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Dysphagia and Diet for People with Traumatic Brain Injury Robert Trombley , Registered Dietitian

Dysphagia and Diet for People with Traumatic Brain Injury Robert Trombley , Registered Dietitian Barbara Goodman, Speech/Language Pathologist. It can happen on any given day. From this:. To this:. Objective. Define basic dysphagia terms and diagnostic tests

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Dysphagia and Diet for People with Traumatic Brain Injury Robert Trombley , Registered Dietitian

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  1. Dysphagia and Diet for People with Traumatic Brain Injury Robert Trombley, Registered Dietitian Barbara Goodman, Speech/Language Pathologist

  2. It can happen on any given day From this: To this:

  3. Objective • Define basic dysphagia terms and diagnostic tests • Understand dysphagia recommendations and diet modifications • Identify best-practices • Recognize potential pitfalls • Strategies for compliance

  4. Unique and Lifelong Experience

  5. How often does dysphagia occur and who does it affect? • Statistics in the incidence of dysphagia in the traumatic brain injury individual vary widely; one study reporting 80% effected and 16% needing assistance with eating one year post injury (Duong, Englaneder, Wright, Cifi, Greenwald and Brown, 2004) • Dysphagia prevalence increases with age, therefore, people with a TBI may acquire dysphagia as they age. • 61% of adults admitted to acute trauma centers • 41% of individuals in rehab settings • 30% - 75% of patients in nursing homes • 10 million Americans (adults and children) are evaluated each year with swallowing difficulties • ASHA, Communication Facts: Special Populations: Dysphagia- 2008 Edition, compiled by Andrea Castrogiovannirder

  6. Definition: Dysphagia is defined as a difficulty in swallowing. This includes any difficulty in the process of: biting, chewing, handling and/or swallowing of food and/or liquid. One example of a swallowing problem that we can all relate to is when food or drink “goes down the wrong way”, which we all have experienced at one time or another. For people with dysphagia, this problem is occurring more frequently.

  7. Swallowing: The Delicate Ballet

  8. The Normal Swallow

  9. http://www.radionz.co.nz/national/programmes/ourchangingworldhttp://www.radionz.co.nz/national/programmes/ourchangingworld

  10. People with traumatic brain injury may have damaged the cranial nerves and/or have structural abnormalities (to their jaw, neck, throat) affecting swallowing. • Symptoms: • Coughing • Throat clearing • Hunching of shoulders • Sensation of food getting caught • Reddening in the face and/or facial grimacing • Pain with swallowing • Vomiting • Wet voice • Slow eating - fatigue • Holding food in mouth • Refusal to eat • Weight loss, dehydration • Heartburn or Reflux • Upper respiratory infections and/or pneumonia • Choking

  11. Stages of Swallowing: • Stage One: Oral Phase • Includes oral preparatory phase • Mastication (chewing) of the food • Forms a bolus (mass of soft chewed food) • Bolus moves to the back of the oral cavity into the oropharynx (throat) • Takes approx. one second • Common problems: difficulty in chewing, forming a bolus, controlling the bolus, propelling the bolus to pharynx

  12. Stage Two: Pharyngeal • Tongue pushes food to pharynx, which triggers swallowing response. • Larynx and epiglottis move to close off the airway for protection, breathing stops. • Reflexive, lasting one second or less. • Common problems: delayed swallow, nasal regurgitation, inadequate protection of the airway, pharyngeal stasis • Stage Three: Esophageal • The bolus enters the esophagus and travels to the stomach • Reflexive, takes approx. 3 seconds, may take longer for pill (medication) • Common problems: poor peristalsis, obstructions

  13. Diagnostic Tools Flexible Endoscopic Evaluation of Swallowing (FEES) Modified Barium Swallow Study (MBS) or Videofluoroscopic Swallow Study (VDSS)

  14. Modified Barium Swallow (MBS)

  15. Recommendations: • Diet modifications • Compensatory and/or Facilitation Strategies

  16. Prepare for the MBS (if possible attend)- how is the person eating and drinking now- • What is working for them and what seems to be causing problems: • Symptoms • Types of food or drink that work best or worse • Positioning • Pace of eating and drinking • Bring to the MBS small sample of a simple favorite food (sandwich, pizza) • After the speech pathologist makes the diet recommendations: • Ask, ask, ask questions • What is a thickened liquid? Where do I get these thickening agents? • What is a soft mechanical food? • What is the best position for the person to eat? To drink? • What does a chin tuck look like? • How much food is a normal bite? A normal sip of a drink? • How do I give medications? • Will direct speech therapy help?

  17. A Modified and Thickened WHAT???? • Published 2002 • NDDTF • Academy of Nutrition and Dietetics • American Speech-Language and Hearing Association • Thickened liquids • Dietary textures • Standard of treatment • Great guide for general recommendations for food at the different levels

  18. Regular – Level 4 Chopped – Level 3 Mechanical Soft – Level 2 Puree – Level 1 Primary Food Consistencies

  19. Thin Nectar Honey Pudding Primary Liquid Consistencies Nectar Thick Honey Thick

  20. Denial and Confusion “There is no problem.” “Who says I have trouble eating and drinking?” “Why am I eating this?” Provide clear, simple and consistent language Make sure that everyone is on the same page Do not argue, accept that this is their perspective, but do follow diet recommendations Provide praise for any positive action Be patient

  21. Judgement and Memory • Taking excessively • large bites or sips • Eating very quickly • Unable to remember strategies • Precut food • Pre-teach • Verbal reminders • Visual/auditory reminders- pictures, clock • Special cups, silverware, plates

  22. Adverse health outcomes Weight loss Dehydration Malnutrition Respiratory illness Pneumonia Upper respiratory infection Bronchitis

  23. The yuck factor or Lost passion for food

  24. Gaining Acceptance Increasing Compliance RIGHT ON! What was that!

  25. Gaining Acceptance Increasing Compliance • Aroma • Seasoning • Layering/Swirling • Piping • Molds

  26. TASTE IT

  27. Kitchen Essentials Appliances and small wares

  28. Kitchen Essentials Food thickeners

  29. Kitchen Essentials Liquid thickeners Gells • Powders

  30. Preparation Tips • Proteins • Marinating • Acid-based marinades • Braised • Stewed • Easier to prepare cold • Proteins molecules tighten • when heated Braising and stewing tenderizes the connective tissue Never use water Stocks, Gravies Fats/oils, Mayonnaise Milk/Cream

  31. Preparation Tips • Starches • Rice • Pasta, Noodles, Macaroni • Potatoes • Beans

  32. Preparation Tips • Fruits & Vegetables • Skins • Stringy • Woody • Seeds • Dried fruits • Apples • Grapes • Pineapple • Asparagus • Broccoli stalks • Carrots • Celery • Raisins

  33. Go from fear and confusion…. To confidence and success • Successful Functional Outcomes: • Compliance • Satisfaction • Limited level of distress-both the caregiver • and the TBI individual • Good health

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