Rehabilitation - how to rehabilitate?

DNB
#1

Early treatment has been shown to reduce the risk of aspiration pneumonitis , to reduce complications related to malnutrition and dehydration , to reduce the length of hospital stay

REHABILITATION - HOW TO REHABILITATE ??

1 EXERCISE TRAINING -

A ) daily tongue training - causes increase in proportion of neurons in the primary somatosensory cortex ( S1 ) and primary motor cortex ( M1 )

B ) non swallow task training to be given first to stimulate oropharyngeal gestures

C ) isometric lingual exercises

D ) expiratory muscle strength training

E ) mendelsohn and maasko manuever ( in mendelsohn there is prolonged swallowing and in maasko there is anchoring of anterior part of tongue )

F ) New - pulsed electrical stimulation is delievered in a controlled structured manner ( 59 sec on , 1 sec off for 60 continuous minutes daily for 2 weeks ) - it should only be given to patients who can overcome hypolaryngeal lowering

2 COMPENSATORY STRATEGIES

  • Is divided into posture , manuevers and diet modification

  • are performed with every swallow or just before swallowing - self dilatation of UES by balloon catheter and by thermal tactile stimulation

  • a chilled laryngeal mirror is to be stroked to anterior faucial pillars 5 to 6 times before a meal and intermittently throughout the meal

  • implementation of postural strategy ( use of gravity , changes in anatomy to assist propelling bolus of improving airway protection )

A ) eg -

1 - chin tucking to widen the vallencula

2 - positioning the epiglottis in more protective position posteriorly to prevent aspiration

3 - collapsing pharyngeal space by turning the patient head to impaired side

4 - head rotation to both sides to enhance opening of UES

5 - breath holding to improve voluntary airway closure

6 - oral hold

7 - bolus modification

  • By modification of food and liquid properties ( most common strategy (

Eg -

1 in patients who have decreased oral strength or coordination - soft solid foods such as chopped or puried

  • Surgery

A ) UES dilatation

B ) Cricopharyngeal myotomy

C ) Pharyngeal bypass