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Speech and Swallowing in Scleroderma 15 th Scleroderma Canada Conference

Speech and Swallowing in Scleroderma 15 th Scleroderma Canada Conference. Lindsey Lorteau, M.S., SLP Speech-Language Pathologist. Speech Production. “Normal” Speech Articulation / Pronunciation Phonation / Voice Respiration / Breathing Resonation / Nasality. Speech Problems.

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Speech and Swallowing in Scleroderma 15 th Scleroderma Canada Conference

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  1. Speech and Swallowing in Scleroderma15th Scleroderma Canada Conference Lindsey Lorteau, M.S., SLP Speech-Language Pathologist

  2. Speech Production • “Normal” Speech • Articulation / Pronunciation • Phonation / Voice • Respiration / Breathing • Resonation / Nasality

  3. Speech Problems • Xerostomia (dry mouth,  saliva flow), often seen in Sjögren’s syndrome  Difficulty pronouncing sounds • Microstomia ( mouth opening)  Difficulty pronouncing sounds • Collagen build up  Difficulties with voice quality, Breathing issues

  4. Speech Management • Stay hydrated! • Use your voice well – be careful, avoid straining your voice • Avoid noisy areas • Speak slowly but naturally • Stay well rested • Consider speech therapy

  5. Swallowing Definitions • Dysphagia: disruption of normal swallowing process • Penetration: entry of material to laryngeal vestibule • Aspiration: entry of material to trachea, below level of vocal folds (VF) • Bolus: food after it’s been chewed, ready to swallow • Assessment: Clinical Dysphagia Assessment • Videofluoroscopic Swallow Study (VFSS) • Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

  6. Anatomy of Swallow • Oral cavity: Lips, tongue • Nasopharynx • Soft palate, Posterior pharyngeal wall • Pharynx • Laryngeal cartilages • Bone . . . Hyoid, Mandible • Laryngeal muscles • Esophagus

  7. Physiology of Swallow • Oral phase • lasts about 1 second • Pharyngeal phase • lasts less than 1 second • Esophageal phase • lasts from 8 - 20 seconds (dependent on bolus consistency)

  8. The normal swallow (VFSS)

  9. Swallowing Assessment • “he’s choking” • “he swallows fine, he just coughs alot” • “there’s something stuck in my throat” • Usually completed by SLP • May be GI, Dietitian involved

  10. Swallowing Assessment cont’d • Clinical signs of aspiration risk • Where is the swallowing problem? • Oral, pharyngeal or esophageal • Indications for Instrumental Exam • Symptoms inconsistent with clinical findings • Contribute to possible medical diagnosis • Determine if dysphagia contributing to nutritional or pulmonary compromise • Safety or efficiency of swallowing is a concern • Guide management

  11. Purpose of Swallowing Assessment • Promote good health • Improve quality of life • Ability to enjoy food and beverages • Imposed dietary restrictions • Social nature of eating/drinking • Prevent life-threatening conditions • malnutrition • dehydration • pneumonia

  12. Dysphagia & Aspiration Pneumonia (Langmore, 1998) • Colonization (altered oropharyngeal flora) • Aspiration into lungs • Larger volume aspiration • Microaspiration • Host resistance • Pulmonary clearance • Systemic immunologic response • Pneumonia

  13. VFSS • Accepted standard for detecting & evaluating swallowing abnormalities • Dynamic view of oral cavity and pharynx, cervical esophagus • Side and Front views • Barium mixed with food/liquid • Clinician judgement

  14. Swallowing Problems • Xerostomia  difficulties with dry foods, bolus formation/transit • Microstomia  difficulties biting, chewing, placing dentures, hygiene • May see pharyngeal issues, including retention, aspiration, and UES incoordination (especially with prominent esophageal dysmotility)

  15. Swallowing Problems cont’d •  tension for esophageal contractions  Poor esophageal motility (lower 2/3), especially for solid foods > liquids •  Lower Esophageal Sphincter pressure  Reflux (Reflux Esophagitis, LPR) • Esophageal atrophy, fibrosis, strictures

  16. Swallowing Problems cont’d • ‘Globus’ sensation – symptoms referred to throat, making you feel like there’s something stuck • Needs further assessment

  17. Barium Swallow Examples • Scleroderma esophagus peptic stenosis as seen in a double-contrast examination of the esophagus

  18. VFSS Examples • Laryngeal penetration (thick arrow) or tracheal aspiration (thin arrow) may occur as a result of post swallow stasis in the valleculae – See more at: http://www.oralcancerfoundation.org/complications/dysphagia.php#sthash.XyjC166j.dpuf

  19. VIDEO • Penetration

  20. VIDEO • Aspiration

  21. Therapeutic Intervention • Exercises • Postural changes to alter bolus flow • Optimal oral hygiene, saliva substitute • Diet modifications • Alternative eating • Reflux management (conservative, medical, surgical) • Esophageal dilation

  22. Resources • Speech-Language & Audiology Canada http://sac-oac.ca/ • Canadian Association of Gastroenterology http://www.cag-acg.org/ • Canadian Digestive Health Foundation http://www.cdhf.ca/ • Dietitians of Canada http://www.dietitians.ca/

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