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Breathing, Digestion and Swallowing: Best Practices in Dysphagia Management

What’s the safest diet? Is he aspirating? Can she swallow these pills? He hates the pureed food - what else can we do? She’s refusing the thick liquids! Is he going to get pneumonia? Does he need a feeding tube?
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Information

Faculty:
Angela Mansolillo
Duration:
6 Hours 10 Minutes
Format:
Audio and Video
Copyright:
Jul 17, 2020

Description

What’s the safest diet? Is he aspirating? Can she swallow these pills? He hates the pureed food - what else can we do? She’s refusing the thick liquids! Is he going to get pneumonia? Does he need a feeding tube?

These are issues that we face every day in our work with children and adults with dysphagia. How do we keep our clients safe, while making sure they’re well hydrated and well nourished, and normalize eating as much as possible?

Sometimes, it’s about more than just swallowing.

This course will examine the inter-relationships between respiration, gastrointestinal function, and swallowing to allow clinicians to better identify the underlying causes of their client’s swallowing difficulties. We’ll look at specific respiratory and GI diagnoses and their impact on what, when, how much, and how safely our clients eat. Using clinical case studies, we’ll examine the evidence to provide you with the tools you need to perform a thorough assessment and implement a comprehensive treatment plan that takes into account all of the potential contributing factors. ​

Handouts

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

Faculty

Breathing, Digestion and Swallowing: Best Practices in Dysphagia Management

Angela Mansolillo, MA/CCC-SLP, BCS-S Related seminars and products: 10


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 currently 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 for inpatient and outpatient programming including quality improvement initiatives, patient education, and clinical policies and protocols. In addition, she is an adjunct faculty member at Elms College Department of Communication Sciences and Disorders in Chicopee, Massachusetts. Over the course of her career, she has worked in a variety of clinical settings, provided numerous regional and national presentations, and lectured at several colleges and universities throughout Massachusetts. Angela is a sought-after speaker for both live and online continuing education courses as she seamlessly blends current research with clinical experience. She is a recent recipient of the Massachusetts Speech and Hearing Association’s Award for Clinical Excellence.

Speaker Disclosures:

Financial: Angela Mansolillo has an employment relationship with Cooley Dickinson Hospital. She receives a speaking honorarium from PESI, Inc.

Non-financial: Angela Mansolillo is board certified specialist, Swallowing and Swallowing Disorders of the American-Speech-Language-Hearing Association.