(2009) found that dysphagia occurs in over one third of patients admitted to stroke rehabilitation units. Instrumental techniques are usually conducted either independently by the SLP or by the SLP in conjunction with other members of the interprofessional team (e.g., radiologist, radiologic technologist, physiatrist, otolaryngologist). Journal of Gastroenterology and Hepatology Research, 3(5), 10731079. Clinicians should be aware that research into the overall efficacy of dysphagia treatment is ongoing; therefore, treatment options may evolve. (2017). 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). 109(4):578-83. (1991). Kaneoka, A., Pisegna, J. M., Saito, H., Lo, M., Felling, K., Haga, N., LaValley, M. P., & Langmore, S. E. (2017). Comparison of 2 interventions for liquid aspiration on pneumonia incidence: A random-ized trial. Prevalence of dysphagia among community-dwelling elderly individuals as estimated using a questionnaire for dysphagia screening. Prevalence of oropharyngeal dysphagia in Parkinsons disease: A meta-analysis. Instrumental procedures are also used to determine appropriateness and effectiveness of treatment strategies. https://doi.org/10.18502/ijnl.v17i4.592, Alagiakrishnan, K., Bhanji, R. A., & Kurian, M. (2013). Consistent with the World Health Organizations (2001) International Classification of Functioning, Disability and Health framework, the purpose of assessment is to identify and describe. (2012). The manometric examination revealed a markedly elevated resting peak UES pressure and greatly elevated pharyngeal pressures (approximately 250 mmHg). Various neurological diseases are known to be associated with dysphagia. Archives of OtolaryngologyHead & Neck Surgery, 130(2), 208210. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. Dysphagia, 31(3), 424433. Techniques and exercises: Maneuvers: Chin tug and turn. Other studies suggest that dysphagia occurs in 29%64% of stroke patients (Barer, 1989; Flowers et al., 2013; Gordon et al., 1987; Mann et al., 1999). 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). radiation treatment protocols in head and neck cancer; psychosocial, environmental, and behavioral factors. Maintenance and/or maximization of an individuals health status is a primary concern. Hold this posture for 3-5 seconds. Parkinsonism & Related Disorders, 18(4), 311315. Examples of maneuvers include the following: Swallowing exercises include exercises of the lips, jaw, tongue, soft palate, pharynx, larynx, and/or respiratory muscles to improve function. https://doi.org/10.1055/s-0035-1564721, Saito, T., Hayashi, K., Nakazawa, H., Yagihashi, F., Oikawa, L. O., & Ota, T. (2017). https://doi.org/10.1007/s00455-013-9488-3, Sun, Y., Chen, X., Qiao, J., Song, G., Xu, Y., Zhang, Y., Xu, D., Gao, W., Li, Y., & Xu, C. (2020). Additional systematic reviews and studies have reported varied estimates of dysphagia prevalence in the following: drooling and poor oral management of secretions and/or bolus; ineffective chewing, in consideration of the individual variability in mastication cycles and time (Shiga et al., 2012); food or liquid remaining in the oral cavity after the swallow (oral residue); inability to maintain lip closure, leading to food and/or liquids leaking from the oral cavity (anterior loss of bolus); food and/or liquids leaking from the nasal cavity (nasopharyngeal regurgitation); complaints of food sticking or complaints of a fullness in the neck (globus sensation); complaints of pain when swallowing (odynophagia); changes in vocal quality (e.g., wet or gurgly sounding voice) during or after eating or drinking; coughing or throat clearing during or after eating or drinking; difficulty coordinating breathing and swallowing; acute or recurring aspiration pneumonia/respiratory infection and/or fever (Bock et al., 2017; DiBardino & Wunderink, 2015; Marik, 2010); changes in eating habits, for example, avoidance of certain foods/drinks (Sura et al., 2012); weight loss, malnutrition, or dehydration from not being able to eat enough (Saito et al., 2017; Via & Mechanick, 2013); and, complaints of discomfort related to suspected esophageal dysphagia (e.g., globus sensation, regurgitation). This simple exercise can strengthen muscles to improve your swallowing ability. If the individuals swallowing does not support nutrition and hydration via oral intake, the swallowing and feeding team may recommend alternative avenues of intake (e.g., nasogastric [NG] tube, gastrostomy). (2007). Malnutrition, dehydration, and ancillary feeding options in dysphagia patients. Timing refers to the timing of rehabilitation relative to the onset of dysphagia. Dysphagia, 33(2), 258265. International Journal of Speech-Language Pathology, 17(3), 222229. First, the possibility of vocal hyperfunction is a concern due to the effortful phonation produced with the EPG. The natural history and functional consequences of dysphagia after hemispheric stroke. A., & Lam, P. (2014). Annals of the American Thoracic Society, 14(3), 376383. Clinical Interventions in Aging, 7, 287298. However, clinicians were not concerned about the possible effects of this rehabilitation protocol on cardiac events. Oropharyngeal dysphagia profiles in individuals with oculopharyngeal muscular dystrophy. To PEG or not to PEG. A report by the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) estimates that approximately one third of patients with dysphagia develop pneumonia and that 60,000 individuals die each year from such complications (Agency for Health Care Policy and Research, 1999). A systematic review and meta-analysis of pneumonia associated with thin liquid vs. thickened liquid intake in patients who aspirate. American Journal of Speech-Language Pathology, 20(2), 124130. Effortful Swallow Position: Seated upright in a chair Repetitions: 10x Sets: 1x Frequency: 3x/day Steps: 1: Press your tongue firmly against the roof of your mouth 2: Squeeze the walls of your throat together forcefully and swallow hard *Tip: Pretend you are trying to swallow a hard-boiled egg. Swallowing assessment allows the SLP to integrate information from the following: Assessment may result in one or more of the following outcomes: Patients with suspected dysphagia may warrant further instrumental assessment to examine the impact of swallowing anatomy and physiology on clinical presentation (McCullough et al., 2005; OHoro et al., 2015). American Journal of Speech-Language Pathology, 25(4), 453469. Gender difference in masticatory performance in dentate adults. Conservative estimates suggest that dysphagia rates may be. The number of repetitions is patient specific. The VFSS is also known as the modified barium swallow study (MBSS) and is a radiographic procedure used to gain further information regarding dysphagia. https://doi.org/10.1001/archotol.131.9.762, Martino, R., Foley, N., Bhogal, S., Diamant, N., Speechley, M., & Teasell, R. (2005). (2012). Clinical Neurology & Neurosurgery, 104(4), 345351. Kalf, J. G., de Swart, B. J. M., Bloem, B. R., & Munneke, M. (2012). International Journal of Otolaryngology, 2012, Article 157630. https://doi.org/10.1155/2012/157630. Asking the right questions in the right ways. Indications for rehabilitative exercises -appropriate etiology of the dysphagic physiology -cognitively able -motivation to perform exercises independently -good support systems Oral rehab exercises: hypertonicity -slow, progressive stretching exercises to relieve spasms or hyperfunction https://doi.org/10.1007/s00455-015-9637-y, Bchet, S., Hill, F., Gilheaney, ., & Walshe, M. (2016). Nutrition Journal,12(1), 1-8. Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction. All screening procedures include communication of results and recommendations to the team responsible for the individuals care and to the patient and caregivers. determining the effectiveness and possible impact of current diet on overall health (e.g., positioning, feeding dependency, environment, diet modification, compensations). https://doi.org/10.1007/s00455-004-0013-6, Kim, H. D., Choi, J. Gather saliva in your mouth or take a sip of water. Dysphagia management in acute and sub-acute stroke. Diseases of the Esophagus, 31(1), 17. The New England Journal of Medicine, 324(17), 11621167. B., Colantuoni, E., & Needham, D. M. (2017). Prevalence of dysphagia in multiple sclerosis and its related factors: Systematic review and meta-analysis. The effortful swallow achieves overload through high effort. https://doi.org/10.1016/j.otc.2013.08.002, Vose, A., Nonnenmacher, J., Singer, M., & Gonzlez-Fernndez, M. (2014). Monitoring the presence of the signs and symptoms of oropharyngeal and/or esophageal swallowing dysfunction. The benefit of head rotation on pharyngoesophageal dysphagia. An evaluation of the impact of cognitive deficits on safety/functionality of swallowing. American Journal of Physical Medicine & Rehabilitation, 99(8), 701711. Inadequate fluid intakes in dysphagic acute stroke. Otolaryngologic Clinics of North America, 46(6), 965987. https://doi.org/10.1044/2020_AJSLP-19-00063, Garca-Peris, P., Parn, L., Velasco, C., de la Cuerda, C., Camblor, M., Bretn, I., Herencia, H., Verdaguer, J., Navarro, C., & Clave, P. (2007). Ayman, A. R., Khoury, T., Cohen, J., Chen S., Yaari, S., Daher, S., Benson, A. Swallow normally, but tightly squeeze your tongue and throat muscles throughout the swallow. Journal of Oral Rehabilitation, 44(1), 5964. 8, AHCPR Publication No. Patients are instructed to swallow hard. Determine with specificity the relative safety and efficiency of various bolus consistencies and volumes. Dysphagia, 16 (3), 190-195. Screening for dysphagia may be conducted by an SLP or any other member of the patients care team. Preferred practice patterns for the profession of speech-language pathology [Preferred practice patterns]. Scientific Reports,13(1), 2626. Format refers to the structure of the assessment or treatment session, such as whether a person is seen for treatment one on one (i.e., individual), as part of a group during mealtime, or via telepractice. Management of GERD-related chronic cough. (1999). 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. Journal of Communication Disorders, 46(3), 238248. Journal of Clinical Gastroenterology, 51(5), 417420. https://doi.org/10.1016/j.apmr.2006.11.002. understand issues relative to radiation equipment, equipment maintenance, and safety. https://doi.org/10.1097/MCG.0000000000000624, Bahat, G., Yilmaz, O., Durmazoglu, S., Kilic, C., Tascioglu, C., & Karan, M. A. 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). A. Chua, S., Dodd, H., Saeed, I. T., & Chakravarty, K. (2002). typical and atypical parameters of structures and functions affecting swallowing; effects of swallowing impairments on the individuals capacity for, performance in, and participation in activities; and. (2023). The prevalence of dysphagia in community-dwelling adults over the age of 50 years is estimated to be somewhere between 15% and 22% (Aslam & Vaezi, 2013; Barczi et al., 2000), and in skilled nursing facilities, the prevalence rises to over 60% (Steele et al., 1997; Suiter & Gosa, 2019). Although the body of literature concerning the value of electrical stimulation for swallowing is large, the benefits remain unclear (Carnaby-Mann & Crary, 2007; Clark et al., 2009; Humbert et al., 2012; Sun et al., 2020). Journal of Medical Ultrasound, 21(4), 181188. Improved Pharyngoesophageal Segment Opening. Clinical Nutrition, 26(6), 710717. Administration of an interview or a questionnaire that addresses the patients perception of and/or concern with swallowing function (e.g., the 10-item Eating Assessment Tool [EAT-10]; Cheney, 2015). develop a treatment plan to improve the safety and efficiency of the swallow. Seminars in Speech and Language, 21(4), 347364. Molfenter, S. M., Hsu, C.-Y., Lu, Y., & Lazarus, C. L. (2018). Do 5 reps 2 times per day. Wirth, R., Dziewas, R., Beck, A. M., Clav, P., Hamdy, S., Heppner, H. J., Langmore, S., Leischker, A. H., Martino, R., Pluschinski, P., Rsler, A., Shaker, R., Warnecke, T., Sieber, C. C., & Volkert, D. (2016). (2018). Therapeutic exercises. https://doi.org/10.1016/j.clnu.2007.08.006, Gonzlez-Fernndez, M., & Daniels, S. K. (2008). Study with Quizlet and memorize flashcards containing terms like Effortful swallow - targets, Effortful swallow - contraindications, Effortful swallow - dosage and more. assessment of respiratory status, cough, and throat clearing abilities. SLPs work collaboratively with other professionals, individuals, families, and caregivers. The symptoms of cricopharyngeal dysfunction in children can include: difficulty swallowing. (1999). However, other parties (e.g., state regulatory agencies) may require a radiologist to be present during the VFSS. Aghaz, A., Alidad, A., Hemmati, E., Jadidi, H., & Ghelichi, L. (2018). Effortful Swallow . How to do it: Have the client squeeze hard with their swallowing muscles when they swallow. A significant association of malnutrition with dysphagia in acute patients. Archives of Physical Medicine and Rehabilitation, 88(2), 150158. . Special considerations may need to be made regarding PPE for COVID-19. Logemann, J. Internal and external evidence may come from. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. The decision to recommend use of a feeding tube is made in collaboration with the medical team. No contraindications for this technique; do not use with patients with generalized bilateral weakness. Background: Neuromuscular electrical stimulation has been used to improve swallowing function in neurologic patients with dysphagia, but its effect on patients with dysphagia and Parkinson's disease remains unclear. The first pro-posed instruction for the effortful swallow, "as you swal- The effortful swallowing used in our protocol aims to increase muscle strength, improve coordination, and reduce the posterior movement of the tongue base [ 9 ]. INTRODUCTION. Establishing optimal practice patterns. Economic and survival burden of dysphagia among inpatients in the United States. Assessment across the life span: The clinical swallow evaluation. Masako Maneuver: Stick your tongue out of your mouth between your front teeth and gently bite down to hold it in place. Conflict may occur when medical recommendations do not match patient preferences. Chest, 137(3), 665673. The patient, with their proxy, then chooses to accept or reject use of alternative nutrition and hydration following a shared decision making, informed consent discussion. Clinical Rehabilitation, 31(8), 11161125. https://doi.org/10.1016/0003-9993(93)90035-9, Shiga, H., Kobayashi, Y., Katsuyama, H., Yokoyama, M., & Arakawa, I. Assessing and treating dysphagia: A lifespan perspective. See the Assessment section of the Dysphagia Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Aspiration syndromes: Aspiration pneumonia and pneumonitis. 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. https://doi.org/10.1034/j.1600-0404.2002.10062.x, Calvo, I., Sunday, K. L., Macrae, P., & Humbert, I. Some factors to consider while evaluating diet texture modifications for patients with dysphagia include: Despite the risk of aspiration, alternatives to liquid consistency modifications may support overall health of persons with dysphagia when pristine oral health can be maintained (e.g., Frazier Free Water Protocol; Gaidos et al., 2023; Kaneoka et al., 2017; Murray et al., 2016). You can either: Hold this position for 1 minute, and then lower your head and rest for 1 minute. British Medical Journal, 295(6595), 411414. (1992). SLPs with appropriate training and competence in performing electrical stimulation may provide the intervention. Neurogastroenterology & Motility, 30(4), Article e13251. Examining the evidence on neuromuscular electrical stimulation for swallowing: A meta-analysis. the Yale Swallow Protocol (Suiter et al., 2014). 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). (2020). https://doi.org/10.1007/s00520-019-04920-z, Ra, J. Y., Hyun, J. K., Ko, K. R., & Lee, S. J. Journal of Pharmacy Practice and Research,52(4), 283-293. (1993). ASHA recognizes the autonomy of SLPs in completing the VFSS. McGraw Hill. When considering end-of-life issues, it is important for clinicians to respect the patients wishes, including social and cultural considerations. It is important to consider signs and symptoms of dysphagia in the context of other clinical indicators such as the etiology of the dysphagia and the overall health of the patient, rather than relying on a single sign or symptom. Validation of the 3-oz water swallow test for aspiration following stroke. Consideration of the underlying neurophysiological impairment is necessary for understanding swallow function and deficits. These muscles contract in a stereotypic sequence during swallowing and are involved in the biomechanics of hyolaryngeal excursion. Dysphagia in multiple sclerosisPrevalence and prognostic factors. Archer, S. K., Smith, C. H., & Newham, D. J. Journal of Critical Care, 30(1), 4048. Interprofessional practice (IPP) is critical to successfully achieving the desired improvements and outcomes due to complexities of assessment and treatment of swallowing disorders. Patients were asked to "swallow hard" using a "lingual focus" to maximize the oropharyngeal effect of the maneuver [ 14 ]. The physician is ultimately responsible for selecting which type of tube is used, but a brief description of several options is provided below. American Journal of Gastroenterology, 86(8), 965970. A., Pauloski, B. R., Rademaker, A. W., & Colangelo, L. A. High-resolution manometry: What about the pharynx? 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. American Journal of Speech-Language Pathology, 18(4), 361375. The intent of many exercises is to provide lasting functional improvement. cises, swallowing and non-swallowing exercises. Amathieu, R. et al. Dysphagia, 31(1), 4959. Please see ASHAs resource on Alternative Nutrition and Hydration in Dysphagia Care for further information. Effects of transcutaneous neuromuscular electrical stimulation on swallowing disorders: A systematic review and meta-analysis. A later study by Falsetti et al. A., Nicosia, M. A., Roecker, E. B., Carnes, M. L., & Robbins, J. Provider refers to the person providing the assessment or treatment (e.g., SLP, trained volunteer, caregiver). supraglottic swallow, super supraglottic swallow, effortful swallow/Valsalva maneuver, mendelsohn maneuver. ), Normal and abnormal swallowing (pp. 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. Prospective, randomized . Presence and severity of co-morbidities (e.g., dehydration, renal disease, respiratory infections). Squeezing hard with their tongue and throat https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.01.009, Flowers, H. L., Silver, F. L., Fang, J., Rochon, E., & Martino, R. (2013). 6. International Journal of MS Care, 2(1), 4050. Zhou, D., Jafri, M., & Husain, I. Developing the tongue holding maneuver. (2016). intake. https://doi.org/10.1001/archneur.1992.00530360057018, DiBardino, D. M., & Wunderink, R. G. (2015). A number of epidemiologic reports indicate that the prevalence of dysphagia is more common among older individuals and that sarcopenia is positively associated with dysphagia (Barczi et al., 2000; Bhattacharyya, 2014; Bloem et al., 1990; Cabr et al., 2014; Roden & Altman, 2013; Sura et al., 2012; Zhao et al., 2018). Using ethnographic interviewing strategies during the assessment process is an excellent way to gather information about an individuals specific needs (Westby et al., 2003). SLPs lead the team in. Verification of aspiration and thorough assessment of impairments in swallowing physiology or laryngeal/pharyngeal/upper esophageal anatomy require instrumental assessment. https://doi.org/10.1016/j.archger.2012.04.011, American Speech-Language-Hearing Association. Code of ethics [Ethics]. SLPs should maintain competency of skills through reading current research and engaging in continuing education. Hospital Practice, 38(1), 3542. Systematic review and meta-analysis of the association between sarcopenia and dysphagia. A. Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. Qualified SLPs may also screen for esophageal motility and gastroesophageal reflux disease (GERD) to identify the need for appropriate referral. side effects of some medications (e.g., Balzer, 2000); metabolic disturbances (e.g., hyperthyroidism); infectious diseases (e.g., COVID-19, sepsis, acquired immune deficiency syndrome [AIDS]); Meux & Wall, 2003); pulmonary diseases (e.g., chronic obstructive pulmonary disease [COPD]); identifying signs and symptoms of dysphagia; identifying normal and abnormal swallowing anatomy and physiology supported by imaging; identifying indications and contraindications specific to each patient for various assessment procedures; identifying signs of potential disorders in the upper aerodigestive and/or digestive tracts and making referrals to appropriate medical personnel; assessing swallow function as well as analyzing and integrating information from such assessments collaboratively with medical professionals, as appropriate; providing treatment for swallowing disorders, documenting progress, adapting and adjusting treatment plans based on patient performance, and determining appropriate discharge criteria; identifying and using appropriate functional outcome measures; understanding a variety of medical diagnoses and their potential impact(s) on swallowing; recognizing possible contraindications to clinical decisions and/or treatment; being aware of typical age-related changes in swallow function; providing education and counseling to individuals and caregivers; incorporating the clients/patients dietary preferences and personal/cultural practices as they relate to food choices during evaluation and treatment services; respecting issues related to quality of life for individuals and/or caregivers; practicing interprofessional collaboration; educating and consulting with other professionals on the needs of individuals with swallowing and feeding disorders and the SLPs role in the diagnosis and management of swallowing and feeding disorders; advocating for services for individuals with swallowing and feeding disorders; performing research to advance the clinical knowledge base; and.

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