,Inhoud
Leerdoelen............................................................................................................................................... 5
Informatie vooraf over de normale slik................................................................................................... 6
1.1 Dysfagie: definities en classificaties (blz. 19-24) ......................................................................... 7
Definities.............................................................................................................................................. 7
Classificaties ........................................................................................................................................ 8
Indeling volgens leeftijd .................................................................................................................. 8
Indeling volgens fase (volwassenen) ............................................................................................... 8
Indeling volgens etiologie (volwassenen)........................................................................................ 9
1.2 De impact van een slikstoornis .................................................................................................. 10
Gevolgen van dysfagie op sociaal, psychologisch en medisch vlak................................................... 10
Prevalentie......................................................................................................................................... 11
Historiek ............................................................................................................................................ 11
Besluit ................................................................................................................................................ 11
1.3 Kernbegrippen ........................................................................................................................... 11
Kruising luchtwegen en voedselweg ................................................................................................. 11
Premature lekkage ............................................................................................................................ 12
Residu/stase, regurgitatie ................................................................................................................. 12
Laryngeale penetratie of aspiratie .................................................................................................... 13
1.4 Evidence Based Practice ............................................................................................................ 14
2.1 Anatomie en fysiologie van de normale slikact (blz. 49-69)...................................................... 15
Inleiding ............................................................................................................................................. 15
Anatomie ........................................................................................................................................... 15
Orale fase....................................................................................................................................... 15
Faryngeale fase.............................................................................................................................. 16
Oesofageale fase ........................................................................................................................... 18
Fysiologie ........................................................................................................................................... 18
Orale fase....................................................................................................................................... 18
Faryngeale fase.............................................................................................................................. 19
Oesofageale fase ........................................................................................................................... 20
Ademhaling en slikken....................................................................................................................... 20
Anatomie en fysiologie .................................................................................................................. 21
Slikapneu ....................................................................................................................................... 21
Hoest ............................................................................................................................................. 22
De speekselklieren............................................................................................................................. 22
Anatomie van speekselklieren ...................................................................................................... 23
2
, Neur(on)ale controle van het slikken ................................................................................................ 23
Hogere neurale controle ............................................................................................................... 23
Central Pattern Generator/hersenstam ........................................................................................ 24
Perifere neuromusculaire mechanismen/Craniale zenuwen ........................................................ 25
3.1 Diagnostiek (blz. 89-101) ........................................................................................................... 26
Inleiding ............................................................................................................................................. 26
Multidisciplinair gebeuren ............................................................................................................ 26
Rol van de logopedist .................................................................................................................... 26
Terminologie.................................................................................................................................. 27
Signalen voor de verwijzer ................................................................................................................ 29
Anamnese en dossierinzage .............................................................................................................. 30
Voorgeschiedenis .......................................................................................................................... 30
Huidige ziektegeschiedenis ........................................................................................................... 31
Klacht van patiënt/omgeving ........................................................................................................ 31
Screenings en protocollen ................................................................................................................. 32
Sensitiviteit, specificiteit................................................................................................................ 32
Screening (verpleegkundigen) ....................................................................................................... 32
Diagnostisch onderzoek (logopedisten) (blz. 105-126) ................................................................. 32
Formulier voor diagnostisch onderzoek ........................................................................................ 33
Instrumentele onderzoeken (blz. 150-171)....................................................................................... 33
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) ............................................................... 34
Videofluoroscopische Evaluatie van het Slikken (VFES) ................................................................ 36
Overzicht instrumentele onderzoeken:............................................................................................. 38
Adviezen en dieetaanbevelingen (blz. 186-187) ............................................................................... 39
3.2 Behandeling (blz. 188-195)........................................................................................................ 40
Multidisciplinaire samenwerking ...................................................................................................... 40
Multidisciplinaire behandeling bij dysfagie ................................................................................... 41
Aandachtspunten tijdens maaltijden of revalidatie .......................................................................... 42
Verslikken voorkomen:.................................................................................................................. 42
Maatregelen als patiënt toch verslikt:........................................................................................... 43
Eerste hulp bij verslikken............................................................................................................... 43
Medische behandeling ...................................................................................................................... 44
Medicatie ....................................................................................................................................... 44
Logopedische behandeling (blz. 220-242)......................................................................................... 44
Rol van de logopedist .................................................................................................................... 44
Doel van sliktherapie ..................................................................................................................... 44
3
, Terminologie rond sliktherapie ..................................................................................................... 45
Voorwaarden om te kunnen starten met slikbehandeling ........................................................... 46
Principes van neurale en musculaire plasticiteit ........................................................................... 46
Effectiviteit van sliktherapie .............................................................................................................. 47
Revalidatietechnieken: verbeteren van spierkracht en -uithouding van specifieke spieren en
spiergroepen ..................................................................................................................................... 47
3.3 Materiaal (blz. 250-269) ............................................................................................................ 48
3.3 Materiaal (blz. 287-296) ............................................................................................................ 51
Bekers ................................................................................................................................................ 51
Borden ............................................................................................................................................... 52
Bestek ................................................................................................................................................ 52
Antislip ............................................................................................................................................... 53
Slabben .............................................................................................................................................. 53
Medicatie-inname ............................................................................................................................. 53
Houdingscorrectie ............................................................................................................................. 54
Consistentieaanpassingen ................................................................................................................. 54
Waar verkrijgen? ............................................................................................................................... 54
5.1 Specifieke slikproblemen (blz. 383-389) ................................................................................... 55
Hersenletsels ..................................................................................................................................... 55
Degeneratieve neurologische ziektebeelden .................................................................................... 57
Oncologische problematiek............................................................................................................... 57
4
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