(I) Applicable objects
Patients diagnosed with swallowing disorder
(II) Diagnosis basis
According to Dou Zulin, “Assessment and Treatment of Swallowing Disorders”, August 2009, published by People’s Health Publishing House
Swallowing disorders (dysphagia, deglutition dlsorders, swallowing disorders) are difficulties in eating due to impaired function of the jaw, lips, tongue, soft palate, pharynx, esophageal sphincter or esophagus, which cannot safely and effectively deliver food from the mouth to the stomach for adequate nutrition and water.
There is no precise definition of swallowing disorder, and the following criteria should generally be met.
① Problems in the delivery of food or drink from the mouth to the stomach;
② Failure to swallow properly due to poor control or coordination of oral and pharyngeal muscles, resulting in malnutrition;
(③ food mistakenly entering the trachea, causing recurrent lung infections and aspiration pneumonia by mistake.
(C) Exclusion criteria.
1, food can not enter the mouth (Feeding disorder is the inability to take food into the mouth)
2, abnormal gastric emptying (the outlet of the stomach is blocked, and food cannot enter the small intestine from the stomach).
(IV) Assessment methods
1. General evaluation before ingestion
(1) Underlying diseases: grasp the development of different underlying diseases such as brain injury, tumor, myasthenia gravis, etc., which is conducive to the adoption of different means of rehabilitation.
(2) Systemic status: Pay attention to the presence of fever, dehydration, low nutrition, respiratory status, physical strength, disease stability, etc., to confirm whether the patient is suitable for feeding.
(3) Level of consciousness: Use Glasgow Coma Scale, etc. to evaluate the state of consciousness and confirm whether the patient’s level of consciousness allows for awake feeding and whether it changes over time.
(4) Higher brain functions: Observe whether there are problems with language function, cognition, behavior, attention, memory, emotion and intelligence level.
2.Evaluation of swallowing function
(1) Oral function: careful observation of mouth opening and closing, lip closure, tongue movement, presence of salivation, soft palate uplift, swallowing reflex, vomiting reflex, dental status, oral hygiene, composition, vocalization (open nasal sound: soft palate paralysis; wet hoarseness: saliva and other residues in the upper part of the vocal cords), intraoral perception, taste, and random coughing, etc.
(2) Swallowing function: The following two types of tests can be performed at the bedside.
(1) “Repeated saliva swallowing test”: The examinee takes a sitting position and a relaxed position when lying in bed. The examiner places a finger on the laryngeal node and hyoid bone of the subject and asks him/her to swallow as fast as possible repeatedly.
The number of times the laryngeal node and hyoid bone cross the finger with the swallowing motion and move forward and upward and then reset within 30 s is observed. In elderly patients, 3 times is sufficient.
②”Drinking water test”: let the patient drink a teaspoon of water, if there is no problem, ask the patient to take a sitting position, swallow 30 ml of warm water in one gulp, and record the drinking water.
I. Can finish the water in one gulp, no choking;
I. Can finish it in one sip without choking; II. Can finish it in two or more sips without choking;
III. Can finish drinking at once, but choking;
IV. Drinking in two or more times and choking;
V. often choke and have difficulty finishing the whole drink.
In case I, if the drink is finished within 5 seconds, it is normal; more than 5 seconds, it is suspected to have swallowing disorder; case II is also suspected; cases III, IV and V are determined to have swallowing disorder.
3.Evaluation of swallowing process
(1) Preliminary phase: state of consciousness, presence or absence of higher brain dysfunction, appetite.
(2) Preparatory phase: opening, lip closure, ingestion, spilling of food from the mouth, tongue movement (back and forth, up and down, left and right), jaw (up and down, rotation), chewing movement, change in eating pattern.
(3) Oral phase: swallowing and delivery (amount, manner, time required), residual in the mouth.
(4) Pharyngeal phase: laryngeal movement, choking, pharyngeal discomfort, residual pharyngeal sensation, changes in voice, and any increase in sputum volume.
(5) Esophageal phase: chest suffocation, swallowed food reflux.
4. Auxiliary examination
In order to correctly evaluate the swallowing function, understand whether there is a possibility of misopharyngeal and the period of misopharyngeal occurrence, such means as video swallowing imaging, endoscopy, ultrasound and swallowing pressure examination can be used. Among them, video swallowing imaging is the most credible method of misopharyngeal evaluation.
(E) Choice of treatment plan.