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Introductie: slik en logopedie?- Dysfagie: enorme expansie afgelopen 10-20 jaren
- Internationaal: toenemende research
- Erkenning van dysfagie als terugbetaalbare stoornis in nomenclatuur sinds 2004
- Implementatie in curricula opleidingen
- 2005 ASHA survey:
• 87 % SLP primary providers of dysphagia services
• dysphagia 50 % of clinical time in USA (+ 21% last 10 years)
Historisch:
- Slikken bij CP children sinds 1930
• CP = hersenverlamming (cerebral palsy)
- Eerste artikel SLP literature: Larsen, 1972
• JSHD “Rehabilitation for dysphagia paralytica”
• introduced aspects of the clinical exam, radiographic techniques, postural
adjustment, dietary changes, electrical stimulation and maneuvers
Breaking point: Evaluation and Treatment of Swallowing Disorders; JA Logemann, 1983
13 roles of SLP (ASHA):
1. identification of individuals at risk
2. conduct of clinical examination of the upper aerodigestive tract
3. conduct instrumental examinations
4. make management decisions regarding method of intake and medical risks
5. provide treatment
6. assessment and management of swallowing/feeding in infants and children
7. provide education, counseling and training
8. manage or participate in swallow/feeding team
9. maintain quality control / risk management
10. provide discharge planning and f/u care
11. teach / supervise clinicians and students
12. provide public education
13. conduct research
Dysfagie (dysphagia) NIET DYSFASIE !!!!!
- dys : afwijkend, stoornis
- Phago/phagein : slikken/eten
- Swallowing = 'the function of clearing food and drink through the oral cavity,
pharynx and oesophagus into the stomach at an appropriate rate and speed' (ICF
code b5105)
- Dysphagia is classified under 'digestive symptoms and signs' in the International
Classification of Diseases (ICD-10, code R13)
≠
- Eetstoornis (cfr boulemie, anorexie, ...)
- Eetmoeilijkheden door bv verminderde oog-hand coördinatie
1
,Indeling:
- Neurogene dysfagie
- Structurele dysfagie UEF
- Iatrogene dysfagie
• Als gevolg van een andere behandeling (bv bestraling)
- Presbyfagie
• Slikken bij oudere personen (hoeft niet pathologisch te zijn)
- Psychogene dysfagie LEF
Algemene aspecten slikken:
Gastro-intestinaal systeem
Voedsel/vocht innemen,
+ Verwerken om nutrienten/vocht op te nemen en vezels/bacteriëen af te scheiden
Bij slikken: eerst UES open dan LES
Bij braken: open
Bij rust: gesloten
Functies G-I systeem:
- Ingestie
- Digestie (vertering, omzetten ingestie in voedingsstoffen)
- Absorptie (opname nutrienten, vocht)
- Verdediging
Normale slikfysiologie:
1. anatomie
2. innervatie
3. fysiologie van normale slikact
Anatomie:
Ruimte tussen tongdorsum en
epiglottis: valecularuimte
Zone boven UES: sinus
piriformes (L+R)
2
,Farynx:
SP: glijbaan die eindigt in UES
Posterior: achter
Anterior: neus
UES (Upper esophageal Sphincter), PE segment (faryngo-esofageaal segment):
Anatomie van de UES:
- M Cricopharyngeus is het hoofdbestanddeel
- Hoge druk zone van 3 tot 6 cm lengte
- Gestreepte spier
- C-vormig
• Hoefijzer
- Piekdruk is 1 – 2 cm lager dan de top van de tracheale luchtkolom
Hangt aan WK (achter) en aan thyroid en cricoid (voor)
3
, Bezenuwing van de UES:
- M. constrictor pharyngis inferior: dense pharyngeale plexus
- M. cricopharyngeus: pharyngeale plexus en N Recurrens
- Proximaal deel van de slokdarm: N Recurrens
Slikfysiologie: slikact: 1-2 sec en 33 spieren
- Orale fase = bewust
• Voorbereiding
• Oraal transport
- Faryngale fase = onbewust
- Oesofagale fase = onbewust
Oraal voorbereidende fase:
Kauwen (mechanisch verkleinen)
Vermenging met speeksel
- Bepaald door CNS
- Mee beïnvloed door interne/externe factoren:
• Dentitie
• Kauwkracht
• Voedselkenmerken
• Speekselhuishouding
Faryngale fase:
4
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