Kristi Roya and Allison Latiolais
COPD: Treatment and Maintenance of Dysphagia

---To make treatment most effective the clinician must:
 --Understand the patientís medical problems
  causing the dysphagia, as well as the patientís
  swallowing physiology.
 --The treatment plan must be tailored to the
  specific diagnosis.

Planning Treatment
---Respiratory function should be considered.
 --Normal swallowing requires airway closure for a  brief period of time-3-5 seconds or more  during continuous cup drinking.
 --If a patientís respiratory function is poor, they  may be unable to tolerate even the normal  brief duration of airway closure duration.
---Some swallowing therapy procedures require modifying airway closure duration, such as super-supraglottic swallowing.
---If respiratory function is severely affected, some types of swallowing therapy may need to be postponed until respiration improves.
--Diet should also be considered:

Gastroesophageal Reflux: Compensatory Procedures
 ---Cigarette smoking may influence reflux, therefore, smokers with complaints and disorders caused by reflux should strongly be
  advised to STOP smoking.
 ---Rehabilitative measures may also be helpful, including dietary modification and training in specific swallowing techniques.

Gastroesophageal Reflux: Therapy Procedures:
---Laparoscopic Antireflux Surgery (LARS)
 --These procedure has been shown to be safe  and effective for the control of  gastroesophageal reflux disease.
 --This is a surgical procedure that involves twisting the top of the stomach around the lower esophageal sphincter to reduce reflux.
 --This procedure can be performed safely in an ambulatory surgery center.
 ---The outpatient setting is a safe, cost-effective, and patient friendly location for the performance of Laparoscopic Antireflux Procedures.
---Some complications with LARS include:

---This treatment is used in the elderly, as well as adult patients with COPD.
---The indication of LARS usually depends on the age of the patient.
---Maintenance: Quality of life after LARS is evaluated by performing a 24 hour PH monitoring and esophageal manometry.
---Reflux decreases significantly after surgery and is comparable to that of healthy individuals.

Reduced Airway Closure, Reduced Laryngeal Elevation, & Aspiration
--Compensatory Strategies work best because other types of exercises may put further stress and work on the respiratory system and may be unproductive.
---Compensatory changes usually do not increase muscular effort or the duration of airflow closure, which tends to be a problem with patients who have a respiratory disease.
---They do not fatigue the patient as much as some swallowing exercises.
---These treatment procedures are those that control the flow of food and eliminate the patientís symptoms, such as aspiration.
---They do not change the physiology of the patientís swallow.

---Postural Techniques

Food Consistency Changes Sensory Awareness Reduced Airway Closure, Reduced Laryngeal Elevation, and Aspiration: Therapy Procedures
 --Are designed to change swallowing physiology.
---Therapy Techniques: