Breathing, Digestion and Swallowing: Best Practices in Dysphagia Management

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Handouts/Brochure

Speaker

Angela Mansolillo, MA/CCC-SLP, BCS-S Related seminars and products

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Angela Mansolillo, MA/CCC-SLP, BCS-S, is a speech-language pathologist and board-certified specialist in swallowing disorders with more than 30 years of experience. She is a senior speech-language pathologist at Cooley Dickinson Hospital in Northampton, Massachusetts where she provides evaluation and treatment services for adults and children with dysphagia and is involved in program planning and development including quality improvement initiatives, patient education, and clinical policies and protocols. She is also adjunct faculty at Elms College Department of Communication Sciences and Disorders in Chicopee, Massachusetts and a guest lecturer in the Department of Communication Disorders at the University of Massachusetts. Over the course of her career, she has worked in a variety of clinical settings with children and adult populations with a career-long focus on feeding and swallowing disorders. Recently, she authored Let’s Eat!: A Clinical Guide to the Management of Complex Pediatric Feeding and Swallowing Disorders. Angela is a recent recipient of the Massachusetts Speech and Hearing Association’s Award for Clinical Excellence and is a sought-after speaker for both live and online continuing education courses as she seamlessly blends current research with clinical experience.

 

Speaker Disclosures:
Financial: Angela Mansolillo has an employment relationship with Elms College and Cooley Dickinson Hospital. She is a consultant with Dysphagia Services and receives speaking honorarium from ContinuEd, Medbridge, Advantage CE, and Dilgem Continuing Education. Angela Mansolillo receives a speaking honorarium, recording, and book royalties from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Angela Mansolillo is a member of ASHA.

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Objectives

1. Use your understanding of the interrelationships between the respiratory and gastrointestinal systems to identify and treat the causes and not just the symptoms of dysphagia in your pediatric and adult clients.
2. Evaluate the impact of respiratory and gastrointestinal functions on swallowing systems in order to choose targeted interventions and increase your effectiveness in reducing aspiration risk.
3. Design effective treatment plans for clients with respiratory and GI disease processes including COPD, respiratory failure, and GERD.
4. Prepare your diagnostic tool box to include cough testing, water screenings, pulse oximetry, respiratory muscle strength testing, and other evidence-based tools.
5. Develop successful treatment plans by identifying reflux disease and its impact on swallowing function in your clients.
6. Design assessment strategies that allow you to identify those clients who are more likely or less likely to get sick as a result of aspiration.

Outline

RESPIRATORY SYSTEMS

Breathing/swallowing coordination

• Overview of systems – anatomy/physiology
• Breathing/Swallow coordination
• Coordination and aspiration
• Airway protective mechanisms
• Reflexive cough

GASTROESOPHAGEAL SYSTEMS

The impact on feeding and swallowing

• Esophageal function
• Digestive functions
• Reflux mechanisms
• When does GER become GERD?
• GERD signs and symptoms
• GERD and feeding/swallowing difficulties
• Esophageal/Pharyngeal inter-relationships

GI/RESPIRATORY RELATIONSHIPS

What’s the connection?

• Pressure, energy, and innervation
• Extra-esophageal reflux

ASPIRATION

How much is too much?

• Pulmonary Clearance Mechanisms
• Predictors of pneumonia in various populations

RESPIRATORY DISEASE PROCESSES

The impact on feeding/swallowing

• Pediatric:
  • Infant Respiratory Distress Syndrome (IRDS)
  • Bronchopulmonary Dysplasia (BPD)
  • Respiratory Synctial Virus (RSV)
  • Congenital Heart defects
• Adult:
  • Obstructive Sleep Apnea (OSA) and dysphagia
  • Congestive Heart Failure (CHF)
  • Obstructive Conditions
  • Restrictive Conditions

PNEUMONIAS

It’s not all aspiration

• Pneumonia vs Pneumonitis
• Community Acquired Pneumonia
• Healthcare Acquired Pneumonia
• Aspiration Pneumonia

AIRWAY MANAGEMENT

What’s the impact on swallowing?

• Non-invasive positive pressure ventilation
• High flow nasal cannula
• Intubation
• Tracheostomies

ASPIRATION ASSESSMENT

Clinical Assessment – Making the Most of your Bedside Eval

• Cognitive assessment
• Pitch elevation
• Serial swallows
• Oral mechanism
• Respiratory factors
• Cough
• Respiratory muscle strength
• 3 oz water tests
• Understanding lab values
• Pulse Oximetry

Instrumental assessment – Which type and when?

• Modified Barium Swallow studies
• Fiberoptic Endoscopic Evaluation of Swallowing

ASPIRATION MANAGEMENT

Diet modifications – Not such a benign intervention

• Implications of dietary changes
• Compliance issues
• Thick liquids – pros and cons
• Water protocols

Strategies and Exercises – What does the evidence tell us?

• Compensation
• Sensory interventions
• Principles of exercise physiology
• Lingual strengthening
• Pharyngeal strengthening
• Expiratory muscle strength training

REFLUX ASSESSMENT

What do these tests tell me?

• Upper GI studies
• Ph Monitoring
• Esophagoscopy
• Scintigraphy

REFLUX MANAGEMENT

What’s the dysphagia clinician to do?

• Lifestyle modifications
• Positioning
• Diet modifications
• Medications
• Effects of acid suppression
• Surgical interventions
• New directions in reflux management

Target Audience

• Speech-Language Pathologists
• Speech-Language Pathology Assistants
• Occupational Therapists
• Occupational Therapy Assistants
• Respiratory Therapists
• Nurses
• Nursing Assistants
• Restorative Nursing Staff
• Dietitians
• Dietary Managers
• Long-Term Care Professionals