¶ … Swallowing Difficulty and Speech Difficulty on Quality of Life in Patients with PEG Tubes vs. Those on NGT Feeding Systems
Stroke can effect neurological functioning and can have an effect on the patient's ability to talk and swallow. This condition can lead to severe malnutrition A decision is often made to feed the patient using a tube feeding method. Many studies have been performed to measure the clinical outcomes of these procedures, but few have focused on the effects of the patient's quality of life after receiving these interventions. This study will measure the effects of having a PEG tube inserted on the patient's quality of life as it relates to their ability to communicate and swallow. Two research questions will be answered: "Does a PEG procedure have an effect on the patient's ability to communicate their wishes and improve there satisfaction with the quality of their life in regards to self-care?" And "Does the PEG method offer more satisfaction in regards to quality of life than the NGT method?"
The Effects of Swallowing Difficulty and Speech Difficulty on Quality of Life in Patients with PEG Tubes
There are two primary methods for administering food to patients who can no longer swallow or have difficulty swallowing. The first is by way of an NGT tube, which is inserted through the nasal cavity and goes into the stomach. This procedure severely limits the patient's ability to speak or swallow. The other popular method is PEG where a tube is inserted through an incision in the abdominal wall. In this case a patient's ability is speak or swallow is not limited by the procedure itself. However, in stroke patients this ability may already be impaired. Many of us consider the ability to communicate our own wishes and enjoy conversation with other human beings a factor in determining our quality of life. Being unable to communicate with another creates a feeling of isolation or helplessness.
The PEG tube is inserted through an incision and provides liquid food to the patient if they are unable to maintain nutrition through normal means due to a difficulty in swallowing. Tube feeding is considered a medical intervention and is not obligatory care (Taylor, 2001). Percutaneous Endoscopic Gastrostomy (PEG) was first used in 1979. It is becoming standard procedure in many clinical settings. It is considered safe and only requires local and IV anesthesia (Taylor, 2001). Although it is relatively simple, there have been many issues arising from its use.
PEG feeding is typically used in patients with a neuromuscular disorders, including stroke, and cancer. Many of these studies have centered on the effectiveness of the PEG procedure in preventing malnutrition and improving patient outcomes. One of these studies was conducted by James and associates (1998) and looked specifically at a group of patients following PEG placement after dysphagic stroke. Little data is available about tube placement and adverse events after placement (Taylor, 2001). Many of the studies, which have been conducted, have been inconclusive or did not draw a definitive correlation between PEG feeding and patient survival or improvement. Therefore, the effectiveness of the procedure itself must be questioned. Most studies involving this technique have focused on clinical outcomes and have not considered the psychological and comfort levels of the patients from the patient's perspective.
These patients may exhibit swallowing difficulties, particularly failure to manage the food properly once it is in the mouth, called oral phase dysphagia. Or a patient may demonstrate Pharyngeal phase dysphagia, in other words, they may aspirate when swallowing. PEG feeding is used in these patients to prevent aspiration pneumonia, prevent malnutrition and provide comfort. As clinical evidence on the usefulness of this technique is questionable at best, as indicated by a review of clinical studies (Taylor, 2001), we must then focus our attention on the patient comfort issue.
The term "quality of life" means different things to different people. Many of us would agree that whatever means we use to determine our level of quality of life, it is an important factor in the decisions that we make. When faced with a life threatening or debilitating illness we must make many decisions regarding the procedures used and their effect on the quality of life.
For Dysphagia stroke patients a large part of their recovery focuses on regaining basic functions of life. One of the goals in therapy is to regain the ability to speak and swallow. The NGT makes it difficult to perform the therapy to regain these functions. The PEG tube should help allow...
Ease up a range of motion, and foster muscle control. They are said to be used before or together with actual speech production treatment. The evaluation found that these methods and procedures are questionable in matters concerning the implied cause of developmental speech sound disorders, the neurophysiologic differences between the limbs and oral musculature, the development of new theories of movement and movement control, and the sparseness of research
This may consist of arising and seating in chairs securely. Following the progressive characteristics of this illness, all people gradually lose their capability simply to move and will need to advance and use a wheelchair. References Burbank, P.M. (2006). Vulnerable older adults: Health care needs and interventions. New York, NY: Springer Pub. Donaldson, I.M., & Marsden, C.D. (2011). Marsden's book of movement disorders. Oxford: Oxford Univ. Press. Egerton, T., Williams, D. & Iansek,
Speech Pathology Some of my earliest childhood memories involve the brief period during first or second grade when I had to overcome a stuttering problem. I remember the social discomfort of worrying about how people might react to me once I started talking. I also remember the frustration of people talking to me as though I was unintelligent because they drew that conclusion from my speech pattern without listening to what
Speech Problems and Psychological Damage From Cleft Lips and Cleft Palates Cleft lips and cleft palates are among the most common of birth defects and if left untreated can lead to serious speech problems as well as psychological damage that can result both from those speech and communication problems as well as from the ostracism that a child with a facial deformity must endure. However, while the consequences of cleft lips and
For patients whose primary concern is a loss of language abilities due to loss of cognitive abilities therapies to help improve cognitive function will be combined with exercises that ask the patient to perform various language tasks. Speech and language therapy is only a small portion of the many different specialists that any patient with a CNS dysfunction will need. Aphasia Aphasia is the result of damage to the language centers of
Patient can be positioned upright, on the side, or in prone position so that saliva can be swallowed or let drool 2. Cleaning of oral tract and teeth is possible 3. During cuff deflation intervals, only minimal secretions from above the cuff have to be suctioned 4. During cuff-deflation and tube-occlusion intervals, the patient can breathe spontaneously and sufficiently through the upper airway for a minimum of 20 minutes with sufficient and
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