2 dysphagia 181014 revisi

7/26/2019 2 Dysphagia 181014 Revisi

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181014 1

CURRICULUM VITAE

Full Name : MOHAMMAD SAIFUL-ISLAM doctor, neurologist, consultant (cerebroascular!

"osition#$ob %itle : Medical Sta&&, Stro'e Unit, Deartment o&

Neurolog), Facult) o& Medicine Airlangga Uniersit)#Dr Soetomo *eneral Hosital,

Suraba)a

+ducational ecords : Medical Doctor, Facult) o& Medicine AirlanggaUniersit), Suraba)a Secialist in Neurolog), Facult) o& Medicine, Airlangga Uniersit), Suraba)a %raining "rogram in te .linical Management o& Stro'e "atients at Sir .arles *airdner Hosital, "ert, /estern Australia (0112!


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NEUROLOGIC ASPECTON

DYASPHAGIA

Moammad Sai&ul-Islam


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Dysphagia is common and has !!n "!po"#!d #o !p"!s!n# in $%&' o( p!"sons ) ag! $*

M!chanica+ dysphagia Oral: Am)loidosis, congenital

abnormalities, Intraoral tumor, liin3uries, macroglosia,scleroderma, %M$ d)s&untion,4erostomia

"ar)ngeal: .erical antosteo)tes, diteria,t)romegal), retroar)ngealabscess#tumor

+soageal: .austic in3ur),esoageal .a#dierticulum#in&ection#stricture#ulceration,*+D, iatal ernia, osteriormediastinal mass

Pfeiffer RS. NICP 2012;153-163


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N!,"om,sc,+a"dysphagia

Oroar)ngeal: in&lammator)m)osties, mitocondrialm)oat), muscular d)stro),NM$ disorders (M*, L+MS,botulism!, scleroderma, sti&& mans)ndrome

+soageal: Am)loidosis,In&lammator) m)oaties(dermatom)ositis, ol)m)ositis,scleroderma

Pfeiffer RS. NICP 2012;153-163


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N!,"og!nic dysphagia

Oroar)ngeal: Arnold-.iar)mal&ormation, basal gangliadiseases (DL5, HD, MSA, "D,

"S", /ilson disease!, ."M, .",drug related, in&ection (rabies,encealitis, oliom)elitis!, masslesion (tumor, emorrage,abscess!, motor neuron disease(ALS!, MS, erieral neuroat)

(*5S!, sinocerebellar ata4ia,s)ringobulbia, stro'e

+soageal: Acalasia, autonomicneuroat), "D, esoagealmotilit) disorders, .agas diseasePfeiffer RS. NICP 2012;153-163


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IMPAIRED S-ALLO-ING OR DYSPHAGIAocc,"s .,i#! ("!.,!n#+y in n!,"o+ogica+ pa#i!n#s


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HO- COMMON ISDYSPHAGIA A/TER STRO0E 1

Diagn!"i#"e#$ni%&e

In#i'en#e f'(!)$agia

C,"so"y

sc"!!ning#!chni.,!

37-45%

C+inica+#!s#ing

51-55%

Ins#",m!n#a+#!s#ing 2V/S3

64-78%

*ar"in R e" a+. S"r,e 2005;362756-2763


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DOES DYSPHAGIA MATTER 1

DYSPHAGIAIN ACUTE STRO0E PATIENTS IS A

MAR0ER O/ POOR PROGNOSIS

MALNUTRITIONDEHYDRATIONASPIRATIONPNEUMONIA

PROLONGED HOSPITAL STAYINCREASED MOR4IDITY 5 MORTALITY


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DOES DYSPHAGIA MATTER 1

S#,dy Dysphagic Non%Dysphagic

RR 2"andom3

6$' CI

-!igh#2'3

RR2"andom3

6$' CI

C$&a e" a+

DePi)) e" a+

/r'n e" a+

/""i+e e" a+*ann e" a+

Si"$ar' e" a+

Sa+a e" a+

To#a+5 CI

621

1082

737

502482

2060

1168

&789**

232

157

450

130246

57

211

:6896;

7.4

4.40

13.2

22.6.16

34.05

8.21

;**


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181014 10

O"opha"yng!a+ dysphagiais "!po"#!d ?i#h an incid!nc! o( 7*@;**' inpa#i!n#s ?i#h Pa">insons dis!as!

C+ini#a++( re+ean" !a++ing

i)airen" i! genera++(

a!!#ia"e' i"$ a'an#e'

!"age f "$e 'i!ea!e I" re'e! %&a+i"( f +ife

#)+i#a"e! e'i#a"in in"a,e

an' +ea'! " a+n&"ri"in an'

a!)ira"in )ne&nia $i#$ i!a a9r #a&!e f 'ea"$ in

Par,in!n:! 'i!ea!e

Suntru S et al6 Brain 7809136; 726738


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NEURAL MECHANISMS O/ S-ALLO-ING

Subcortical andcortical sensorimotor

Medullar) s;allo;ing

centerMotor outut (Nn6


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NEURAL MECHANISMS O/ S-ALLO-ING

BRAINSTEM

S7a++7ingCen"e

r

THALAMUS

SENSORI-MOTOR NEOCORTEX

inferir )re- an' )!"-#en"ra+ g(r&!

!+ihoodo( s?a++o?ing p"o+!ms

Decrease LOC

!""r s#$$#& 'a(ace D")'(e *e+#,ares#s O(er a&e A'"r+a( $"&)e,a(a$a( +".e+e$ /ea0 "r a'se$ ."()$ar c")&*

M"#s$ "r ')''(#& ."#ce E.#ece "2 ,e)+"#a Re)ce ,*ar&ea( sesa$#"

ESOPHAGEALPHASE

P"ima"y #!s#


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ASSESSMENT O/ S-ALLO-ING

B CLINICAL /EATURES

D)soniaD)sartriaAbnormal gag re&le4Abnormal olitional coug


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MANAGEMENT

GOALS

"reention o&asiration,

de)dration,malnutrition

eabilitation o&d)s&unction

eestablisment o&oral inta'e

COMPENSATORYSTRATEGY

%o 'ee atients sa&e

;en eating

REHA4ILITATIVE

STRATEGY %o seed te recoer)rocess


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COMPENSATORY TREATMENT

Nil b) mout

(N5M! N* and "+*

&eeding

Feeding

training

Ne&r+gi#a+ ar' Dr Se" !)i"a+ S&raa(a D#.


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SUMMARY

Neurogenicd)sagia

.ommon roblemin neurologicaldiseases

Neural

mecanismsAssessmentManagement


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180512 FOEL 22220711 FOEL 22

22

Suramadu Long Bridge(Surabaya-Madura)

THAN0 YOU

2 dysphagia 181014 revisi

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