Nmc_header
Home Home | NovaMind Home | Heart_white Friends | Mail_white 0 New Messages | Person_white Profile | ? Help
Login | Sign Up
Search:  Signup to RSS feed
 Subscribe
Share/Save/Bookmark

Dysphagia in PD

Dysphagia in Parkinson's Disease>

Mind Map branch: Dysphagia in PD Dysphagia in PD management holistic considerations PD features: depression Cognitive impairment Medication on/off cycles assessments clinical bedside VF FEES CA treatment approach mainly compensatory strategies body posture/head position liaise with PT OT consistency adaptation advice liaise with dietician most nutritional and safest for swallowing consistencies oral stage disorder: hard consistencies likely difficult assess impact individually thickened fluids necessary? alter bolus size sensory stimulation pharyngeal swallow delay El Sharkawi et al 2002 MDT/dietitian liason food and fluid intake limiting factors fatigue Poor concentration slowness small high calorie snacks appropriate? + cognitive impairment: verbal timely oral routine for swallow thermochemical stimulation ice cold citrus drink traditionally viewed to assist in triggering swallow Hamdy et al 2003: (stroke pts and normals) time/swallow ability to control slower bolus? sip capacity risk of valleculae residue overspill? c/o food sticking in pharynx alter head position alternate solids/liquids clear remaining residue post solid swallows medication No PD meds in syrup form controlled release tablets crushing Dispersable Madopar dissolved and thickened if severe dysphagia NG with Dispersable Madopar Apomorphine injection UK approved 1993 same effect as levodopa but avoidance of on/off cycling agonist to LD side effects low incidence neuro-psych problems Paraenteral delivery infusion injection Expensive: underused research ongoing medication delivery methods alert carers: signs of aspiration emergency procedure for choking food pocketing likelihood oral hygiene issues regular dental apts needed medications causing mouth dryness safe feeding techniques (if PT unable to feed self) Pts dependent on others for feeding aspiration risk Langmore et al 1998 give: accurate, individualised advice: feeding Swallowing verbal written direct therapy LSVT improves swallowing El Sharkawi et al 2002 51% in VF observed swallowing motility disorders neuromuscular control overflow: increased effort saliva management therapeutic head and body positioning verbal/electronic reminders to swallow fluid intake if drooling causes excessive fluid  liaise with: dietician Patient and carers Pharmacological Hyosine patch SE's in older people: hallucination Confusion sublingual atropine effective Occasional SEs easy and inexpensive Botulinum toxin for ++ severe cases wears off over few months repeated injections SE: toxin spreads into pharyngeal MM. swallowing difficulty Surgical excision/rerouting not preferred option in older, later stage PD QOL impact drooling: often late stage feature most pts have this to some degree Embarrassment / frustration Prevelance  95% of PD sufferers Logemann et al 1975 severity still significant feature of condition manage assess usually not severe enough to require non-oral feeding presentation VF shows motility disorders in all swallow stages (Logemann 1988) oesophageal phayrngeal aspiration silent aspiration laryngeal elevation/closure delayed swallow trigger oral disturbed lingual movements ROM/coordination ant-post bolus movement bolus control chewing tongue based retraction causes erratic tablet absorption response to residue in valleculae impact on saliva control rocking/pumping tongue motion

Map Branches

Comments

►0 map comments of 0 total for this map