Rol Del To en Disfagia Orofaringea

The occupational
therapist’s role in
neurogenic dysphagia
Margaret Walker DipOT (NZ)

ARCOS - Association for Rehabilitation of
Communication and Oral Skills
Overview
 Role of OT
 Results of pilot study
 Implications
 Issues for the whole team

Why Dysphagia?
• Doctors
• Nurses
• Speech and language therapists
- why occupational therapists?

Increasing Population
 Incidence in UK
Stroke: 150,000 per year
occupy 25% of long term beds
over 300,000 living with moderate
to severe disabilities
TBI: estimated 1 million per year

up to 11 thousand with severe brain
injury (unconscious ≥ 6 hours) per year
4,500 per year require FT life long care ↑ each year
MS: estimated 100,000
MND: 2 cases per 100,000 per year, currently approx 5000
HD: 5-10 cases per 100,000 per year

Increasingly Complex
symptoms
Pilot Survey 2009
 Questionnaire via email

- What is the current perception of
occupational therapists about their role in
the treatment of neurogenic dysphagia?
- Are there any differences in the
occupational therapy role in various
countries in the treatment of neurogenic
dysphagia?
The occupational therapist’s role in neurogenic Dysphagia
Country qualified Country currently working
1. Workplace: Acute Clinic Rehabilitation Community Independent

(several options possible)
Other:
2. Does your work bring you into contact with patients/clients with dysphagia Yes No
3. Are you involved in the treatment of their dysphagia Yes No
If Yes, what is your role in dysphagia management? (Please select appropriate items listed below)
positioning assisting coughing/throat clearing

providing equipment eg. utensils, cups improving oral movements
oral hygiene facilitated swallowing
increase coordination of breathing and swallowing
liaising with other colleagues eg. speech and language therapist, nurse, physiotherapist
Other:
If No, who in your team treats individuals with dysphagia?

speech therapist nurse
physiotherapist doctor
Other:
4. Do you think occupational therapists have a role in dysphagia managements? Yes No
If Yes, what role and why?:
If No, why not?:
5. How do symptoms of dysphagia influence your treatment of the patient?
Comment:
6. Have your received any dysphagia training? Yes No
Comment:
Survey
 Respondents from
– Australia
– Denmark
– Germany
– Sweden
– United Kingdom
percentage
Pt
’s
w
i th
0
10
20
30
40
50
60
70
80
90
100
Dy
In
sp
h
vo
l
ag
ve
ia
d
in
Rx
of Dy
s
P o sit
i
on
ing
Eq
iu p
m
en
t
Or
al
hy
Co gie
o rd i n e
na
tio
no
fB
&
S
Li a
iso
As n
sis
t Co
ug
h &
Im TC
pro
ve
ora
lm
v ts
Fac
i lita
te
Sw
allo
w
no
yes
% of responses to Questionnaire
– Australia 9%
– Denmark 46%
– Germany 27%
– Sweden 9%
– United Kingdom 9%
Context
Hammel Neurocenter, Denmark
Therapiezentrum Burgau, Germany

Responses to:
Why do OTs have a role?
 Assess body structures, their functions,
activities and level of participation
 Eating and drinking as an ADL
 Moving and Handling skills - know normal
movement & how to facilitate it
 Expert at activity analysis
 Able to or level of demand according to
client’s capacity.
If not, why not?
 Not been expected
 No training
OT input
physical act of taking food to mouth only
Question 5: influence of
dysphagia on treatment -
quotes:
 Can’t lie supine for activities such as
washing and dressing
 If some one is coughing during therapy it is
part of the treatment to facilitate the most
effective coughing possible and subsequent
clearing swallow.
 Priority for breathing problems – trachy
patients constant observation.
Reasons for differences
in responses
 Experience and expectation
 Variations in Training
percentage
Pt
s
w
i th
D
0
10
20
30
40
50
60
70
80
90
100
ysp
In
ha
vo
l
gi
a
ve
d
in
Rx
of Dy
s
P o sit
i
on
ing
Eq
iu p
m
en
t
Or
al
hy
Co gie
o rd i n e
na
tio
no
fB
&
S
Li a
iso
As n
sis
t Co
ug
h &
Im TC
pro
ve
ora
lm
v ts
Fac
i lita
te
Sw
allo
w
no
yes
Questions for the team:
Who addresses these issues?
 Assisted coughing/throat clearing +

subsequent clearing swallow
 Nose blowing
 Oral hygiene
Oral Hygiene
“Good posture” what is it?
 “Upright & alert

sitting”
 “Trunk straight”
Alignment of body parts
Dynamic stability i.e.

combination of stability
and mobility
Pelvis must be anchored

Standing:
Use of appropriate support, completing whole activity use of hands
to face
Issues/Challenges
 Increasing severe and complex cases

 Longevity
 Lack of awareness re influence of
positioning on aspiration of saliva e.g
supine lying, wheelchair tilted back
 Discharged nil by mouth with no input
 Lack of specialist input in care homes
 Independence at all costs
Core Skills for all members
of MDT?
 Ability to move and position clients for
airway protection e.g. side lying and sitting
 Manual support for coughing and throat
clearing
 Emergency procedures choking incidents
 Manual facilitation of swallowing and
removal of saliva
Thank you for your attention!

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The occupational

Margaret Walker DipOT (NZ)

 Results of pilot study

 Issues for the whole team

- why occupational therapists?

TBI: estimated 1 million per year

MS: estimated 100,000

MND: 2 cases per 100,000 per year, currently approx 5000

HD: 5-10 cases per 100,000 per year

 Questionnaire via email

1. Workplace: Acute Clinic Rehabilitation Community Independent

3. Are you involved in the treatment of their dysphagia Yes No

positioning assisting coughing/throat clearing

If No, who in your team treats individuals with dysphagia?

4. Do you think occupational therapists have a role in dysphagia managements? Yes No

If Yes, what role and why?:

If No, why not?:

5. How do symptoms of dysphagia influence your treatment of the patient?

6. Have your received any dysphagia training? Yes No

Hammel Neurocenter, Denmark

Therapiezentrum Burgau, Germany

 Not been expected

 Experience and expectation

 Assisted coughing/throat clearing +

 “Upright & alert

Dynamic stability i.e.

Pelvis must be anchored

 Increasing severe and complex cases

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