Feeding Disorder and Dysphagia
餵食及吞嚥障礙
Feeding disorder and dysphagia can result in malnutrition, dehydration, respiration pneumonia or even death. Common causes of dysphagia include stroke, traumatic brain injury, dementia, Parkinson’s disease, head and neck cancer etc.
吞嚥困難可導致營養不良、脫水、呼吸性肺炎甚至死亡。吞嚥困難的常見原因包括中風、腦損傷、認知障礙、帕金遜、頭頸癌等。
Swallow Easy
吞
Dysphagia Symptoms
吞嚥障礙症狀
Gurgly Voice
聲線混濁
Prolonged Mealtime
進食時間過長
Weight Loss
體重下降
Dehydration
缺水
Food Residue
殘留食物殘渣在口腔
Coughing/Choking/ Throat-clearing
進食時/後咳嗽或清喉嚨
Regurgitation from nose/mouth
食物從鼻孔/口中流出
Frequent
pneumonia/ Fever
經常患上肺炎/發燒
Throat Obstruction
感覺食物哽在喉嚨
Oral Retention
經常含住食物
Multiple Swallows
須多次吞嚥
Breathing Difficulties
氣喘
What is Swallowing
什麼是吞嚥
Swallowing is a process that involves two phases, the oral phase and the pharyngeal phase.
In the oral phase, the jaw, lips and the tongue mechanically break down the food into smaller pieces and mix them with saliva to form bolus. The bolus will then be squeezed posteriorly by the tongue to the throat. After that, the pharyngeal phase begins. The airway will be covered and the oesophagus will be lifted up. The bolus will then enter the oesophagus, marking the end of one episode of swallowing. Having difficulty in either one or both phases would be referred as dysphagia. Patients with difficulty in the oral phase may need extra time to masticate food, have food remaining in mouth after swallowing, experience leakage of food from mouth etc. Patients with difficulty in the pharyngeal phase may experience cough and choking, throat clearing and voice change etc.
吞嚥是一個涉及兩個階段的過程，即口階段和咽階段。在口腔階段，下巴、嘴唇和舌頭會機械地將食物分解成更小的碎片，然後將它們與唾液混合形成食團。然後，食團將被舌頭向後擠壓到喉嚨。之後，咽部階段開始。氣道將被覆蓋，食道將被抬起。然後食團將進入食道，標誌著一次吞嚥的結束。在一個或兩個階段有困難將被稱為吞嚥困難。
口腔期困難的患者咀嚼食物需要額外的時間，吞嚥後食物殘留在嘴裡，食物從口中漏出等。
5 Bodily Systems in Swallowing
涉及五個重要系統
Neurological System
神經系統
The bolus will provide sensory input (taste, pressure, temperature) to the brain. This input is necessary for the brain to trigger and modulate swallowing. The nerve cells in brain will integrate all the information and send signals to different muscles of swallowing. Decreased sensation, combined with decrease brain tissue and delays in the communication between nerve cells may cause delayed triggering of swallow in older adults. For example, patients with Alzheimer’s disease, who may have a degrade of nerve cells in the brain area responsible for swallow reflex and memory functioning, may experience delayed pharyngeal swallow onset, reduced lingual movement, difficulty with oral preparation of the bolus, pharyngeal clearance etc.
食團透過味覺、壓力、溫度等為大腦提供感覺輸入，從而觸發和調節吞嚥活動。大腦中的神經細胞負責整合所有信息，並將信號發送到不同的吞嚥肌肉。感覺下降，加上腦組織減少和神經細胞之間的交流延遲可能會導致老年人延遲觸發吞嚥。 例如，當阿爾茨海默病患者的大腦區域負責吞嚥反射和記憶功能的神經細胞出現退化，可能會出現吞嚥延遲、舌頭運動減少、食團形成困難、清喉嚨等。
Assessment
評估
Our therapist will review the medical history of the patient, examine the intactness of oral structures, the functionality of oral muscles (strength, range of motion and coordination). The neck of patient will also be palpated to determine any abnormalities in the pharyngeal phase. Oral trials will be performed to assess the patient’s ability of swallowing by giving the patient different consistencies of liquids and food. Any signs of swallowing difficulty will be closely monitored during the process. Moreover, the patient’s posture, cognition, protective mechanism (cough strength), voice quality, the ability to clear food residue etc. will be observed.
治療師將回顧患者的病史，檢查口腔結構的完整性、口腔肌肉的功能（力量、運動範圍和協調性）。 患者的頸部也將被觸診以確定咽期是否有任何異常。 將進行口服試驗，通過給予患者不同稠度的液體和食物來評估患者的吞嚥能力。 在此過程中，將密切監測吞嚥困難的任何跡象。 此外，還將觀察患者的姿勢、認知、保護機制（咳嗽強度）、語音質量、清除食物殘渣的能力等。
Treatment
治療
Treatment of dysphagia will focus on the adequate nutritional intake for the patient, maximizing the patient’s quality of life and to ensure safety of swallowing. There are mainly two directions of treatment approach, restoration and compensation.
For restoration, the goal is to help patients improve their swallowing ability. Speech therapist will utilize different swallowing exercises and oromotor exercises to help patients strengthen the muscles for swallowing. Electrical stimulation will also be used to stimulate the nerves.
For compensation, the goal is to apply techniques to compensate for the weakness of the patients.
Speech therapist may modify the diet of dysphagic patients by changing the consistency and volume of liquid, and the texture and size of meal. Some patients may need to change their posture during swallowing to ensure safety, such as chin down. Lastly, swallowing maneuvers can be applied to increase safety such as effortful swallow, which increases the pharyngeal squeeze.
吞嚥困難的治療將著重於為患者提供充足的營養攝入，最大限度地提高患者的生活質量並確保吞嚥安全。治療方法主要有兩個方向—恢復和補償。 恢復方面的目標是幫助患者提高吞嚥能力。言語治療師會利用不同的吞嚥練習和口腔運動練習來幫助患者加強吞嚥肌肉。電刺激也將用於刺激神經。 補償方面的目標是應用技巧來補償患者的弱點。言語治療師可以通過改變液體的稠度和體積，以及膳食的質地和大小來調整吞嚥困難患者的飲食。一些患者在吞嚥過程中需要改變姿勢以確保安全，例如下巴向下。最後，可以應用吞嚥動作來增加安全性，例如用力吞嚥，從而增加咽部的擠壓。
嚴重吞嚥障礙有機會源於其他身體症狀，或會需要進一步評估
Further assessment may be needed for patients with previous medical history