Hospital mealtime volunteers workshop

Julie Quinn Speech and Language Therapist (x2712)21/12/12

By the end of the training you will have a better understanding of the:• Prerequisites for safe eating and drinking• Process of normal swallowing• Warning signs of a swallowing problem (dysphagia)• Types of patients who may experience a swallowing

problem• Practical strategies to support eating and drinking• Actions to take if there is a problem identified

What do you need to do in order to eat and drink safely?

The stages of the normal swallow

Normal swallowing process

• Eating and drinking central to our life• Complex and rapid process involving more than 50

muscles• Voluntary and involuntary control• 4 stages of swallowing• Frequency 2x times per minute

What do we do when we eat and drink?

• What position is your head in, in relation to your body?

• What do your lips do before and after each mouthful?

• What is your tongue doing?• Are you breathing? Do you stop at any point?• Are you able to talk? What happens to your voice

box?• How is drinking different from eating?

Stages of normal swallowingStage 1: Anticipatory phase

• Environment• Sight, smell, touch• Hand to mouth• Saliva• Access • Health

Stage 2 – Oral phase (mouth)• Putting food in mouth• Chewing• Mixing food with

saliva• Lips keep the food in

the mouth• Tongue moves the

food around

Stage 3 – Pharyngeal phase (throat)

• Involuntary phase• Airway shuts to stop

food / drink going wrong way

• Muscles of throat push food down towards oesophagus (gullet)

Stage 4 – Oesophageal phase (gullet)

• Top of oesophagus (gullet) opens

• Food pushed down by rhythmical movement

• Sphincter opens at bottom of oesophagus – food enters stomach

The normal swallow animation

http://www.linkstudio.info/images/portfolio/medani/Swallow.swf

What can go wrong when eating and drinking?

Signs of a swallowing problem• Poor lip closure – food / liquid leaking out of

mouth, dribbling• Difficulty biting and chewing• Difficulty getting the food into a soft ball in the

mouth and moving it backwards• Food pocketing in mouth / sticking to teeth• Food / drink coming down nose

Signs of a swallowing problem• Coughing or choking on food and drink• Wet gurgly voice• Increased breathing rate / shortness of breath• Slow to swallow / swallow not triggering • Avoiding certain food textures• Food sticking in the throat• Fear of eating• Recurrent chest infections

What are the main causes of swallowing problems (dysphagia)?

Potential Causes of swallowing problems

• Neurological changes - stroke, parkinson’s disease, MS, head injury

• Dementia (in end stages)• Structural changes – cancer of the mouth /

throat, surgery or trauma, laryngectomy• Severe confusion / deliruim• Reduced levels of consciousness

Potential consequences of a swallowing problem

• Chest infection / pneumonia• Malnutrition / dehydration /

weight loss• Longer stays in hospital• Slower physical recovery• Anxiety / distress /

embarrassment• Reduced quality of life

What do you do if you think that someone has a swallowing problem?

Stop! Report to the nurse immediately

Vulnerable patients – Issues for discussion

Involving mealtime volunteers with patients who:-

• have swallowing problems??? • are challenging because of their behaviour??• Need to be fed??

Thank you for listening

Any comments, questions?