DYSPHAGIA MANAGEMENT WITH FEES: A CaseBased Approach

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DYSPHAGIA MANAGEMENT WITH FEES A Case-Based
Approach

• Cathleen Bergin, EdD, CCC-SLP
• Rebecca L. Gould, MSC, CCC-SLP, BRS-S
• Joy Hesse, MA, CCC-SLP
• Susan Langmore, PhD, CCC-SLP, BRS-S
• Joseph Murray, PhD, CCC-SLP, BRS-S
• Cesar Ruiz, SLPD, CCC-SLP
• November 20, 2008

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• More than 15 million Americans have some degree
  of dysphagia, and with regular treatment 83
  recover or significantly improve.
• Bello, J. (1994) compiled by Communication
  Facts. ASHA Research Division

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• Pneumonia occurs in 38 of all stroke victims
  and is the most common respiratory complication.
  Pneumonia contributes to about 34 of all stroke
  deaths and represents the third cause of
  mortality in the first month following
  stroke. Stepphens Addington, 1999

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• IS IT SAFE TO FEED
• THIS PATIENT?

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• STATE OF THE ART
• EVALUATION

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EVALUATION

• Clinical bedside swallow evaluation.
• Videofluoroscopic Swallowing Study (VFSS)
• Fiberoptic Endoscopic Evaluation of Swallowing
  (FEES)
• (Reflexive cough test)

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Assess secretions
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ASPIRATION
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Residual

• FEES

• VFSS

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SCALE PREDICTIVENESS OF PNEUMONIA RISK IF FED

• FACTORS
• Multiple or progressive disease/one diagnosis
• Multiple medications (gt5)/ lt5 medications
• NPO (PEG)/ oral
• Oral hygiene fair poor/ good excellent
• Smoker / non-smoker

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SCALE PREDICTIVENESS OF PNEUMONIA RISK IF FED
(contd)

• FACTORS
• Inpatient / outpatient
• Physical ability (mobile)/ sedentary
• Reflexive cough (present) / absent delayed
• Cognitive status (fair-poor)/ good excellent
• Secretion Pooling (minimal) / copious

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SCALE PREDICTIVENESS OF PNEUMONIA RISK IF FED

• Score
• lt 7 Use extreme caution
• 5-6 fair good
• lt3 good excellent