Follow

Share

Speech Pathologists in the medical environment spend the vast majority of the day evaluating and treating patients with Dysphagia. While the underlying etiology and presenting symptoms may vary, the therapeutic methodologies embrace overlapping themes. Less commonly, SLP’s are asked to alleviate swallowing difficulties in individuals with no detectable physiologic pathology as evidenced by objective testing. These patients are likely suffering from a rare condition known as phagophobia.

Phagophobia is a word that comes from Greek phagein, “eat” and phobos, “fear”. It is a fear of swallowing, expressed in various symptoms without any apparent physical reason detectable by physical inspection and clinical analyses. Other terms used to define this disorder include: functional dysphagia, choking phobia, pseudodysphagia and sitophobia. The most common complaints of the condition include difficulty with swallow initiation, abnormal oral behaviors, repetitive lingual movements, complaints of throat pressure and globus (Barofsky and Fontaine, 1998). The by-product of these symptoms functionally manifest in food/texture avoidance, severe anxiety, weight loss and malnutrition. Phagophobia is registered in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The disorder is more common in females vs. males. Onset can range across the lifespan from childhood to geriatric. While incidence rates are extremely low, many patients are incorrectly diagnosed with this disorder and are later found to have an organic source of symptoms. The need to perform a comprehensive, multidisciplinary assessment is paramount in order to ensure that patients receive a correct diagnosis and restorative plan of care.

Some have equated the symptoms of phagophobia with those of a conversion disorder. The premise being that an individual subconsciously transforms psychological conflicts revolving around the act of eating, into somatic symptoms. Researchers have begun to challenge the historic notions of the disorder with clinical studies targeting brain function in these individuals. One study investigated cortical activity in patients suffering from phagophobia. They were able to identify objective changes in brain activity specifically in the insula, dorsolateral prefrontal cortex, and the premotor cortex of the R. Hemisphere. These represent the areas of the brain responsible for proprioception and coordination of temporal sequences and volitional oral-phase swallowing behaviors. (Sunstrup, 2014). Another interesting study by Leopold looked at broadening the traditional patterns of swallow sequencing beyond three phases. Their theory was that clinicians should integrate pre-oral and preparatory phases as part of the swallowing continuum. These crucial precursors to swallowing involve complex somatosensory inputs that can translate into altered motor programming. Patients who sustain repetitive negative stimuli/experiences relating to the act of swallowing may develop this complex disorder that manifests as phagophobia. These studies provide clinicians with heightened insight into the complexity of the condition and offer some clear direction regarding treatment. Unfortunately, there is a paucity of clinical efficacy studies highlighting treatment strategies to rehabilitate swallowing function in these individuals. Those that exist have extremely small sample sizes with limited SLP involvement. The vast majority identified combined methods of cognitive behavioral therapy (CBT) and exposure therapy as being the most effective tools in resolving symptoms of phagophobia. Historically, the role of SLPs in managing this disorder has been questionable. How do we address these patients’ unique complaints in the context of normal/intact swallowing physiology? In many cases, SLPs have opted to refer these patients to a mental health specialist under the premise that skilled dysphagia services were contraindicated. Today, SLPs are reevaluating this position and joining forces with mental health providers to offer patients therapy that addresses underlying swallowing anxieties in concert with oral-motor retraining and exposures to challenge foods and textures. This approach carries enormous promise as an efficacious therapeutic modality that restores normal eating/swallowing behavior through both cognitive and sensorimotor retraining.

Follow

Share

Course Description

This presentation reviews how high-resolution manometry (HRM) transitioned from a research technology to a clinical tool. The opportunity to measure pressures may provide the clinician a more complete profile for planning treatment for patients with complex dysphagia. Case examples are presented to demonstrate the opportunities manometry offers to investigate pressure events during swallowing.

Time ordered agenda

15 minutes – Evolution of HRM for oral-pharyngeal disorders
15 minutes – Techniques and competencies to perform HRM
15 minutes – Case studies
15 minutes  –  Question and answer

Learning Objectives

1) Describe how HRM permits visualization of the pharynx amid 12 sensors.
2) Develop protocol for GI collaboration and training to integrate HRM for oral-pharyngeal disorders.
3) Verbalize patient populations for which HRM is inappropriate.

Disclosures

Molly Knigge, MA, CCC-SLP, BCS-S
Financial: Employed at University of Wisconson Madison Medical Center
Non-Financial: Nothing to disclose

Follow

Share

Course Description:

This webinar is designed for clinicians to develop care programs for hypophonia within iVoiceTherapy.  It is also applicable for any neurogenic disturbance altering other speech subsystems.  Features to enhance compliance with these populations include the built in sound level meter, pitch monitor, journal, voice recorder and audio exercises.  Specific case examples will reflect therapeutic strategies based on medical history.  Should you be unavailable on the scheduled webinar date, this course will available at endo-education.com/online-ceus/ until 2.12.16.  Course 0041.  0.1 ASHA CEUs.  (Introductory level; Professional area).

Time ordered agenda:

12:00 – 12:15   Patient selection:  PD stage, stimulability, family support.
12:15 – 12:30   Programming tasks and exercises
12:30 – 12:45   Case studies
12:45 – 13:00   Question and Answer

Learning Objectives

1) Verbalize appropriate candidates for voice therapy and iVT use to augment care of Parkinson’s disease.
2) Predict timeline of improvement with combination of in-person and iVT care plans.
3) Independently program exercises, alarms, voice files and settings in iVT for Parkinson’s patients.

Disclosures:

This presentation will focus solely on the product iVoiceTherapy and will not include information on other similar or related products.

Liza Blumenfeld
Financial:  Partnership with Sinnova, which receives royalties from sale of iVoiceTherapy.
Non-financial:  Owner of Endo Education, host of iVoiceTherapy training.

Erin Walsh
Financial:  Partnership with Sinnova, which receives royalties from sale of iVoiceTherapy.
Non-financial:  Owner of Endo Education, host of iVoiceTherapy training.

POST-TEST, COURSE EVALUATION, CEUs, PRINT CERTIFICATE

Follow

Share

Course Description

This hour webinar was hosted by the National Foundation of Swallowing Disorders and featured Tiffany Mohr, a medical speech pathologist, with extensive experience in complex swallowing disorders.  It is appropriate for introductory level clinicians seeking review of lung physiology, phases of swallowing and risk factors for aspiration developing into a pneumonia.  Ms. Mohr provides guidance on other types of pneumonia and how they are distinctly different from those related to aspiration.  She discusses aspiration risks based on specific populations including stroke and cancer.  The webinar concludes with a 30 minute question and answer session.  The audience was a mixture of patients, caregivers and speech pathologists.

Time ordered agenda

15 minutes – Basic lung function and swallow physiology.
10 minutes – Pneumonia acquisition.
5 minutes – Medical co-morbidities and aspiration pneumonia.
30 minutes  –  Question and answer

Learning Objectives

1) Describe normal reflex when foreign material enters lungs.
2) Differentiate types of pneumonia and how each are acquired.
3) Verbalize 3 risk factors for development of aspiration pneumonia.

Disclosures

Tiffany Mohr, MA, CCC-SLP
Financial: Nothing to disclose
Non-Financial: Nothing to disclose