intraoral prosthetics

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  • 1. Intra-Oral ProstheticsTaylor Harris &Brittany Janowski

2. What are intra-oral prosthetics? Artificial substitutes for missing,altered, or deformed oral structures Placed in vocal tract Primarily used to improve speech &swallowing 3. Population Head & Neck Cancer Cleft palate Progressive neurologicdiseases Traumatic injuries 4. Multidisciplinary Team Maxillofacial prosthodontist * Speech-Language Pathologist Oral & Maxillofacial Surgeons Plastic Surgeons Head & Neck Surgeons ENT doctors Occupational therapist Physiotherapists Oncologists Physical Therapists 5. Role & Responsibilities of the SLP Determine specific needs Actively participate in design ofappliance Assess effectiveness Provide direction for modifications i.e. size, shape Provide follow-up treatment & monitor Swallowing, speech, voice, resonance Teach patient about care & cleaning 6. Types 7. Palatal Lift Designed to augment or replacehard and soft palate tissue defects Aids in restoration of soft palatefunctions Improves velopharyngeal closure Commonly used for dysarthria;velopharyngeal incompetence 8. Palatal Obturator Closes or occludes openingcaused by cleft or fistula Used to facilitate separation oforal & nasal cavities for speech,feeding, & swallowing hypernasality suckling ability in babies Not to be confused with palatal lift 9. The Latham Device 10. Nasoalveolar Obturator 11. Obturator Categories Modification ObturatorShort term Interim Obturator Post surgery Definitive Obturator Long term 12. Speech Bulb Occludes nasopharynx when the velum isshort (velopharygealindufficiency) Aids in velopharyngeal closure Contains pharyngeal section, goes behindsoft palate Can be combined with an obturator 13. Tongue Prosthetic Sometimes used following totalglossectomy Steel clasps attach to lower teeth Facilitates speech & swallowing 14. Tongue for Speech 15. Limitations of Prosthetic Devices Require insertion and removal Have to redo periodically due togrowth Can be lost or damaged May be very uncomfortable Compliance is often poor Dont permanently correct theproblem Many centers use only if surgery isnot possible 16. Assessment Prosthetic assessment is provided to: evaluate, select, and/or dispense a prosthetic device to improve functional communication including associated activities and participation 17. Who Can Assess Prosthetic assessments are conducted byappropriately credentialed and trainedSLPs SLPs perform assessments as membersof collaborative teams that include Individual family/caregivers Educators medical personnel 18. Why Assess?To identify: underlying strengths and weaknessesrelated to the use of prosthetic as it affectscommunication and swallowing effects of prosthetic on activities such ascapacity and performance in everydaycommunication and participation factors that serve as barriers or facilitatorsfor successful communication/swallowing 19. What Process Includes Review of status Case history info Standardized and/ornonstandardized methods Follow-up services Cost considerations & safetyand health implications Dispensing practices 20. Setting of Assessment Clinical, educational or other naturalenvironment setting conducive to elicitinga representative sample of the clientscommunication using a prosthetic device. Identifying the influence of related factorson functioning (activity and participation)requires assessment data from multiplesettings. 21. Documentation of Assessment Results, interpretation, prognosis, andrecommendations. Provide a rationale for the preferredprosthetic; a description of device;procedures involved in the assessment ofthe device; counseling provided to thepatient; and the patients response. 22. Prosthetic InterventionIntervention services areconducted to assistindividuals to understand,use, adjust, and restore their customized prostheticdevice. 23. Who Provides InterventionServices? conducted by appropriately credentialedand trained SLPs, possibly supported bySLP assistants under appropriatesupervision. SLPs as members of interdisciplinaryteams 24. Expected Outcomes of Treatment Strengths & weaknesses related tocommunication /swallowing Acquire new skills and strategies using thedevice Aid for successfulcommunication/swallowing Provide appropriate accommodations andtrain how to use them Improve abilities, functioning, participation,and contextual facilitators May result in recommendations forreassessment or follow-up, or referral forother services 25. Goal(s) Associated WithProsthetics Painless, efficient swallowing of secretions Unrestricted head movement Elimination or reduction of nasal emission Decrease respiratory effort/long breathgroups Increased subglottal pressures; increasedloudness Improved articulatory precision improved speech intelligibility normalized nasality 26. Clinical ProcessDepending on assessment results,intervention addresses the following: Provide info, course of intervention andduration, effectivecommunication/swallowing Education and maintenance, info aboutsafety and instrument warranty How repair, maintain, and modify Intervention accomplishes objectives Meets the abilities, needs, and wants ofpatient and who they communicates with,considering the environment it will be used 27. Setting of Treatment clinical or educational settings other natural environments that areselected on the basis of intervention goalsand in consideration for the social,academic, and/or vocational activities thatare relevant to the individual. 28. sEMG As muscles contract, microvolt levelelectrical signals are created within themuscle that may be measured from thesurface of the body. A procedure thatmeasures muscle activity from the skin isreferred to as surface electromyography(SEMG). 29. One Researchers Results Eighty-seven percent(39/45) of all patientsincreased their functionaloral intake of food/liquidincluding 92% of strokepatients and 80% ofhead/neck cancer patients. 30. Cultural/Ethical ConsiderationsIt is important to be culturally sensitive inassessment and treatment ofindividuals needing dysphagia management. 31. Things to Consider aboutDiversity Foods to use in dysphagiaassessment and treatment Who is it appropriate to talk with abouttherapy? Choosing assessments that areculturally considerate 32. Counseling Counseling is important forindividuals pre and post surgery Being a part of society andcommunicating with others issomething humans need, and theneed for prosthetics can alter thisfrom happening. 33. References American Speech-Language-Hearing Association. (2001). Roles of Speech-Language Pathologists inSwallowing and Feeding Disorders: Technical Report [Technical Report]. Retrieved fromwww.asha.org/policy. doi:10.1044/policy.TR2001-00150 American Speech-Language-Hearing Association. (2004). Preferred Practice Patterns for the Profession ofSpeech-Language Pathology [Preferred Practice Patterns]. Available from www.asha.org/policy. Crary, M. A., Carnaby, G. D., Groher, M. E., &Helseth, E. (2004). Functional benefits of dysphagia therapyusing adjunctive sEMG biofeedback [Abstract]. Dysphagia, 19, 160-164.doi:10.1007/s00455-004-0003-8 Grames, L.M., Jones, D.L., Kummer, A.W., Kurnell, M.P., Ruscello, D. (2006). Response to Velopharyngeal dysfunction:Speech characteristics, variable etiologies, evaluation techniques, and differentialtreatments by Dworkin, Marunick, &Krouse . Language, Speech, and Hearing Services in Schools.36, 236-238. Light. J. (1995). A review of oral and oropharyngeal prosthesis to faciliatate speech and swallowing. AmericanJournal of Speech-Language Pathology, 4, 15-21. Likes, C. P., McCarthy, E. S., Zwilling, C., Dingman, C. A coordinated, multidisciplinary approach tocaring forthe patient with head and neck cancer [PPT document]. Retrieved from South Carolina SpeechLanguage Hearing Association Web site: http://www.scsha.com/handouts/session42.pdf