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Copy of Medical Template for Doctors and Medical Sales Representatives

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Transcript of Copy of Medical Template for Doctors and Medical Sales Representatives

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Denton Shanks, OGME-3, MPH
Kiki Sheriff, OGME-2, MBS
Kara Lappin, OMS-III, MPH Candidate

Case Presentation
Types of Dysphagia
Prevelance & Incidence
Neurological Dysphagia
Etiology and Pathology
Diagnosis & Treatment
The ASHA defines dysphagia as a Feeding and swallowing disorders in any step of the feeding process—from accepting foods and liquids into the mouth to the entry of food into the stomach and inteastines.
Swallowing difficulty falls into three groups: esophageal, oropharyngeal, and unknown.

Oropharyngeal dysphagia is caused by disorders of the
nerves and muscles in the throat, which make
the muscles weak. This makes it difficult for a person
to swallow without choking or gagging. The causes
of oropharyngeal dysphagia are conditions that primarily affect the nervous system.

Esophageal dysphagia is the feeling that something is
stuck in your throat.

Prevalence of pediatric dysphagia is increasing due to improved survival rates of children born prematurely about 20% since 1990.

25%-45% of typically developing children demonstrate feeding and swallowing problems

Prevalence is estimated to be 30%-80% for children with developmental disorders

Significant feeding problems resulting in severe consequences (e.g., growth failure, susceptibility to chronic illness) have been reported to occur in 3%-10% of children, with a higher prevalence found in children with physical disabilities (26%-90%) and medical illness and prematurity (10%-49%

(Kakodkar & Schoroeder 2013)

Arvedson, 2008; Bernard-Bonnin, 2006; Brackett, Arvedson, & Manno, 2006; Burklow, Phelps, Schultz, McConnell, & Rudolph, 1998; Lefton-Greif, 2008; Linscheid, 2006; Manikam & Perman, 2000; Rudolph & Link, 2002).
Neuromuscular cordination
Signs & Symtoms
Signs and symptoms of swallowing and feeding disorders vary based on the age of child, but may include
back arching;
breathing difficulties when feeding that might be signaled by
increased respiratory rate during feeding,
skin color change such as turning blue,
stopping frequently due to uncoordinated suck-swallow-breathe pattern,
desaturation (decreasing oxygen saturation levels);
changes in normal heart rate (brachycardia or tachycardia) in association with feeding;
coughing and/or choking during or after swallowing;
crying during mealtimes;
decreased responsiveness during feeding;
difficulty chewing foods that are texturally appropriate for age (may spit out partially chewed food);
difficulty initiating swallowing;
difficulty managing secretions (including non-teething related drooling of saliva);
disengagement cues, such as facial grimacing, finger splaying, or head turning away from food source;
frequent congestion, particularly after meals;
frequent respiratory illnesses;
loss of food/liquid from the mouth when eating;
noisy or wet vocal quality noted during and after feeding;
prolonged feeding times;
refusing foods of certain textures or types;
taking only small volumes, over-packing the mouth, and/or pocketing foods;
vomiting (more than typical "spit up" for infants);
weight loss or lack of appropriate weight gain.
Factors affecting Neuromuscular coordination
Premature infats
they lack Neurological maturity to coordinate sucking, swallowing, and breathing
Depending on gastric tube feeding
Independent feeding does not develop in most until well after the gestation

Premature infants’ extended dependence on tube feeding raises the possibility that sensory deprivation may impact upon their early feeding development.
Feeding behavior begins prenatally
swallowing first appears as early as 11 weeks gestation
sucking behavior appears by about 18 to 20 weeks
Premature infants’ extended dependence on tube feeding
raises the possibility that sensory deprivation may
impact upon their early feeding development
Neuromuscular cordination
Premature Babies & Dyspahgia
Prolong dysphagia in premature infants not only
because they entail a delay in oral feeding trials,12 but also
because they interrupt sequences of appetitive and
ingestive behaviors that compose important learning
Prematurituy also is link with other developmental and sever anomalities

physiological and anatomical anomalities

neurologcal anomailties

develepmental anomalities etc
Neuromuscular cordination
Premature Babies & Dyspahgia
Neuromuscular cordination
Premature Babies & Dyspahgia
Neuromuscular cordination
Premature Babies & Dyspahgia
-Difficulty in swallowing that occurs as consequence of disease to either the organs and muscles involved in swallowing, or more commonly to the central nervous system controlling swallowing
Neurogenic Dysphagia
-Cranial nerves help aid in the process of swallowing
V Trigeminal
VII Facial Nerve
IX Glossopharygeal Nerve
X Vagus Nerve
XI Spinal Accessory Nerve
XII Hypoglossal Nerve
Swallowing in the Nervous System
• multiple sclerosis
• amyotrophic lateral sclerosis
(ALS or Lou Gehrig's disease)
• muscular dystrophy
• cerebral palsy
Damages to the nervous system:
Dysphagia & Autism
Disruption in cranial nerve development

"The result of a brain that is not developing & working properly"

"brainstem and the cranial nerve circuits are the root of the problem"
(La Mantia, A.)
Dysphagia & Autism
Dysphagia & Autism
Dysphagia & Autism
Dysphagia & Autism
(take-away: cause is on a neurological level)
prenatal vitamins

critical in early pregnancy for proper neurodevelopment
Risk reduction
Food selectivity- type & texture
(oral preperatory phase)

Possible for occurance of Dysphagia during
any of the stages of swallowing

Different experience for every child
child's experience
Specific impairments identified by SLP

Focus on client's unique disabilities

"Diagnosis- specific treatment of feeding disorders
results in significantly improved energy consumption and nutrition"
Diagnostic Methods
Bedside swallow (Inderect)
Barium Swallow
Fiber optic endoscopy

Dietary Changes
-Restrict diet
-BUT, least restrictive, safest

Liquid Levels
-Thick liquids are easier to
Food Levels
Diet Level 1
-Moderate to severe Dysphagia
-Chewing should be avoided
-Pureed food with pudding-like consistency
Diet Level 2
-Moderate to mild Dysphagia
-Some chewing required
-Soft, moist foods

Diet Level 3
-Mild Dysphagia
-All foods, cut up
The Medulla
-Important functions for swallowing!
Cleft Palate
Structural abnormality
Nasal regurgitation
Babies with cleft lip can typically feed normally, but not cleft palate
Sucking is not the same as babies with regular palates

They are safe and removable
Provide support that normalizes the intraoral cavity
Stimulate mouth
Nasal Regurgitation
Hold baby upright
Lactation specialist may be needed for successful feedings and growth
There are bottles with special nipples available for babies with cleft palate
Cleft Palate
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