MANAGING SYMPTOMS( continued)
How is aspiration pneumonia treated?
Treatment for aspiration pneumonia may include:
• Chest physical therapy: Therapists work to encourage deep breathing and coughing through positioning and percussion of the chest and back. The purpose of this therapy is to help loosen the secretions.
• Suctioning: Nurses use a small tube attached to a suction machine, placed in the nose or mouth, and briefly advanced into the lungs. The purpose of suctioning is to remove the secretions in the lungs caused by the pneumonia.
• Antibiotics: Medications used to treat the infection.
• Oxygen: Occasionally, while the infection resolves, people need oxygen administered through a face mask or nasal cannula.
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What is a swallowing study?
The swallowing evaluation usually consists of a clinical examination and a swallowing study. The clinical examination includes a discussion with the patient and caregiver, identifying concerns, experiences, and observations related to the potential swallowing problem. It is often beneficial to maintain a diary of the swallowing difficulties observed, including the type of foods or liquids and a description of the surrounding circumstances. This will make the swallowing evaluation more thorough and the recommendations more specific to the needs of the patient. The clinical visit also includes an initial assessment of swallowing skills, including observations of eating and drinking. At this time, suggestions to promote safer and easier swallowing may be provided. These suggestions are based on an understanding of normal swallowing physiology and the changes observed in PSP, CBD, and MSA. The clinical examination is also beneficial to determine the need for an imaging study.
The clinical examination may be followed by an imaging study, either a videofluoroscopic swallowing study( VFSS) or a fiberoptic endoscopic evaluation of swallowing( FEES). A VFSS, also called a modified barium swallowing study( MBS), is a video-recorded X-ray examination of the swallowing mechanism during which foods, liquids, and pills containing some form of barium are presented. Varied consistencies and volumes are presented because some things are easier to swallow than others. A fiberoptic endoscopic evaluation of swallowing( FEES) may be performed in a clinic, but this study is typically of less benefit, as it does not visualize the mouth, only the throat, during the swallow. It can also be limited by compromised posture and movement. A swallowing study is used for multiple purposes: to document current swallowing ability, to rule out non-neurogenic causes of dysphagia, to identify strategies that may enhance the ease and safety of swallowing, to assist in patient education, and perhaps to guide timing of feeding tube placement. The swallowing study should replicate the feeding environment. The decision to proceed with this examination is made on a case-by-case basis. Swallowing status should be frequently monitored by repeating the study as the disease progresses.
Will swallowing therapy help?
Currently, there are few reports in the literature as to the role of direct swallowing exercises in any neurodegenerative diseases, much less in PSP, CBD, and MSA. It is difficult to define the benefits of such efforts given the rapidly progressive nature of these disorders. Emphasis should be placed on patient and caregiver education, diet modifications, and feeding and swallowing strategies. The goals are to avoid nutritional deficiency and dehydration, to reduce the risk of choking and aspiration pneumonia, and to continue oral intake as long as possible for enjoyment and independence.