Dysphagia

According to the American Speech-Language Hearing Association (ASHA),

What are feeding and swallowing disorders?

Feeding disorders include problems gathering food and getting ready to suck, chew, or swallow it. For example, a child who cannot pick up food and get it to her mouth or cannot completely close her lips to keep food from falling out of her mouth may have a feeding disorder.

Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:
■Oral phase – sucking, chewing, and moving food or liquid into the throat
■Pharyngeal phase – starting the swallow, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking
■Esophageal phase – relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach

What are some signs or symptoms of feeding and swallowing disorders in children?

Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child.

The following are signs and symptoms of feeding and swallowing problems in very young children:
■arching or stiffening of the body during feeding
■irritability or lack of alertness during feeding
■refusing food or liquid
■failure to accept different textures of food (e.g., only pureed foods or crunchy cereals)
■long feeding times (e.g., more than 30 minutes)
■difficulty chewing
■difficulty breast feeding
■coughing or gagging during meals
■excessive drooling or food/liquid coming out of the mouth or nose
■difficulty coordinating breathing with eating and drinking
■increased stuffiness during meals
■gurgly, hoarse, or breathy voice quality
■frequent spitting up or vomiting
■recurring pneumonia or respiratory infections
■less than normal weight gain or growth

As a result, children may be at risk for:
■dehydration or poor nutrition
■aspiration (food or liquid entering the airway) or penetration
■pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
■embarrassment or isolation in social situations involving eating

How are feeding and swallowing disorders diagnosed?

If you suspect that your child is having difficulty eating, contact your pediatrician right away. Your pediatrician will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders. A speech-language pathologist (SLP) who specializes in treating children with feeding and swallowing disorders can evaluate your child and will:
■ask questions about your child’s medical history, development, and symptoms
■look at the strength and movement of the muscles involved in swallowing
■observe feeding to see your child’ s posture, behavior, and oral movements during eating and drinking
■perform special tests, if necessary, to evaluate swallowing, such as: ■modified barium swallow – child eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
■endoscopic assessment – a lighted scope is inserted through the nose, and the child’s swallow can be observed on a screen.

The SLP may work as part of a feeding team. Other team members may include:
■an occupational therapist
■a physical therapist
■a physician or nurse
■a dietitian or nutritionist
■a developmental specialist

Your child’s posture, self-feeding abilities, medical status, and nutritional intake will be examined by the team. The team will then make recommendations on how to improve your child’s feeding and swallowing.

If feeding therapy with an SLP is recommended, the focus on intervention may include the following:
■making the muscles of the mouth stronger
■increasing tongue movement
■improving chewing
■increasing acceptance of different foods and liquids
■improving sucking and/or drinking ability
■coordinating the suck-swallow-breath pattern (for infants)
■altering food textures and liquid thickness to ensure safe swallowing

What causes feeding and swallowing disorders?

The following are some causes of feeding and swallowing disorders in children:
■nervous system disorders (e.g., cerebral palsy, meningitis, encephalopathy)
■gastrointestinal conditions (e.g., reflux, “short gut” syndrome)
■prematurity and/or low birth weight
■heart disease
■cleft lip and/or palate
■conditions affecting the airway
■autism
■head and neck abnormalities
■muscle weakness in the face and neck
■multiple medical problems
■respiratory difficulties
■medications that may cause lethargy or decreased appetite
■problems with parent-child interactions at meal times

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Brain Functions

Parietal Lobe Functions

  • Sense of touch
  • Spatial perception
  • Differentiation (identification) of size, shapes, and colors
  • Visual perception 

Occipital Lobe Functions

  • Vision

Cerebellum Lobe Functions

  • Balance
  • Skilled motor activity 
  • Coordination
  • Visual perception 

Brain Stem Functions

  • Breathing
  • Arousal and consciousness
  • Attention and concentration 
  • Heart rate
  • Sleep and wake cycles 

Frontal Lobe Functions

  • Attention and concentration
  • Self-monitoring
  • Organization
  • Speaking (expressive language)
  • Motor planning and initiation
  • Awareness of abilities and limitations
  • Personality
  • Mental flexibility
  • Inhibition of behavior
  • Emotions
  • Problem solving 
  • Planning and anticipation
  • Judgment  

 

Temporal Lobe Functions

  • Memory
  • Understanding language (receptive language)
  • Sequencing 
  • Hearing
  • Organization  

Right Hemisphere Brain Damage

According to the American Speech-Language and Hearing Association (ASHA),

What is right hemisphere brain damage?

Right hemisphere brain damage is damage to the right side of the brain. The brain is made up of two sides, or hemispheres. Each hemisphere is responsible for different body functions and skills. In most people, the left side of the brain contains the person’s language centers. The right side controls cognitive functioning (thinking skills).

Damage to the right hemisphere of the brain leads to cognitive-communication problems, such as impaired memory, attention problems and poor reasoning. In many cases, the person with right brain damage is not aware of the problems that he os she is experiencing (anosognosia).

What are some signs or symptoms of right hemisphere brain damage?

Cognitive-communication problems that can occur from right hemisphere damage include difficulty with the following:

  • attention
  • left-side neglect
  • memory
  • organization
  • orientation
  • problem solving
  • reasoning
  • social communication (Pragmatics)

Attention: difficulty concentrating on a task and paying attention for more than a few minutes at a time. Doing more than one thing at a time may be difficult or impossible.

Left-side neglect: a form of attention deficit. Essentially, the individual no longer acknowledges the left side of his/her body or space. These individuals will not brush the left side of their hair, for example, or eat food on the left side of their plate, as they do not see them or look for them. Reading is also affected as the individual does not read the words on the left side of the page, starting only from the middle.

Memory: problems remembering information, such as street names or important dates, and learning new information easily.

Orientation: difficulty recalling the date, time, or place. The individual may also be disoriented to self, meaning that he/she cannot correctly recall personal information, such as birth date, age, or family names.

Organization: trouble telling a story in order,giving directions, or maintaining a topic during conversations.

Problem solving: difficulty responding appropriately to common events, such as a car breakdown or overflowing sink. Leaving the individual unsupervised may be dangerous in such cases, as he or she could cause injury to himself or herself, or others.

Reasoning: difficulty interpreting abstract language, such as metaphors, or responding to humor appropriately.

Social communication (pragmatics): problems understanding nonverbal cues and following the rules of communication (e.g., saying inappropriate things, not using facial expressions, talking at the wrong time).

How can I communicate more effectively with a person with right hemisphere brain damage?

  • Ask questions and use reminders to keep the individual on topic
  • Avoid sarcasm, metaphors, etc., when speaking to the individual
  • Provide a consistent routine every day
  • Break down instructions to small steps and repeat directions as needed
  • Decrease distractions when communicating
  • Provide appropriate supervision to ensure the person’s safety
  • Stand to the person’s right side and place objects to the person’s right if he or she is experiencing left-side neglect
  • Use calendars, clocks, and notepads to remind the person of important information

What causes right hemisphere brain damage?

The causes of right hemisphere brain damage include the following:

  • infection/illness
  • stroke
  • surgery
  • traumatic brain injury (TBI)
  • tumor

 

Dementia

What is dementia?

Dementia is a group of symptoms related to memory loss and overall cognitive impairment. Most types of dementias continue to worsen and are usually irreversible.

Alzheimer’s disease is the most common and well-studied cause of dementia, affecting up to 70% of those diagnosed with dementia.

People with dementia often need help taking care of themselves. They may have difficulty communicating with others. Everyday activities such as grooming, preparing meals, and driving may become difficult.

What are some signs or symptoms of dementia?

The symptoms of dementia can be different depending on the diagnosis. In most cases, people with dementia have a gradual loss of memory and other cognitive functions.

As the disease gets worse, an individual may experience the following:
■Confusion
■Difficulty on the job
■Getting lost in familiar areas
■Problems handling personal affairs (e.g.,finances, housekeeping, grooming)
■Personality changes
■Depression (as the person recognizes his or her deficits)
■Significant memory loss
■Difficulty following simple directions
■Decreasing communication skills
■Difficulty swallowing
■By the final stages, inability to feed himself or herself, walk independently, or speak intelligibly.

What treatments are available for people with dementia?

Several medications exist that seem to slow down the progression of symptoms, but they do not reverse the disease. More often, behavioral interventions are used to help the person recall important information or performing daily activities.

A speech-language pathologist (SLP) can help the person with dementia use strategies to preserve communication and cognitive functioning for as long as possible. Examples of strategies include
■using written cues for completing tasks or to assist memory recall
■developing “memory books” to help recall personal information
■training family members or caregivers in how to communicate better with the person with dementia (see below for examples)

If the individual has swallowing problems, the SLP can work with the person to ensure safe swallowing. This may include teaching compensatory strategies or altering the person’s diet so that he or she can eat without risk of choking or illness.

The ultimate goal of any intervention is to preserve the person’s quality of life for as long as possible.

What can I do to communicate better with a person with dementia?

There are things that caregivers can do to help the person with dementia function more effectively in his or her daily life. Useful techniques include:
■repeating key information when talking with the person to help maintain focus
■giving the person choices rather than asking open-ended questions (e.g., “Would you like coffee or tea?” instead of “What do you want to drink?”)
■keeping information and questions short and simple
■using written cues for activities (such as how to get dressed or how to prepare a simple meal) and to remind the person about appointments or to take medications
■attending support groups to learn about how others cope with the stresses of caring for someone with dementia
■using adult day cares or respite cares to prevent caregiver burnout