Multiple Sclerosis - A Practical Guide to Rehabilitation - 40

AIMS

A PRACTICAL GUIDE TO IDIOPATHIC PULMONARY FIBROSIS

SLPs are encouraged to use objective assessments,
including instrumental evaluations, to determine
the presence of aspiration-penetration and to
monitor potential benefits of swallowing
maneuvers and positioning changes. Objective
assessments are ideal when recommending
exercises to improve swallowing or when
considering changes to food/liquid textures, to
ensure that these changes will positively impact
on swallow safety and/or function. During
instrumental evaluation of swallowing, the
patient is given foods and liquids of varying
consistencies (eg, soft/hard foods and
thin/thicker liquids), in amounts progressing
from smaller to larger bolus sizes. To assess
oropharyngeal swallowing, speech-language
pathologists may use videofluoroscopy or
fiberoptic endoscopy.
The videofluoroscopic swallow study (VFSS),
also called the modified barium swallow (MBS)
study or cookie swallow study, provides a "moving
x-ray" of chewing and swallowing.156 It is
performed in a radiology suite with the patient in
a sitting or standing position. To visualize
swallowing, the test employs small amounts of
barium mixed with foods and liquids. Exposure to
radiation is limited, with the fluoroscope turned
off and on during the procedure. VFSS is not
useful for assessing saliva control due to lack of
contrast in the saliva. A VFSS may also include a
screen of esophageal function. However, SLPs do
not diagnose esophageal dysphagia; this requires
involvement of a radiologist or gastroenterologist.
The Modified Barium Swallow Impairment
Profile (MBSImp)-while not an assessment per
se-is gaining attention as an objective way to
interpret and score VFSS studies. Training is
available online and scoring allows for attention
to 17 different components of the swallow,
including esophageal clearance. Results can be
used to determine the impact of swallowing
interventions and exercises and to track change in
functioning over time.157

40

Fiberoptic endoscopic evaluation of swallowing
(FEES) is useful for visualizing saliva control,
assessing sensory components of swallowing, and
detecting signs of gastroesophageal reflux above
the upper esophageal sphincter. A flexible
endoscope is inserted through the nasal cavity and
toward the throat, and provides direct
visualization of the base of tongue, larynx, and
pyriform sinuses. A colored dye may be used to
visualize food, but no radiation exposure is
involved.158 Because no fluoroscopy is involved,
this assessment can be more easily performed in a
mobile setting or in acute care units, where it may
be difficult to move a patient to diagnostic
imaging for assessment.
Management of Dysphagia in MS
When intervention for swallowing difficulties is
necessary in patients with MS, goals are to reduce
the risk of aspiration and aspiration pneumonia;
improve comfort of swallowing, nutrition and
hydration; and increase independence,
participation, and quality of life.
Management strategies for dysphagia include159
* Positioning of trunk, legs, and arms
* Specialized positioning of the head and neck
* Manipulation of food/liquid consistencies
* Modifications to eating schedules
* Modifications to bolus size
* Consuming smaller, more frequent meals
* Use of nutritional supplements
* Reducing the rate of eating
* Adding moisture to foods to improve bolus
lubrication
* Alternating solids and liquids
* Specialized feeding equipment
* Manipulating the patient's environment
* Training the patient, family, and caregivers
* Following up with appropriate professionals
(eg, a dietitian, gastroenterologist, or
otolaryngologist)
Education for patients and family or caregivers is
crucial for management of dysphagia. Education

Speech, Swallowing Issues, and Oral Health



Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
Multiple Sclerosis - A Practical Guide to Rehabilitation - 5
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Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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