Assessing the Interrelationships Between the Respiratory and Gastroesophageal Systems
The American Speech-Language-Hearing Association estimates that more than 15 million people in the United States have dysphagia. With dysphagia being that common, the need for an effective treatment plan is considerable. Furthermore, dysphagia is often correlated with many other medical conditions, including gastrointestinal conditions, nervous system disorders and respiratory disorders. These medical conditions can exacerbate the patient's dysphagia and complicate the assessment process. Clinicians who fail to recognize the interrelationships between the respiratory and gastroesophageal systems may be under-treating the patient's condition.
This one-day seminar will help give clinicians a clearer picture of the respiratory and gastrointestinal systems, their relationship to each other, and their impact on dysphagia management. Disease processes, with particular emphasis on aspiration pneumonia and gastroesophageal reflux disease, will be discussed along with strategies for clinical management. Participants will leave the seminar with the skills to do a thorough assessment and treat the whole patient, not just their symptoms.
Course Content
RESPIRATORY SYSTEMS
u Overview of systems
- anatomy/physiology
- pulmonary function
u The apneic signal
u Respiratory cycles
u The relationship of coordination to aspiration
u Laryngeal Chemical Responses (LCRs)
u Reflexive cough
GASTROESOPHAGEAL SYSTEMS
u Overview of systems
- esophageal function
- primary peristalsis
- secondary peristalsis
- tertiary contractions
u Barriers to reflux
u Saliva swallows
u Digestive acids
u Constipation
REFLUX
u Relationship to feeding disorders
u Reflux mechanisms
- Transient Lower Esophageal Sphincter Relaxations (TLESRs)
- LES incompetence
- anatomical abnormalities
u GERD signs and symptoms
u When does GER become GERD?
u Reflux, feeding and swallowing behaviors
u Relationship to dysphagia
GI/RESPIRATORY RELATIONSHIPS
u Pressure relationships and their effect
u Asthma/gastroesophageal reflux connection
u Allergens
u Respiratory congestion
u Laryngopharyngeal Reflux (LPR)
ASPIRATION
u Definition
u Signs and symptoms
u Effects on the airway
u How much aspiration is too much?
u Risk factors
u Aspiration and oral hygiene
RESPIRATORY DISEASE PROCESSES
u Infant Respiratory Distress Syndrome (IRSD)
- symptoms
- treatment
- complications
- IRDS and feeding
u Bronchopulmonary Dysplasia (BPD)
- symptoms
- treatment
- prevention
- complications
- feeding
- nutrition
u Cardiac Impairment
- CHF
u Obstructive conditions
- COPD
- bronchitis
- CF
- pulmonary function tests
- relationship to dysphagia
u Restrictive conditions
- pulmonary function tests
- relationship to dysphagia
- pneumonia vs. pneumonitis
- pneumonia-aspiration and otherwise
- neuromuscular diseases
ASPIRATION MANAGEMENT
u Artificial airways
- ventilation and oxygenation
- patient airway
- airway obstruction
- pulmonary toilet/access
- naso/oropharyngeal airways
- endotracheal intubation
- tracheostomy
u Tracheostomy vs. intubation
- advantages/disadvantages of intubation
- when to convert from ET to trach
- why aspiration is common in tracheostomies
- tethering effect
- subglottic pressure changes
- cuff effects
u Mechanical ventilation
u Assessment of aspiration
- clinical assessment
- instrumental assessment
- penetration-aspiration scale
- 3 oz. water test
- blue dye studies
ASPIRATION MANAGEMENT (continued)
- enteral feedings
- tracheostomy
- glucose oxidase reagent strips
- cervical auscultation research
- pulse oximetry
- Reflex Cough Testing (RCT)
w RCT and stroke
u Airway protection techniques
- cuff management
- occlusion of tracheostomy tube
- decannulation
- speaking valve/Passy-Muir valve
w Who is a candidate?
w contraindications
w oral/pharyngeal therapy
u Aspiration management
- diet
- oral care
- environmental modifications
REFLUX MANAGEMENT
u UGI
u pH monitoring
u Esophagoscopy (with/without biopsy)
u Scintigraphy/Milk scan
u Clinical assessment
- children
- adults
u Lifestyle modifications
u Diet modifications
- children
- adults
- diet and LES pressure
u Medication
- antacids
- physical barriers
- prokinetics
- acid suppressants/histamine blockers
- acid blockers/proton pump inhibitors
- effects of acid suppression
- medications that increase reflux
u Positioning
u Medical/surgical interventions
- indications
- fundoplication
- endoscopic procedures
w stretta system
w plicator device
w endocinch
w enteryx injection
CASE STUDIES
is an approved provider #50-466 with the Florida Department of Health Board of Occupational Therapy Practice. This course is approved for 6 contact hour(s) for Occupational Therapist and Occupational Therapy Assistants.
This educational offering qualifies for 6 continuing education hour(s) as required by many national, state and local licensing boards and professional organizations. Save your course outline and certificate of completion, and contact your own board or organization for specific filing requirements.
| File type | File name | Number of pages | |
|---|---|---|---|
| Handouts (6.2 MB) | Available after Purchase | ||
| Presentation (2.9 MB) | Available after Purchase |
ANGELA MANSOLILLO, MA/CCC-SLP, BCS-S, is a Speech-Language Pathologist and Board Recognized Specialist in Swallowing Disorders with more than 20 years of experience. She is currently a senior Speech-Language Pathologist at Cooley Dickinson Hospital in Northampton, Massachusetts, where she provides evaluation and treatment servicesfor adults and children with dysphagia and is involved in program planning and development for inpatient and outpatient programming including quality improvement initiatives, patient education, and clinical policies and protocols. In addition, she is an adjunct faculty member at Elms College Department of Communication Sciences and Disorders in Chicopee, Massachusetts. Over the course of her career, she has worked in a variety of clinical settings, provided numerous regional and national presentations, and lectured at several colleges and universities throughout Massachusetts.
Ms. Mansolillo received her Bachelor of Arts degree in Communication from Rhode Island College in 1983 and earned her Master of Arts in Speech-Language Pathology in 1985 from the University of Connecticut. She is a member of the American Speech-Language-Hearing Association and is a member of Special Interest Division 13, which focuses on swallowing and swallowing disorders.
Disclosure:
Finacial- Receives a speaking honorarium from Vyne, LLC.
Nonfinancial-No relevant nonfinacial relationship exists.
Speech Therapists, Speech Therapy Assistants, Occupational Therapists, Certified Occupational Therapy Assistants, Rehab Managers, Directors of Nursing, Nurses, Restorative Nursing Staff, Dietitians, Dietary Managers, Nursing Assistants, Respiratory Therapists
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