Dysphagia
SPT
- consult, if fails bedside swallowing
- SPT examination
> cognitive-linguist screen: attention, memory, executive, language
> oral-motor eval: face muscle; lingual and labial muscles strength, rate, and ROM; dentition; cough; voice; speech
> swallow: PO trial w/ ice chips; oral phase (acceptance, mastication); pharyngeal phase (HLE palpation, cough?)
MBSS & FEES
DHT
PEG-tube
- IR, GI, or surgery
- contraindication: stomach remnant absence
JJ tube
TPN
- PICC team for PICC line and consent
- infection risk, especially fungal
- bad if normal intestinal funciton
Phagenyx
- 3 sessions (at bedside) in 3 consecutive days, repeat swallowing study (no need to remove), and can repeat more 3 days
- time-consuming
- patient feels some sensation during sessions, no major complications
- price 5K$
- some rules
> switch the TFs to "no fiber-rich feeds"
> convert meds to liquid/IV; if unable, administer meds crushed one at a time and manually flushed (kangaroo pump does not facilitate enough pressure)
> write in patient's room the depth (55cm)
> If clogged, you can do whatever you need to unclog
> manual flushes as able
> not-MRI compatible
> place bridal
Physician Screening Protocol
- only to give initial meds per oral route
