Adult Dysphagia Flashcards
Dysphagia
A swallowing disorder that may occur as a result of various medical conditions. Dysphagia is defined as problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction.
true presence and cause is not fully known.
1/3 who have dysphagia get pneumonia
Cranial nerves
A lot are used when eating and drinking
Muscles of orofacical structures
Same muscles utilized for speech as for swallowing
Different function from speech vs swallowing
Oral Phase
Orbicularis and oris muscles- labial closure
Incisivus labii muscles- pucker
innvervation CS VII
Function- grasping function, creation of labial seal.
Levator anguli oris, depressor labii oris, lavator labii superioris-depressor labii inferioris (smile), mentalis (frown)- these muscles make the lips part/retract/press upper and lower lips can move away and towards eachother. can be active singlularly or in combination
Oral phase (cheeks)
Buccinator(lateral wall of oral cavity) and Risorius muscle- together form check contraction.
-Temporary storage for mastication of bolus formation.
Innervation- motor innervation is from the buccal branch of the facial nerve VII. sensory innervation is from the buccal branch of the mandibular part of the trigeminal (CN V)
Tongue
Most important structure in oral phase
- function: hold and manipulate the bolus
- transport the bolus
- -initiate the pharyngeal swallow
muscular hydrostat- no skeleton
tongue blood supply from lingual artery that branches off of the external carotid artery.
-begins to develop in 4th week of human development
Tongue Intrinsic muscles
make up the body of the tongue
innervation- CN XII
change the shape of the tongue
superior longitudinal (tip up- creates the concave space for the bolus to rest (holds liquid)
Tongue extrinsic muscles
origionate outside the tongue and insert into the tongue.
function- elevate or depress the tongue, protrusion or retraction.
Hypoglossus- causes the tongue to depress and retract.
-Syloglossus- causes the back of the tongue to elevate and move posterior
-Palatoglossus- lowers the velum, elevates the back of the tongue. essential for bolus transfer.
Genioglossus- aids in multiple different movements of the tongue (below the tongue)
Taste
a form of chemoreception (thousands of taste buds in the oral cavity) heavily distributed on the tongue.
-thermoreceptors- aid in temperature sensation
Tongue conditions- Ankyloglossia
also known as tongue tie, is a congenital oral anomaly that may decrease mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. can affect eating, speech, and oral hygiene.
Tongue conditions- Black hairy tongue
a condition in which small bumps on the tongue elongate with black or brown discoloration, giving a black and hairy appearance. The appearance may be alarming, but it is a harmless condition. Predisposing factors include smoking, xerostomia (dry mouth), soft diet, poor oral hygiene and certain medications.
muscles of the velum (soft palate)
levator veli palatine (velar elevation)
Tensor veli palatine (velar tension)
function- close off the velopharyngeal port. (mort complex for swallowing than it is for speech.
muscles of mandible
- Temporalis
- Lateral pterygoid
- Medial pterygoid
- Masseter
help the jaw move.
mandibular elevation
temporalis, masseter, medial pterygoid
Mandibular depression
Lateral pterygoid
Suprahyoid muscles
form the floor of the mouth, position the hyoid bone
Infrahyoid muscle function- depress the hyoid
Suprahyoid muscles
Mylohyoid- elevates and pulls forward the hyoid bone/depresses the mandible and opens the mouth
Digastric muscle- anterior belly- pull the mandible forward and bring down
posterior belly- draws back the hyoid bone.
Geniohyoid- pulls the hyoid bone forward and up, lateral movement of the mandible
Stylohyoid- elevate the hyoid during swallowing, pulls hyoid backwards to keep the mouth open.
Infrahyoid muscles
Sternohyoid- depress the hyoid
Thyrohyoid- depress the hyoid, elevate the larynx
Sternothyroid- depress the larynx (important for mastication/chewing as well as swallowing, pitch, volume.
Pharynx
3 section: Nasopharynx, Oropharynx, and Laryngopharynx
Parynx (outer layer) function is to constrict/narrow pharyngeal cavity (during swallowing, these muscles constrict to propel the bolus downwards.
Inferior pharyngeal constrictors are the strongest and have 2 main components (thyropharyngeus and cricopharyngeus)
Pharynx inner layer
stylopharygeus, salpinogopharyngeus, and palatopharyngeus
during swallowing these muscles act to shorten and widen the pharynx.
Upper esophageal sphincter
boundary between the pharynx and esophagus, Tonically closed (contracted)
function is to prevent laryngeal reflux during esophageal peristalsis.
Esophageal stage
8-20 second transit time
peristalic wave pushes bolud ahead of it and continues in sequential manner
the esophagus
muscular tube that extends from pharynx through esophageal hiatus of the diaphragm.
Upper 1/3 of esophagus is striated muscles while lower 2/3 is smooth muscle.
function is to carry material to the stomach
3 esophageal areas
cervical esophagus (pharynx to the top of the sternum) 4-5 cm long
Thoracic esophagus (bulk of the esophagus) chest cavity
Abdominal esophagus (shortest section) enters the stomach at an angle.
Oral preparation stage
reduces food to consistency for swallow.
lip closure
facial tone
lateral jaw and tongue movement
soft palate pulled anteriorly to contract back of tongue.
Oral stage
anterior to posterior contact of midline of tongue with palate propels bolus backward to pharynx; tongue tip and lateral margins maintain contact with anterior and lateral alveolar ridge, sealing bolus on midline of tongue.
1 second
Pharyngeal stage
valve function and pressure generation.
base of tongue move backward to pharyngeal wall
laryngeal closure
CP and UES opening
1 seconds
Esophageal stage
8 to 20 seconds
Primary peristalsis
The peristaltic contracts are:
- move down the esophagus
- 10 to 15 seconds to complete a primary peristaltic activity
Secondary Peristalsis
Residual food in the esophagus, as seen with ineffective peristalsis, may be bleared by what is called secondary peristalsis.
-does not involve full swallowing reflex.
swallowing evaluations
video swallow
FEED
Speech-language evaluation
motor speech evaluation
Phases of swallowing
Oral prep/oral
Pharyngeal
Esophageal
Oral motor exam
evaluation with different consistencies
- ice chips/thin liquids
- nectar thick liquids
- puree
- soft and/or regular solids
diagnosis that may have a higher risk for Dysphagia
Stroke Brain injury Bain tumor Neurological progressive diseases -multiple sclerosis -Parkinson's disease -Alzheimer's Disease -Myasthenia Gravis -ALS
KU hospital swallow screenings
- Kansas stroke Dysphagia screening
- KU prolonged intubation screening
recommendations
diet placement
- alternate nutrition
- -short-term
- -long-term
video swallow evaluation
Gold standard
Dysphagia treatment
goal is to reestablish oral feeding while constantly maintaining adequate nutrition/hydration program and safe swallowing.
alter structure and or function or compensatory: compensating for the problem
diet modification
altering bolus characteristics of food
- Solids: puree, chopped/mechanically altered, soft
- Liquids: nectar thick, honey thick, pudding thick
strength training
intensity, specificity, transference
Shaker exercises, IOPI, EMST
Postural/Position technique
purpose- redirect the movement of the bolus in the oral cavity and pharynx and modify pharyngeal dimensions in a systematic way.
postural techniques may be appropriate to use with patients with neurological impairments, head and neck cancer resections, and other structure damage.
Chin down posture- chin is tucked down toward the neck during the swallow.
Chin up posture- chin is tilted up which can help facilitate movement of the bolus from the oral cavity.
Head rotation (turn to the side) head is turned to left or right side, typically the damaged side, to direct bolus to the stronger of the sides
Head tilt: Head is tilted toward the strong side to keep the food on the chewing surface.
sensory stimulation
thermal-tactile stimulation- iced lemon glycerin swab.
Tactile stimulation- applied to the tongue, around the mouth, and or in the oropharynx.
may prime the swallow system for the subsequent presented bolus to lower the threshold needed to initiate a swallow response and improve the timelines of the swallow.
dysphagia maneuvers
specific strategies that- change the timing or strength of particular movements of swallowing.
-require following multistep directions.
dysphagia maneuvers
specific strategies that- change the timing or strength of particular movements of swallowing.
-require following multistep directions.
Effortful swallow
purpose is to increase posterior tongue base movement to facilitate bolus clearance
(swallow and push hard with the tongue against the hard palate
Mendelsohn maneuver
purpose is to elevate the larynx and open the esophagus (prolong the width/duration of CP opening) during the swallow to prevent food/liquid from falling into the airway.
(when you swallow feel your larynx (voice box) move up in your throat. Swallow again and try to keep your voice box up. So hold it up with your muscles for several seconds)
Supraglottic swallow
Purpose is to close the vocal folds by voluntarily holding one’s breath before and during swallow in order to protect the airway
(hold your breath, swallow, and then cough)
Non-oral nutrition types
G tube J tube G-J tube NG tube (corpak Total parenteral nutrition (TPN)- feeding intravenously, bypassing the usual process of eating and digestion. nutritional formula
