The Brain, The Body,and You: Nutrition, Swallowing and HydrationAudrey Brown, SLP & Ruth Doran, ProfessorPresented by St. Lawrence College With support from the MOHLTC Stroke System of Southeastern Ontario

This project is supported by:

Effective SwallowingSensory InputMotor ActivitiesFeedingSwallowingDYSPHAGIA (dis-FAY-ja)Difficulty or discomfort in swallowingAffects 50% of stroke survivors

Factors Affecting SwallowingMotor control of the tongue and facial musclesSensory integrityAbility to understand or use languageCognitionSalivary flowTaste and temperature sensitivityUnderlying conditions

And while were thinking about spitTry thisSwallow the saliva in your mouth now.Do it again.Now do it again.How about once more?Whats happening?

Underlying conditionsGERDDecreased alertnessImpulsive behaviourRespiratory complicationsSensory deficitsAbnormal reflexesReluctance to eat (multi-factorial)

Types of DysphagiaRelated to Phase of the SwallowOral-phase dysphagiaDifficulty manipulating food and forming a bolusOral-pharyngeal dysphagiaDelay or abnormality in transfer of bolus from oral cavity to pharynxEsophageal dysphagiaInefficient/impaired transfer of bolus through upper esophageal sphincter, down esophagus, and into stomachDue to obstruction, dysmotility, or sphincter impairment

Think about itWhat are the challenges YOU face with NUTRITION, SWALLOWING AND HYDRATION in your workplace?NutritionSwallowingHydration

The Interprofessional Dysphagia TeamSpeech-Language PathologistDietitianPhysicianNursing StaffOccupational TherapistPhysiotherapistStroke survivor, family and care providers

What is YOUR roleYou are the FIRST LINE in identifying swallowing problems in your clientsYOU can help actively contribute to:The PLEASURABLE EXPERIENCE of eatingThe IDENTIFICATION of potential swallowing problemsCarrying through with a SWALLOWING CARE PLAN

Dysphagia ScreeningIdentifies the presence or absence of dysphagiaIdentifies risk of complications of dysphagiaWhat is your role?ListenObserveListen some more

How can you tell?Coughing or gaggingThroat clearingHas a wet, gurgly voiceTakes a long time to swallow and eatMay attempt to swallow several timesFood pockets in mouthDroolingPoor chewingComplaints of pain, something sticking

SometimesThere are no signs at all!

Dysphagia ManagementBased on history, assessment findings and prognosisObjectives:To protect the airway from obstructionReduce the chance of food or fluid entering the lungsEnsure adequate nutrition and hydrationMaintain quality of life

Common Special DietsPureed foodsMinced/moist minced foodsNo dry particulates (cookies, pie crust)No bread productsNo mixed consistenciesNo thin fluidsThickened fluids (proceed with caution)Foods which may cause reflux

Swallowing Care PlanPositioning informationPain managementFood/fluid textureAdaptive equipmentFeeding techniquesCommunication strategiesBehaviour managementAfter-meal care

RememberDo not call attention to food textures that are undesirable to you. Yes, this person may rather have a steak and baked potato, but he/she is not able to swallow that texture safely.

YUCK

Complications of DysphagiaAspiration pneumonia, chokingDehydrationMalnutritionIncreased length of hospital stayPlacement decisionsSocial isolationQuality of life issues

DehydrationA client may be at risk for dehydration if he/she:Has the inability to swallow thin fluidsRefuses to take fluids at meals/snacksNeeds assistance to eat/drinkLacks the feeling of thirstHas communication problemsHas memory problemsIs ill (e.g., GI complications, URI)Has a fear of incontinence

What are the signs of dehydration?Decreased urine outputDark, concentrated or foul-smelling urineFrequent UTIsThick, stringy salivaConstipationConfusionRapid weight lossFeverDecreased skin elasticity

What are the signs of malnutrition?Weight lossReduced vitalitySkin breakdownImpaired wound healingReduced resistance to infection

General Feeding Tips and StrategiesKeep client upright at 90 degree angle during meals, and between 60-90 degrees for at least ONE HOUR after mealsHead slightly flexed forwardHead in midlineSmall amounts of food and liquid at a time (think about 1 level teaspoon ONLY) if feedingFollow recommendations (e.g., double swallow, clear throat, cough, turn to left/right, diet modifications)

Also, dont forgetSupport the legs in bed (pillow under knees) and pillows to prop the body to midlineSlow rate of feeding dont forget to talk!ALWAYS be at eye-level or below. Absolutely NO exceptions.Wait for the person to swallow before continuingMinimize distractions. KNOW YOUR CLIENT

Mouth and Dental CareOral HygieneTo remove plaque from teeth, dentures, roof of mouth, tongue and cheeksIdeally after each meal (in some cases, before as well)Especially after last mealCheck for pocketing of foodAssist the client as required in care plan

Oral Care ToolsSoft toothbrush or electric toothbrushAlcohol-free mouthwashIf dentures, denture brush or soaking fluidToothettes are NOT effective plaque is the ENEMY!