What Are Different Types of Swallowing Problems?

The evaluation of the rehabilitation of dysphagia mainly focuses on the swallowing function, and the rehabilitation methods are mainly aimed at the swallowing function, and appropriate diet and psychological guidance are given.

Swallowing disorder rehabilitation

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The evaluation of the rehabilitation of dysphagia mainly focuses on the swallowing function, and the rehabilitation methods are mainly aimed at the swallowing function, and appropriate diet and psychological guidance are given.

Western Medicine Name

Swallowing disorder rehabilitation

Affiliated Department

Department of Physiology-Stomatology

Cause

Both

Meaning

Obstacles in transporting food from the mouth to the stomach

1. Definition: Dysphagia is a manifestation of obstacles in the process of transporting food from the mouth to the stomach. Eating due to impaired mandibular, lips, tongue, soft palate, throat, esophageal sphincter or esophageal function

1.General evaluation before feeding

(1) Basic diseases: Grasp the occurrence and development of different basic diseases such as brain injury, tumors, and myasthenia gravis, etc., which is conducive to adopting different rehabilitation methods.

(2) Whole body state: Pay attention to the problems such as fever, dehydration, low nutrition, respiratory state, physical strength, disease stability, etc., and confirm whether the patient is in a state suitable for feeding.

(3) Level of consciousness: Use Glasgow Coma Scale to evaluate the state of consciousness and confirm whether the patient's level of consciousness can be consciously eaten and whether it has changed over time.

(4) Advanced brain function: observe whether there is any problem with language function, cognition, behavior, attention, memory, emotion or intelligence level. Different scales can be used for analysis.

2. Evaluation of feeding-swallowing function

(1) Observation of oral function: Careful observation of mouth opening and closing, lip atresia, tongue movement, drooling, soft palate lifting, swallowing reflex, vomiting reflex, dental status, oral hygiene, articulation, vocalization (nasal opening: Soft palate palsy; wet hoarseness: saliva and other residues in the upper vocal cords), oral consciousness, taste, etc.

(2) Observation of swallowing function: There is no need for equipment, and there are two types of tests that can be performed by the bedside:

A. "Repeated saliva swallowing test": The examinee takes a sitting position and takes a relaxed position when lying in bed. The examiner placed his fingers on the throat and hyoid bones of the examinee and allowed them to swallow repeatedly as quickly as possible. Observe the number of times that the throat and hyoid bones crossed the fingers with swallowing movement within 30 s, moved forward and upward, and then reset. Senior patients can do it 3 times.

B. "Drinking test": Ask the patient to drink two or three mouthfuls of a teaspoon of water. If there is no problem, watch the patient take a seat, swallow 30 ml of warm water, and record the drinking situation. .Drink more than two times without gluttony; III. Can finish it once, but with gluttony; IV. Drink more than two times with glutinous; In case I, drinking is normal within 5 seconds; if it is over 5 seconds, swallowing disorder is suspected; in case II it is also suspicious; in cases III, IV and V, swallowing disorder is determined.

3. Evaluation of feeding process Evaluation includes:

(1) Early oral cavity: state of consciousness, presence or absence of advanced brain dysfunction, fast food, appetite.

(2) Oral preparation period: opening, closing lips, feeding, food spilling from the mouth, tongue movements (back and forth, up and down, left and right), jaw (up and down, rotation), chewing movements, and changes in eating patterns.

(3) Oral period: swallowing (amount, method, time required), residual in the oral cavity.

(4) Pharyngeal period: laryngeal movement, dysphagia, pharyngeal discomfort, pharyngeal residual sensation, sound changes, and whether sputum volume increases.

(5) Esophageal period: chest tightness, swallowing food countercurrent.

In addition, it is necessary to pay attention to food contents, dysphagia food characteristics, time required, one intake, position, help method, effectiveness of residue removal method, fatigue, environment, helper problems, etc.

4. Auxiliary examinations include television fluorescence radiation swallowing function test, television endoscope swallowing function test, ultrasound examination, radionuclide scanning examination, manometry examination, electromyography examination, pulse oximetry and so on.

5. Evaluation of swallowing function:

(1) Sato 7 grade evaluation method

Level 7: Normal: No difficulty in swallowing and no need for rehabilitation medical treatment.

Level 6: For mild problems: There is a slight problem when swallowing. It is necessary to change the shape of the food when ingesting. For example, you need to eat soft food due to insufficient chewing.

Level 5: Oral problems: Moderate or severe disorders during oral swallowing. The chewing morphology needs to be improved. The time for eating is prolonged. Food residues in the oral cavity are increased. Others need to be prompted or monitored during swallowing.

Level 4: Chance swallowing for chance: Swallowing swallows in the usual way, but it can fully prevent swallowing after adjusting the posture or changing the mouthful and swallowing compensation.

Level 3: Swallowing due to water: Swallowing with water can not be controlled by using the method of preventing swallowing. Changing the food form has a certain effect. You can only swallow food while eating, but the energy intake is insufficient.

Level 2: Swallowing for food: Changing the shape of food has no effect. Water and nutrients are basically supplied by the vein.

Level 1: Swallowing for saliva: Swallowing can cause swallowing, and you cannot eat or drink.

(2) Degree of Swallowing Disorder (VGF)

A. Oral period

Cannot feed food from the mouth into the throat, out of the lips, or into the throat by gravity only-0 points

Ca nt form a lump into the throat, but can only form food into the throat in a group of spirits1 point

It is not possible to feed the food completely into the throat at one time. After one swallowing action, some food remains in the mouth-2 points

Feed food into the throat in one swallow-3 points

B. Throat stage

Can not cause the throat to lift, the epilepsy of the atresia and the soft palatal arch to close, and insufficient swallowing reflexes-0 points

There are a lot of residual food in the pit of the throat and the piriform fossa-1 point

Keep a small amount of leftover food, and swallow it several times to swallow all the leftover food into the throat-2 points

Feed food into the esophagus in one swallow-3 points

C. Most swallowed, but no choking-0 points

Most swallowed, but with choking 1 point, few swallowing, without choking 2 points

Slight swallowing, choking-3 points

No swallowing-4 points

Degree judgment: 0 points for severe cases and 10 points for normal cases

(3) Grade of swallowing disorder

A. Severe (inability to pass through the mouth)

1. Unable to swallow, not suitable for swallowing training.

2. Serious swallowing and difficulty swallowing are only suitable for basic swallowing training.

3. Reduced swallowing, can take food training.

B. Moderate (oral and supplementary)

4. Can eat in small amounts and fun.

5. A part (1-2 meals) of nutritional intake can be carried out through the mouth.

6. Three meals can take nutrition through the mouth.

C. Mild (single transoral)

7. All meals can be swallowed through the mouth.

8. Except for foods that are particularly difficult to swallow, all three meals can be taken by mouth.

9. Can swallow common food, but requires clinical observation and guidance.

D. Normal

Functional recovery training-indirect training

1. Lips, tongues and other sports: strengthen muscle strength and expand mobility, automatic movements, other movements: use cotton swabs and tongue depressors.

2. Cold stimulation method: induce swallowing reflex, use a cotton swab moistened with cold water to stimulate soft palate and cause swallowing.

3. Neck relaxation training, articulation training and breathing training.

4. Posture adjustment: Choose a posture that prevents pharynx residues from entering the airways, sitting back to back.

5. Neck forward flexion: to prevent mistaken swallowing and easy to induce swallowing reflex.

6. Repeated swallowing: remove pharynx residue, swallow food multiple times

7. Alternate swallowing: alternate swallowing of different forms of food is conducive to the removal of pharynx residues, and solid food and liquid food are swallowed alternately.

8. Swallowing on the healthy side: Swallow food on the healthy side.

9. Nodular swallowing: tilt your head back, then head forward, and do swallowing at the same time, which is helpful to remove the food left in the epiglottis valley.

10. Turn your head to swallow: Turn your head to swallow left and right, which will help to clear the residual food on the pear-shaped crypts on both sides.

11. Promote swallowing reflex technique: Induces swallowing reflex through the feeling of swallowing muscle groups, rubbing the skin along the thyroid cartilage with the fingers to the upper and lower jaw, Mendelson technique is applied.

12. Voluntary cough: A conscious cough causes food that enters the airways to be coughed out.

13. Balloon catheter dilatation.

14. Physical therapy: electrical stimulation therapy maintains swallowing reflex, prevents disuse muscle atrophy, strengthens the muscle strength of the swallowing muscle, and iontophoresis.

15. Acupuncture treatment.

Dietary guidance-direct training

1. Eating position-the position applicable to the patient is not completely the same, and it should be adjusted from person to person in actual operation. For bedridden patients, the torso is generally taken in a supine position at 30 degrees, the head is bent forward, and the hemiplegia side shoulders are pillowed. The nurse is located on the healthy side of the patient, and the food is not easy to leak out of the mouth, which facilitates the transport of food to the tongue and reduces backflow and Swallowed. For those who can still get out of bed, take a straight forward bend, and the body can lean to the healthy side by 30 degrees, which will increase the tension of the hyoid muscles, raise the throat, and food will easily enter the esophagus. If the head can be turned to the paralyzed side by 80 degrees, the pharynx on the healthy side is enlarged to facilitate food entry to prevent accidental swallowing.

2. Choice of food

A. According to the characteristics of the patient's diet and the degree of swallowing disorders, choose foods that are easy to be accepted by the patient. Pay particular attention to the diet habits of southerners who like rice and northerners who love pasta. For patients with poor preparation period, do not eat meat or other solid objects. Use the food that is most easily swallowed. The jelly-like food is uniform in density, should be sticky but not loose, and easy to move in the mouth. It is easy to deform when passing through the pharynx and esophagus. The residue is not easy to swallow, such as vegetable puree, jelly, custard, thick soup.

B. For those who are moderately lethargic or lethargic, swallow a liquid diet that is easy to swallow. The nutritionist will mix the staple food with fresh milk, vegetable juice and fruit juice. With the improvement of swallowing function and the recovery of physical fitness, the food is made into frozen, porridge-like food, and the color, aroma, taste and temperature of the food must be taken into account. The color is fresh, the flavor is strong, and the taste is good, which is good for eating and digestion.

C. In addition, according to the specific situation of the patient, determine the posture in which the patient eats, how much food to eat, and which swallowing method to choose to prevent the swallowing more effectively, reduce the residue, and eat smoothly. . In addition, reasonable dietary matching should be carried out according to the comprehensive situation of patients with dysphagia, so as to ensure the nutritional supply of patients with dysphagia.

Psychotherapy

Doing good psychotherapy is the foundation and guarantee of successful training. Patients with dysphagia are often accompanied by varying degrees of limb hemiplegia, aphasia, or speech insufficiency. They are prone to irritability, irritability, and depression, and some refuse to eat. Therefore, when carrying out diet training, targeted psychological counseling should be carried out according to the personality characteristics, education level and social experience of different patients. Do the ideological work of patients and their families well. We enable patients to understand the mechanism of swallowing, master training methods, encourage patients to increase their confidence in rehabilitation, and actively cooperate with training.