Samenvatting van volledige lessenreeks en handboek m.u.v. deel over slikstoornissen bij kinderen (geen leerstof).
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Bachelor In De Logopedische En Audiologische Wetenschappen
Zorgtraject: Slikstoornissen (E0F53A)
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DYSFAGIE
Handboek voor de klinische praktijk
Jolien Van Baelen
,INHOUD
1. Dysfagie: definitie en classificatie ................................................................................................................. 6
1.1. Definitie .................................................................................................................................................. 6
1.1.1. Algemene aspecten van slikken ....................................................................................................... 6
1.2. Classificaties ........................................................................................................................................... 7
1.2.1. Indeling volgens leeftijd .................................................................................................................. 7
1.2.2. Indeling volgens fase ....................................................................................................................... 7
1.2.3. Indeling volgens etiologie ............................................................................................................... 8
1.2.4. Indeling volgens probleemgebied (kinderen) .................................................................................. 9
1.2.5. Klinische indeling (kinderen) ........................................................................................................ 10
1.2.6. Besluit classificaties ...................................................................................................................... 10
1.3. ICF ........................................................................................................................................................ 11
2. De impact van een slikstoornis .................................................................................................................... 12
2.1. Gevolgen van dysfagie op sociaal, psychologisch en medisch vlak..................................................... 12
2.2. Prevalentie ............................................................................................................................................ 12
2.3. Historiek ............................................................................................................................................... 12
2.4. Besluit ................................................................................................................................................... 13
3. Kernbegrippen ............................................................................................................................................. 13
3.1. Kruising luchtweg en voedselweg ........................................................................................................ 13
3.2. Premature lekkage ................................................................................................................................ 13
3.3. Residu / stase, regurgitatie .................................................................................................................... 13
3.4. Laryngale penetratie en aspiratie .......................................................................................................... 13
4. Evidence Based Practice.............................................................................................................................. 15
1. Anatomie en fysiologie van de normale slikact ........................................................................................... 16
1.1. Inleiding................................................................................................................................................ 16
1.2. Anatomie .............................................................................................................................................. 17
1.2.1. Orale fase ....................................................................................................................................... 17
1.2.2. Faryngeale fase .............................................................................................................................. 17
1.2.3. Oesofageale fase ............................................................................................................................ 18
1.3. Fysiologie ............................................................................................................................................. 19
1.3.1. Orale fase ....................................................................................................................................... 19
1.3.2. Faryngeale fase .............................................................................................................................. 20
1.3.3. Oesofageale fase ............................................................................................................................ 21
1.4. Ademhaling en slikken ......................................................................................................................... 21
1.4.1. Anatomie en fysiologie.................................................................................................................. 21
1.4.2. Slikapneu ....................................................................................................................................... 21
1.4.3. Hoest .............................................................................................................................................. 22
1.5. De speekselklieren ................................................................................................................................ 22
1.5.1. Anatomie van de speekselklieren .................................................................................................. 22
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, 1.6. Neur(on)ale controle van het slikken.................................................................................................... 22
1.6.1. Hogere neurale controle................................................................................................................. 22
1.6.2. Central Pattern Generator / hersenstam ......................................................................................... 23
1.6.3. Perifere neuromusculaire mechanismen / craniale zenuwen ......................................................... 23
1. Diagnostiek .................................................................................................................................................. 25
1.1. Inleiding................................................................................................................................................ 25
1.1.1. Multidisciplinair gebeuren ............................................................................................................. 25
1.1.2. Rol van de logopedist .................................................................................................................... 27
1.1.3. Terminologie ................................................................................................................................. 27
1.2. Stap 1: Signalen voor de verwijzer ....................................................................................................... 29
1.3. Stap 2: Anamnese en dossierinzage...................................................................................................... 29
1.3.1. Voorgeschiedenis........................................................................................................................... 30
1.3.2. Huidige ziektegeschiedenis ........................................................................................................... 31
1.3.3. Klachten patiënt / omgeving .......................................................................................................... 31
1.4. Stap 3: Screenings en protocollen ........................................................................................................ 32
1.4.1. Inleiding ......................................................................................................................................... 32
1.4.2. Sensitiviteit, specificiteit ............................................................................................................... 32
1.4.3. Screening (verpleegkundigen) ....................................................................................................... 32
1.5. Stap 4: Diagnostisch onderzoek (logopedisten) ................................................................................... 40
1.5.1. Inleiding ......................................................................................................................................... 40
1.5.2. Formulier voor diagnostisch onderzoek ........................................................................................ 41
1.5.3. Dysfagieonderzoek bij patiënten met een tracheacanule ............................................................... 54
1.6. Onderzoeksprotocollen; gestandaardiseerd / genormeerd slikonderzoek: overzicht ............................ 55
1.6.1. Gestandaardiseerd diagnostisch slikonderzoek: MASA ................................................................ 65
1.7. Voedselevaluatie: MISA....................................................................................................................... 65
1.8. Stap 5: Instrumentele onderzoeken....................................................................................................... 66
1.8.1. Fiberoptic Endoscopic Evaluation of Swallowing (FEES)............................................................ 67
1.8.2. VideoFluoroscopische Evaluatie van het Slikken (VFES) ............................................................ 77
1.8.3. VFES vs. FEES ............................................................................................................................. 82
1.8.4. Andere instrumentele onderzoeken ............................................................................................... 82
1.9. Stap 6: Schalen en vragenlijsten rond ernst, outcome en quality of life ............................................... 87
1.9.1. Bestaande schalen en vragenlijsten ............................................................................................... 87
1.9.2. Ernstschalen: Ernstschaal dysfagie ................................................................................................ 88
1.9.3. Penetratie-aspiratieschalen: Penetration Aspiratie Scale (PAS) .................................................... 89
1.10. Stap 7: Adviezen en dieetaanbevelingen ............................................................................................ 90
2. Behandeling ................................................................................................................................................. 91
2.1. Inleiding................................................................................................................................................ 91
2.1.1. Multidisciplinaire samenwerking .................................................................................................. 91
2.1.2. Aandachtspunten tijdens maaltijden / revalidatie .......................................................................... 91
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, 2.2. Medische behandeling .......................................................................................................................... 93
2.2.1. Medicatie ....................................................................................................................................... 93
2.2.2. Chirurgische mogelijkheden .......................................................................................................... 93
2.2.3. Alternatieve voedingswijzen ......................................................................................................... 96
2.2.4. Tracheacanules ............................................................................................................................ 102
2.2.5. Discussiepunten bij de medische behandeling ............................................................................ 107
2.3. Logopedische behandeling ................................................................................................................. 110
2.3.1. Rol van de logopedist .................................................................................................................. 110
2.3.2. Doel van sliktherapie ................................................................................................................... 110
2.3.3. Terminologie rond sliktherapie ................................................................................................... 111
2.3.4. Voorwaarden om te kunnen starten met slikbehandeling ............................................................ 113
2.3.5. Principes van neurale en musculaire plasticiteit .......................................................................... 113
2.3.6. Effectiviteit van sliktherapie ........................................................................................................ 115
2.3.7. Revalidatietechnieken .................................................................................................................. 115
2.3.8. Compensatietechnieken ............................................................................................................... 126
2.3.9. Overzicht ..................................................................................................................................... 136
2.3.10. Prothesen ................................................................................................................................... 137
2.3.11. Biofeedback ............................................................................................................................... 138
2.3.12. Enkele aandachtspunten binnen de revalidatie .......................................................................... 139
3. Materiaal .................................................................................................................................................... 140
3.1. Bekers ................................................................................................................................................. 140
3.2. Borden ................................................................................................................................................ 141
3.3. Bestek ................................................................................................................................................. 141
3.4. Antislip ............................................................................................................................................... 141
3.5. Slabben ............................................................................................................................................... 141
3.6. Medicatie-inname ............................................................................................................................... 141
3.7. Houdingscorrectie............................................................................................................................... 142
3.8. Consistentieaanpassingen ................................................................................................................... 142
1. Inleiding..................................................................................................................................................... 144
1.1. Hersenletsels ....................................................................................................................................... 144
1.1.1. Kenmerken volgens localisatie van het letsel .............................................................................. 145
1.2. Degeneratieve neurologische ziektebeelden ....................................................................................... 148
1.3. Oncologische problematiek ................................................................................................................ 148
1.3.1. Chirurgie ...................................................................................................................................... 149
1.3.2. Voedelconsistentie ....................................................................................................................... 153
1.3.3. Chemo-radiotherapie ................................................................................................................... 153
1.4. Gastroenterologische stoornissen ....................................................................................................... 155
2. Alfabetische lijst van specifieke problemen .............................................................................................. 156
2.1. Achalasia ............................................................................................................................................ 156
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