Neurodisability'Teeth, Tongue and Taste

1
Neurodisability.Teeth, Tongue and Taste
Pauline Watt-SmithSenior Dentist, Royal
Leamington Spa Rehabilitation HospitalBelfast
ISDH13 June 2008
2
Royal Leamington Spa Rehab Hospital
3
Introduction

• It is difficult to find a complete definition of
  Neurodisability as it covers many disorders
• Groups of patients suffering with neurodisability
  may present as a result of trauma, cerebral
  palsy, stroke, MS,MND epilepsy, dementia,
  AIDS,Huntingdons Chorea or as one of the many
  disorders that contribute to neurodisability e.g.
  Friedlichs Ataxia

4
Neurodisability a definition

• Wade has defined Rehabilitation in terms of
  structure, process and outcome
• Structure involves the multidisciplinary team who
  work towards common goals for each patient and
  involve and educate the family
• They have relevant knowledge and skills
• They can resolve most of the common problems of
  their patients

5
Neurodisability and Rehabilitation

• Process involves educational and problem solving
• It focuses on the patients behaviour
  (disability) which includes assessment and goal
  setting
• It evaluates whether intervention is necessary
  and this may include either treatment or support

6
Neurodisability and Rehabilitation

• Outcome aims to maximise participation of the
  patient in their social setting
• Minimise pain and distress experienced by the
  patient
• Minimise stress and distress on patients family
  and carers
• It is a complex process involving a broad range
  of clinical, social and philosophical concepts

7
Patients within Neurodisability

• Patients are referred to Leamington after their
  acute condition has been stabilised. Neurological
  disease places substantial demands on health care
• Consultation statement
• Points highlighted to the patients
• Patients information handbook

8
Patients Information Handbook

• Open Letter
• Welcomes the patient to the ward
• Campion
• Campion ward is for high dependency care
• Nursing
• This explains the colour coding of the uniform
• Catering
• This describes the catering facilities and times
  of meals

9
Patients Information Handbook

• Infection Control
• C.Difficile and MRSA can seriously debilitate an
  already compromised patient so strict hygiene is
  vital and alcohol gel is used by staff and
  visitors
• Neuropsychology
• We have a Consultant Psychologist on site for
  advice and assessment
• Occupational Therapy
• This is a very important part of rehabilitation.
• Physiotherapy
• Again, physiotherapists play an integral role in
  rehabilitation

10
Patients Information Handbook

• Dietician
• Many of the patients are PEG fed with staged
  diets
• Dental
• There are 2 dental surgeries on site and all new
  patients are assessed by the dentist
• Speech
• Speech and Language therapists are an invaluable
  asset to assist in Rehabilitation

11
Facilities within the Rehab Hospital
12
Facilities within the Rehab Hospital
13
Facilities within the Rehab Hospital
14
Facilities within the Rehab Hospital
15
Facilities within the Rehab Hospital
16
Facilities within the Rehab Hospital
17
Facilities within the Rehab Hospital
18
Poor Oral Hygiene in a Peg fed patient
19
Use of a mouth prop to examine
20
An acrylic appliance to raise the soft palate and
improve clarity of speech
21
A stroke victim left with left side hemiplegia
22
The use of a turntable for transfer to dental
chair
23
The brake is applied whilst patient finds balance
24
Brake released and patient is turned
25
Patient sits down confidently
26
We can see patients in their own chair when
hoisting could be difficult
27
Reverse view of tailor made head rest!
28
Oral Hygiene and prevention of oral disease is
vital
29
The use of 2 toothbrush technique
30
Fitting of a full lower implant retained denture
31
Fitting of implant retained full dentures
32
Use of the Bedi wedge for examination
33
A lady with cortico basal degeneration
34
View of fixed limbs and neck
35
Examination of neurologically impaired young woman
36
She has no speech
37
She requires head and limb supports
38
A young man with neurological impairment of
unknown aetiology
39
He required conservative treatment under G.A.
40
He was intubated
41
Scaling and non-invasive build-up of central
incisors
42
The use of intra-nasal midazolam prior to
treatment
43
Hoisting some patients is still necessary
44
After treatment hoisting into chair
45
Summary

• Neurodisability covers many disorders and working
  within a multi disciplinary framework is vital
• Patients within neurodisability require special
  care,however,this should not be a barrier to
• Dental treatment provided and complex dental
  procedures can be executed to improve
  aesthetics,speech and taste.
• Where possible keep it simple and easy for
  patient and carer to maintain.

46
Thank you for your attention.any questions?