COSD 610: Pediatric and Adult Dysphagia
Prerequisite: Graduate standing or permission
Credit Hours: (3)
Study of normal adult and infant swallow physiology related to various mechanical, structural, and neurological disorders of swallowing, including clinical and instrumental assessment methods and treatment strategies emphasizing a multi disciplinary approach to the whole patient. Lecture.
Detailed Description of Content of Course
Students will gain a thorough understanding of the phases of normal swallow physiology as a foundation on which to base clinical decision making for assessment and therapeutic needs of the dysphagic individual. The following topics will be included in the course:
1. Normal Aerodigestive Tract
A. Anatomic review of the structures involved in swallowing
1) oral
2) pharyngeal
3) laryngeal
4) esophageal
5) respiratory
B. Neural Control
1) Central Control
2) Peripheral Innervation
C. Biomechanics and bolus flow
1) bolus preparation
2) bolus propulsion
3) airway protection
4) swallow initiation and coordination
5) respiratory-swallow coordination
D. Developmental influences throughout the lifespan
1) early development of swallowing and feeding in infancy and childhood
2) changes with aging
2. Abnormal Swallowing
A. Etiology and conditions
1) neurogenic
2) structural
3) systemic
4) congenital
B. Signs and Symptoms
1) prolonged feeding/eating
2) oral expectoration
3) nasal regurgitation
4) uncontrolled bolus flow into pharynx
5) laryngeal penetration
6) aspiration
7) stasis
8) residue
9) retrograde bolus flow
10) esophageal considerations
C. Pathophysiology of swallowing in infants and adults -> impairments in:
1) bolus preparation
2) bolus propulsion
3) airway protection
4) swallow imitation and coordination
5) respiratory-swallow coordination
6) esophageal components
3. Assessment
A. History
1) past medical history
2) current medical status and medications
3) pertinent diagnostic examinations
4) speech-language history
5) cognitive history
6) developmental history
a) gross motor
b) fine motor
c) neurodevelopmental milestones
d) state/organization
e) behavior
f) feeding development
7) psychosocial history
g) functional independence
h) support systems
i) activity level
j) psychiatric history
8) Diet/nutritional history
k) how does patient eat?
l) what does patient eat?
m) dietary restrictions
B. Noninstrumental (Clinical) Exam
1) Observation of patient and environment
a) posture and movement
b) pulmonary
c) diet
d) communication/cognition
e) level of alertness
f) care giver-patient interaction
2) Multi system sensorimotor exam
a) structure
b) function
c) reflexes
d) sensation
3) Clinical “hands on” exam with trial swallows
a) oral
b) pharyngeal
c) laryngeal
d) respiratory
e) sensory
C. Instrumental Exam
1) Videofluroscopy
a) definition and rationale
b) procedure/protocol
c) findings and interpretations
d) advantages and disadvantages
2) Flexible endoscopy
a) definition and rationale
b) procedure/protocol
c) findings and interpretations
d) advantages and disadvantages
3) Cervical Auscultation
a) definition and rationale
b) procedure/protocol
c) findings and interpretations
d) advantages and disadvantages
4. Other medical diagnostic procedures
A. upper gastrointestinal series
B. pH monitoring
C. laryngoscopy
D. bronchoscopy
E. Consideration for differential assessment of infants
5. Management of Dysphagia
A. Treatment planning
1) nutrition/hydration status
a) means of nutrition
b) types of nutrition
c) nutritional risk
2) management strategies
3) treatment candidacy and prognosis
4) other referrals
5) patient/care giver/team education
6) discharge planning
B. Clinical Management
1) swallowing maneuvers
2) compensatory postures and positioning
3) bolus modification
4) adaptive equipment
5) physio-therapeutic exercises
6) sensory stimulation
7) biofeedback
C. Prosthetic management
D. Surgical/medical management
E. Treatment risks, benefits, and complications
F. Nonoral feeding
G. Counseling families and patients regarding diagnosis and treatment planning
6. Documentation
A. Assessment
B. Progress notes and treatment outcomes
C. Discharge summary
7. Ethical Issues
A. Patient rights and quality of life
B. Advanced directives
C. ASHA Code of Ethics
8. Efficacy
A. Quality management
B. Clinical research on treatment
9. Models of delivery
A. Dysphagia program planning and implementation
B. Team approach
C. Family, staff, patient education
D. Service delivery models
E. Multi disciplinary interactions
Detailed Description of Conduct of Course
Information will be presented via lecture including guest speakers, multimedia presentations, video taped samples of normal and abnormal swallowing disorders, student presentations., slides, and educational video tapes on a variety of dysphagic topics. Students may be required to view video tapes on reserve in the library for later class discussion. Students will engage in small group interaction to develop assessment and/or treatment approaches given case studies. Learning will culminate in a final case study project to be completed individually and which will require students to assimilate and integrate their knowledge of dysphagia through writing.
Goals and Objectives of the Course
The student will:
1. Understand the basic neurophysiology of normal vs. abnormal swallowing in adults and infants/children
2. Recognize anatomic landmarks imaged on videofluroscopic X-Ray which are important to swallowing.
3. Understand the conduct and interpretation of the modified barium swallow examination.
4. Understand the conduct and interpretation of the clinical dysphagia examination
5. Understand the basic principles of swallowing management and decision making for a variety of neurological, mechanical, and structural disorders.
6. Demonstrate proficiency reading and interpreting scholarly research related to dysphagia.
Assessment Measures
All students must complete and attain a minimum of 80% accuracy on a written competency based examination on normal swallow physiology to ensure a thorough understanding of normal. Additional assessments may include but not be limited to take-home projects targeting integration and application of material covered in class, presentation of research article (s) to the class, interpretation of videotaped imaging studies, and a case management project.
Other Course Information
None.
Review and Approval
10-01 - New Course Approved by: Raymond Linville, Chair - COSD Curriculum Committee
1-30-03 - Course Title Changed by: Raymond Linville - COSD Curriculum Committee