speech and swallowing

7/30/2019 Speech and Swallowing

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2011 Annual Membership Meeting

SPEECH & SWALLOWINGAnne G. Lefton, M.A. / CCC-SLP

Nancy Sedat & Associates

Swallowing

Transference of material from:

Mouth Esophagus

Throat Stomach

3 Phases of Swallowing

Oral

Pharyngeal

Esophageal

Normal Swallow Sequence


In the mouth:

lips, teeth and tongue help

for further stages ofswallowing.

Lips

Teeth

Tongue

Bolus


Access between the nasal

cavity and mouth closes

pharynx (throat).

Nasal Cavity

Pharynx

Bolus


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Bolus is propelled

esophagus

s esop agus en ranceopens: Epiglottis helps

guard against access to

the lungs.

Epiglottis

To the Lungs

Esophagus Entrance


The airway reopens and

the esophagus entrance

contractions move bolustoward 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 Sheltmanfrom Follow the Swallowby Jo Puntil-Sheltman

Evaluation of Swallowing Function

Non-instrumental clinical evaluation

Instrumental assessment

Modified Barium Swallowing Study (MBSS) aka: Videofluorosco ic Swallowin Examination

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)


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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 cough

2. Heimlich Maneuver

3. Stack breathin

4. Portable suction

5. CoughAssist device

[www.respironics.com]

CoughAssist

Mechanical In-Exsufflator

Reducing Risk of Aspiration

Swallowing techniques

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

Reducing Risk of Aspiration [cont.]

Changes in food & liquid consistencies

Avoid problem textures and consistencies

Gel/powder liquid thickener

Steak consistency diet

Pot roast consistency diet

Meat loaf consistency diet

Pudding consistency diet

Cream consistency diet (tube feedings)


Positioning

Head and neck support

Chin tuck

Scandishake

Behavioral changes

Reduce distractions

Eat more calories early in the day or when there is less

fatigue


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Pill management

Take with applesauce, yogurt, pudding, ice cream, or

any other slippery medium Long-necked bottles

Carbonated beverages

Cool Whip!

Crush with pharmacists 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

Feeding Tubes [cont.]

Decisions to have or not have:

Used to maintain nutrition/hydration; consider before

eating becomes exhaustive Risks increase as respiratory function declines

Will not eliminate the risk of choking on saliva

Ataxia and Speech


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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)

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

Sometimes likened to drunken s eech

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

HyponasalityMay occur due to timing errors between the muscles of the

velum and the other muscles of articulation.

Soft Palate / Velum


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Phonation: the sound of the voice

Harsh vocal quality

due to decreased muscle tone Vocal tremor


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

s or e vowe s

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) Im rove breath su ort and coordination of breathin 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 speechSLOW 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


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Compensatory Strategies

For the Communication Partner Ascertain patients preferred strategy when not intelligible

Decrease the need for repitition fatigue and frustration

Ask yes/no questions Know the topic

Maintain eye contact

Give undivided attention

Dont interrupt or finish sentences

Let the speaker know the parts of the message you did notunderstand so s/he will not have to repeat the entiremessage.

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,

ere s a ways a way o eep you unc on ng

at the highest level possible.

2011 Annual Membership Meeting

THANK YOU!Anne G. Lefton, M.A. / CCC-SLP

Nancy Sedat & Associates

References

Freed, D. (2000). Motor speech disorders diagnosis and treatment. SanDiego, 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

gui e oo or peope wit ataxia. National Ataxia Foundation, 1-60.

Yorkston, K.M., Beukelman, D.R., & Bell, K. (1988). Clinical management ofdysarthric speakers. San Diego, CA: College-Hill Press.

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