consent
Alternative Methods of Nutrition
Feeding Tubes
G-tube goes into stomach through an opening in skin
Feeding Tubes [cont.]
What it does: Provides nutrition via an alternate route Allows one to receive required nutrition and
hydration when no diet texture can be swallowed safely or when oral feeding is not meeting nutritional / hydration needs
Allows for the combination of oral eating for pleasure and tube feeding for fluids and calories
Ataxia and Speech
Speech
“Normal” sounding speech requires perfect coordination of the following systems: Articulatory system (e.g., lips, tongue, etc.) Resonatory system (e.g., velum/soft palate) Phonatory system (e.g., vocal cords) Respiratory system (e.g., lungs)
Random Speech Facts…
Approx. 14 different sounds produced every second when we verbalize.
Over 100 different muscles coordinate during speech.
“Its Greek to Me”
Ataxia comes from: Greek word for “lack of order”
Ataxic Dysarthria
Disorder of sensorimotor control for speech production that results from damage to cerebellum or to its input and output pathways
Effects of Ataxia on Speech
Effects of Ataxia on Speech
Articulation: disruption of the timing, force, range, and direction of movements. Imprecise consonant articulation Distorted vowels
Breakdown is most evident during longer strings of speech
Effects of Ataxia on Speech [cont.] Resonance:
Hypernasality Hyponasality
May occur due to timing errors between the muscles of the velum and the other muscles of articulation.
Soft Palate / Velum
Effects of Ataxia on Speech [cont.] Phonation: the sound of the voice
Harsh vocal quality due to decreased muscle tone
Vocal tremor
Effects of Ataxia on Speech [cont.] Respiration:
Uncoordinated movements of the respiratory muscles Exaggerated movements
Excessive loudness Paradoxical movements (different muscle
groups work against each other) Talking too quickly Decreased vocal volume Trying to talk on residual air
Most Common Speech Changes Imprecise consonants Excess and equal stress Articulatory breakdown Distorted vowels Harsh vocal quality Mono pitch/Mono loudness Slowed speech rate
Treatment
What to do about it…
1. Evaluation by a Speech-Language Pathologist
2. Treatment Exercises will target the affected system(s)
Improve breath support and coordination of breathing and speaking
Rate control techniques (e.g., finger/hand tapping to set the pace of appropriate syllable production)
Increase articulatory accuracy: over-articulate Develop stress and intonation skills to regulate
pitch and loudness
Compensatory Strategies
For the Speaker... Energy conservation Minimize environmental noise/distractions Establish context of message Alter your rate of speech…SLOW it down. Exaggerate articulation of final consonants
in words Use gestures/point to props Boil down the message
decrease “filler” words Keep important/key words
Compensatory Strategies
For the Communication Partner… Ascertain patients preferred strategy when not
intelligible Decrease the need for repetition fatigue and
frustration Ask yes/no questions Know the topic Maintain eye contact Give undivided attention Don’t interrupt or finish sentences Let the speaker know the parts of the message
you did not understand so s/he will not have to repeat the entire message.
Patience
Augmentative/Alternative Communication (AAC) Low tech
Communication board Alphabet board Phrase board
High tech Speech generating devices
An SLP can help explore your options
Other Voice amplification
Chattervox OR SoniVox
Take Home Message
With regard to speech or swallowing, there is always a way to keep you
functioning at the highest level possible.
2011 Annual Membership Meeting
THANK YOU!Anne G. Lefton, M.A. / CCC-SLPNancy Sedat & Associates
References
Freed, D. (2000). Motor speech disorders diagnosis and treatment. San Diego, CA: Singular Thomson Learning, 2000.
Puntil-Sheltman, J. (1997). Follow the swallow. Seal Beach, CA: Sheltman Publishing, 37-40.
Rangamani, G.N., J. (2006). Managing speech and swallowing problems: A guidebook for people with ataxia. National Ataxia Foundation, 1-60.
Yorkston, K.M., Beukelman, D.R., & Bell, K. (1988). Clinical management of dysarthric speakers. San Diego, CA: College-Hill Press.