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Samenvatting dysphagia/dysfagie (Nederlands)

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Bevat volgende hoofdstukken: - Algemeen kader & inleiding - Fysiologie & pathofysiologie - Assessment: niet-instrumenteel - Beoordeling: instrumenteel - Behandeling door SLP - Medische behandeling & teamaanpak

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  • December 19, 2022
  • 52
  • 2022/2023
  • Summary
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Dysphagia – dysfagie
Dysphagia – dysfagie...........................................................................................................................1
1 Algemeen kader & inleiding .............................................................................................................3
1.1 Referentiekaders: ICF & EBP ......................................................................................................3
1.2 Doelen stellen: SMART & SMARTER ...........................................................................................3
1.3 Definitie & classificatie ..............................................................................................................3
1.3.1 Classificatie.........................................................................................................................4
1.4 Prevalentie ................................................................................................................................4
1.5 Gevolgen van dysfagie ...............................................................................................................5
1.6 Team aanpak .............................................................................................................................5
1.7 Instelling ...................................................................................................................................5
1.8 Concepten, trefwoorden & anatomie ........................................................................................5
2 Fysiologie & pathofysiologie.............................................................................................................7
2.1 Anatomie en fysiologie: inleiding ...............................................................................................7
2.2 Fysiologie van deglutitie: fasen + hersenzenuwen .....................................................................7
2.2.1 Voorbereidende fase ..........................................................................................................8
2.2.2 Orale fase ...........................................................................................................................9
2.2.3 Faryngeale fase ..................................................................................................................9
2.2.4 Slokdarmfase.................................................................................................................... 12
2.3 Pathofysiologie........................................................................................................................ 12
2.3.1 Neurologische aandoeningen ........................................................................................... 13
2.3.2 Structureel: aangeboren/verworven ................................................................................. 13
2.3.3 Structureel: therapie ........................................................................................................ 14
2.3.4 Iatrogeen.......................................................................................................................... 14
2.3.5 Presbyfagie....................................................................................................................... 14
3 Assessment: niet-instrumenteel ..................................................................................................... 15
3.1 Assessment: inleiding .............................................................................................................. 15
3.2 Screening ................................................................................................................................ 15
3.3 Anamnese en dossieronderzoek .............................................................................................. 17
3.3.1 Medische voorgeschiedenis & slikklachten ....................................................................... 17
3.3.2 Voorgeschiedenis slikken .................................................................................................. 18
3.4 Klinische slik-evaluatie............................................................................................................. 20
3.4.1 Indicatie + basisbegrippen ................................................................................................ 20
3.4.2 (Hoofd hals) lichamelijk onderzoek ................................................................................... 21
3.4.3 Motorische en sensorische functie ................................................................................... 23
3.4.4 Functionele observatie slikken .......................................................................................... 25

1

,4 Beoordeling: instrumenteel............................................................................................................ 27
4.1 Assessment: introduction ........................................................................................................ 27
4.2 Endoscopy: FEES...................................................................................................................... 27
4.2.1 Indicaties .......................................................................................................................... 28
4.2.2 Beperkingen ..................................................................................................................... 28
4.2.3 Beoordelingstaken............................................................................................................ 29
4.3 Radiography and DSS............................................................................................................... 31
4.3.1 Introductie ....................................................................................................................... 31
4.3.2 Indicaties .......................................................................................................................... 32
4.3.3 Onderzoek ........................................................................................................................ 32
4.3.4 DSS - dynamisch slikonderzoek ......................................................................................... 32
4.3.5 FEES vs DSS ....................................................................................................................... 35
4.4 Other techniques .................................................................................................................... 35
4.5 Conclusion of diagnostic process ............................................................................................. 36
5 Behandeling door SLP .................................................................................................................... 37
5.1 Behandelplan: inleiding ........................................................................................................... 37
5.2 Gedragstherapie...................................................................................................................... 37
5.3 Rehabilitatietechnieken........................................................................................................... 38
5.4 Compensatietechnieken .......................................................................................................... 40
5.5 Andere hulpmiddelen .............................................................................................................. 44
6 Medische behandeling & teamaanpak ........................................................................................... 46
6.1 Medische therapie .................................................................................................................. 46
6.2 Chirurgische therapie .............................................................................................................. 48
6.3 Uitvoering van de behandeling en follow-up ........................................................................... 51
6.4 Team aanpak ........................................................................................................................... 51




2

, 1 Algemeen kader & inleiding
1.1 Referentiekaders: ICF & EBP




Health condition: bijvoorbeeld: slokdarmverlamming, deel weggenomen van de
slokdarm
Body functions and structures: voorbeeld: lippen, bijten
Activity: eten en drinken, voorbereiden van het eten
Participation: niet meer op restaurant durven gaan, sociale interactie
Environmental factors: beschikbaarheid van hulpmiddelen, voedselaanpassingen
Personal factors: persoonlijke motivatie, voorkeuren, culturele of religieuze
voedselkeuzes

1.2 Doelen stellen: SMART & SMARTER


SMART  doelen
SMARTER  proces samen met de cliënt/patiënt




1.3 Definitie & classificatie
Dys-fagie (dysphagia)
- Griekse wortel: "phagein" = om in te nemen
- "dys": stoornis/moeilijkheid
- ≠ dysphasia! (= spraakprobleem)
- ≠ eetstoornis (bijv. anorexia)
- ≠ motorisch probleem (bv. zwakte, slechte coördinatie van de bovenste ledematen)
- Voedingsstoornis  slikstoornissen bij zuigelingen of kinderen, niet gebruikt bij volwassenen
- Een symptoom van een onderliggende ziekte (bv tumor, Parkinson,…)

Dysfagie: Groher & Crary (2016) van Tanner: stoornis van emotionele, cognitieve, sensorische en/of
motorische handelingen die betrokken zijn bij het overbrengen van een stof van de mond naar de
maag, waardoor hydratatie en voeding niet op peil blijven en een risico op verslikking en aspiratie
ontstaat.

In het kort: dysfagie = slikprobleem (swallowing problem)



3

, 1.3.1 Classificatie
Op basis van leeftijd
- Pediatrisch  OPO OMFT
- Volwassenen + presbyfagie  OPO Dysfagia
o Presbyfagie = dysfagie veroorzaakt door het feit dat je ouder wordt

Op basis van stadia/fase (volwassenen)
- Oropharyngeale dysfagie (oropharyngeal)
- Slokdarm dysfagie (esophageal)

Op basis van etiologie (volwassenen)




 Neurologische condities is een groot onderdeel hieruit

1.4 Prevalentie
- Een veel voorkomend fenomeen
- Verschillende cijfers?
o Bevolking (leeftijd: oudere volwassenen, premature pasgeborenen)
o Criteria
- Globaal, 3-4% van de bevolking
- Specifieke pathologiegroepen: >50%




Stille aspiratie = voedsel of drank komt in de longen, maar de patiënt reageert er niet op (kucht niet
of iets dergelijks) waardoor het erg gevaarlijk is.

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