Aspiration Flashcards
What is aspiration
Any entry of secretion, food or any foreign material into the airway that passes below the true vocal folds
When can aspiration occur?
Before: when food tips over the tongue prematurely
During: when there is inadequate airway protection, epiglottis hasn’t tipped over or the UEW hasn’t opened up sufficiently
After: when there is pooling in the valleculae (epi didn’t tip sufficiently) or inadequate pharyngeal constriction or pooling in the pyriform sinus (UES hasn’t opened) and the food ends up in a place it can all when there isn’t adequate protection
Factors that can influence whether aspiration leads to pneumonia: (3)
- > volume of aspirated material
- > toxicity/nature of aspirated material
- > ph of aspirated material
- > mobility of patient
- > health and immunity of patient
- the state of the patient’s lungs
Risk factors of aspiration pneumonia:
- medical/health status
- use of multiple medications
- oral hygiene
- dependent for oral care
- feeding independence
- bed bound state
- smoking
Clinical signs of aspiration:
cough, wet voice, beathing changes
Respiratory signs of aspiration:
breathlessness, chest pain, wheeze, crackles, reduced chest expansion
Radiological signs of aspiration
lung collapse or consolidation
Signs of aspiration in paediatrics:
- recurrent bacterial chest infection
- choking and coughing before, during and or after swallow
- wet or gurgly sounding voice quality after feeding
- breathing changes
- facial colour changes
- signs of distress
Red flags in paediatrics:
- inability to transition to baby food puree by 10 months of age
- inability to accept any table food solids by 12 months
- inability to transition from breast/bottle to cup by 16 months
- has not weaned off baby foods by 16 months
non-physiological factors that can further compromise swallow safety and function
- attention, alertness
- fatigue
- behavioural problems
- postural control
- feeding dependence/upper limb mobility
- environmental factors/distraction
Changes to swallow function due to presbyphagia
- decreased muscle strength and speed
- alterations in sensation
- reduced respiratory capacity and elasticity of the lungs
- reduced taste and smell
- difficulties with harder textures
- increased swallow duration
Neurological causes of dysphagia
- neurological dysphagia is the result of some impairment of the sensorimotor control of the oral and/or pharyngeal stages of swallowing
- the onset, nature and severity of dysphagia will depend on the nature of the disease or neurological problem
Unilateral cortical stroke swallowing deficits
UMN pathways
- difficulty initiating a saliva swallow
- delayed triggering of pharyngeal stage swallow
- incoordination of oral movements
- increased pharyngeal transit time, reduced pharyngeal constriction
- aspiration
Brain stem stroke swallowing deficits
- absent or delayed pharyngeal response
- reduced hyolaryngeal excursion
- reduced pharyngeal constriction
- reduced laryngeal closure/vocal fold paralysis
- incoordination of breathing and swallowing
Dementia swallowing deficits
- unexplained weight loss*
- oral stage dysfunction* (increased oral prep time, long meal times)
- pharyngeal-stage dysfunction (delayed swallow initiation, reduced hyolaryngeal excursion, inefficient pharyngeal clearance)
- aspiration (if oral and pharyngeal stage impaired)
- feeding limitations
PD’s swallowing deficits
- poor lip closure, lingual tremor, repetitive tongue pumping*, drooling
- piecemeal deglutition, buccal retention
- vallecular and pyriform retention*
- reduced laryngeal elevation
- penetration/aspiration
Motor neuron disease swallowing deficits
- reduced oral control of bolus due to oral/tongue weakness
- reduced oral prep/chewing (weakness)
- reduced oral transit (velar leak, nasal regurgitation, reduced tongue pump, reduced pharyngeal constriction)
- residue (valleculae and pyriform sinus pooling)
- aspiration, ineffective airway clearance (cough weakness), shortness of breath
HD’s swallowing deficits
- chorea – involuntary movements and respiration/choking risk
- hyperextension of neck and trunk
- reduced mastication and lingual conntrol, drooling, trachyphagia
- delayed and repetitive swallow
- aspiration, coughing on liquids, choking on foods
- disrupted breath control during the swallow, phonation during swallowing
- aerophagia, vomiting
Myasthenia Gravis
- fatigue* - signs and symptoms of dysphagia worsen with repeated use of muscles
- flaccid weakness – oral and pharyngeal stage symptoms
- aspiration
TBI
- neurological damage (UMN/LMN) – oral and/or pharyngeal stage dysphagia
- reduced lingual control, loss of bolus control, delayed swallow common
- sensory and motor impairments
- disrupted consciousness/cognitive difficulties
- reduced laryngeal elevation and airway protection, aspiration
- trauma (may have fractured teeth/jaw), tracheostomy
CP swallowing changes
Oral phase: increased duration, impaired tongue control
Pharyngeal phase: delayed swallow, reduced peristalsis
4 main effects of medication on swallowing function
- depress the CNS
- tardive dyskinesia
- impact oesophageal function
- affect salivary flow
