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Dysphagia > Chapter 1: Dysphagia overview > Flashcards

Chapter 1: Dysphagia overview Flashcards

1
Q

What is Dysphagia?

From the Greek root:

A

phagein (to ingest)

With the prefix ‘dys-’ meaning a disorder or difficulty swallowing

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2
Q

What is Dysphagia?

A ___________, not a ____________________

A

A symptom, not a disease, with clinical signs. It is a symptom of an underlying disease not a primary medical diagnosis.

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3
Q

Definition of Dysphagia

Simplest and most frequently used definition:

A

Difficulty moving food from the mouth to the stomach

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4
Q

Definition of Dysphagia

Expanded by Leopold & Kagel (1996)

A

Dysphagia is all of the behavioral, sensory, and preliminary motor acts in preparation for the swallow including cognitive awareness of the upcoming eating situation, visual recognition of food, and all of the physiologic responses to the smell and presence of food such as increased salivation.

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5
Q

Dysphagia: The term should refer to a swallowing disorder that involves:

A

any one of the three stages of swallowing: oral, pharyngeal or esophageal

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6
Q

It is described most often by its:

A

clinical characteristics.

Complaints such as coughing and choking during or after a meal, food sticking, regurgitation, odynophagia (painful swallowing), drooling, unexplained weight loss, and nutritional deficiencies all may be associated with dysphagia.

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7
Q

Text prefers:

Tanner (2006),

A

“Dysphagia: [an] impairment of emotional, cognitive, sensory, and/or motor acts involved with transferring a substance from the mouth to the stomach, resulting in failure to maintain hydration , nutrition and posting a risk of choking and aspiration” (p. 152.)

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8
Q

Difference between FEEDING and SWALLOWING:

Feeding:

A

placement of food in the mouth, manipulation of food in the oral cavity prior to the initiation of the swallow including mastication of food and the oral state of the swallow when the bolus is propelled backward by the tongue. Oral prep and oral stages of the swallow. (From plate to mouth, does not include any of the stages of the swallow. )

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9
Q

Difference between FEEDING and SWALLOWING:

Swallowing:

A

techniques for reducing delay in triggering the pharyngeal swallow, improving pharyngeal transit time and the individual neuromotor actions comprising the pharyngeal stage of the swallow and well as all of the techniques to improve the oral prop and oral stages of the swallow –the entire act of deglutition from placement in the mouth until material enters the stomach.

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10
Q

Swallowing disorder:

A

the act of swallowing

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11
Q

Feeding disorder:

A

result of weakness or incoordination in the hand or arm used to move the food from the plate to the mouth

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12
Q

Eating disorder:

A

anorexia or bulimia nervosa: poor appetite, changes in dietary selections, problems with oral preparation of the bolus, may have swallowing difficulties.

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13
Q

Who manages dysphagia?

Dysphagia Team Members

A

 Speech Language Pathologist- often the team leader/coordinator of the swallowing team (additional role of the SLP)
 Otolaryngologist
 Gastroenterologist
 Radiologist
 Neurologist
 Dentist
 Nurse; referrals most often from nurses because they will be the ones most likely to notice the patient choking
 Dietician; referrals and ensure consistency
 Occupational Therapist; food from plate to mouth and adaptive feeding equipment
 Respiratory Therapist
 Physical Therapist; arm and hand strength and positioning
 Neonatal Development Specialist

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14
Q

History of SLPs and Dysphagia

A

 History of dysphagia study: Late 1970s and early 1980s
 Logemann’s “purple book” 1983. ASHA:First practice guide 1987
 Most recent – 2002; many other documents developed to help the SLP
 Special interest division formed in 1992 Swallowing and Swallowing Disorders – Division 13.
 Specialization now available: Board-Recognized Specialist in Swallowing and Swallowing Disorders (BRS-S)

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15
Q

SLPs Today

A

 Swallowing is one of the 9 major areas of required knowledge now.
 The Standards and Implementation for the CCC in SLP (2005) Standard III-C states: specific knowledge in the area of swallowing (i.e. oral, pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myofunction) is required.

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16
Q

Means…….JOBS FOR SLPS!!

A

 ASHA 2002 Omnibus Survey:
 90% of SLPs in residential health care work with dysphagia
 84% in hospitals
 50% in non-residential health care,
 11% in schools.
 Recent Health Care survey (2002) SLPs in adult health care settings spend 31% of their time in services related to dysphagia

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17
Q

Incidence: (definintion)

A

Reported frequency of new occurrences over a period of time (e.g. a year) related to a population

18
Q

Prevalence: (definition)

A

Number of cases in a population during a shorter period, often a specific setting

19
Q

Prevalence and incidence help

A

medical personnel who screen, hospital administrators, third-party payors, groups like ASHA.

20
Q

Prevalence of dysphagia is highest among those with

A

neurologic disease

21
Q

Prevalence of dysphagia

A

ASHA: about 300,000 to 600,000 new cases are identified annually.

Acute care= 1/3 of all patients are dysphagic
Acute Rehab. = 42%
Chronic Care = 60%
-Cherney (2001)

22
Q

Prevalence By Setting

A

General Community: Among older persons, dysphagia at 16-22%

Acute care intensive care units and skilled nursing facilities– highest risk for dysphagia,

Varied reports: as high as 87% nursing home residents at risk.

Acute General Hospitals:

  • Groher & Bukatman = 13%
  • Acute Rehab. Hospitals: About 1/3
23
Q

Levels of Care

A

Acute Care Setting: hospitals

Subacute Care Setting: not acute, oriented toward rehabilitation

Rehabilitation Setting: Jim Thorpe

Skilled Nursing Facility-SNF Unit (bridge between rehab and going home or rehab and going to a nursing home) “swing beds”

Home Health

24
Q

Signs/Complaints indicating Dysphagia

A 
	Coughing
	Choking:  during or after a meal
	Food sticking
	Regurgitation
	Odynophagia- painful swallowing
	Drooling
	Unexplained weight loss
	Nutritional deficits
25
Q

Stroke:

A

Acute= 50% or more have dysphagia; reduced to 10-28% with dysphagia in a week.

Daniels: 65% of patients had dysphagia, 2/3 silent aspirators, long-term, 94% returned to oral intake. Not dependent upon whether silent or not.

26
Q

CVA: : swallowing is bilateral based in the brain, depending on the area affected they are most likely to have trouble in the following areas:

  1. Right CVA
  2. Left CVA
  3. Bi-lateral CVA
  4. Brainstem CVA
A
  1. Pharyngeal phase
  2. Oral phase
  3. Overall problems
  4. No swallow reflex
27
Q

Head/Neck Cancer:

A

Pauloski, et al: 59% symptoms of dysphagia

28
Q

Head injury:

A

Reports range from 4.5%-78% (due to different severity levels)

29
Q

Traumatic Brain Injury

A

 1/4 have dysphagia
 delayed or absent reflex
 cognition
 laryngeal penetration w/out cough

30
Q

Spinal Cord Injury (esp. C2, C3)

A

 tongue base: where the cranial nerves exit

 laryngeal elevation due to vagus nerve

31
Q

Other disorders:

A

o Any Tumor involving the alimentary tract
o Dementia
o Age-related changes

32
Q

Progressive Neurological Disorders

A

 Amyotrophic lateral sclerosis
 Multiple sclerosis: swallowing problems that look and act like a stroke
 Myasthenia gravis: orals and pharyngeal phase
 Parkinson’s Disease
 Huntington’s Disease: trouble controlling musculature
 Progressive Supranuclear Palsy: frequently misdiagnosed with PD, don’t respond to dopamine as those with PD do
 Wilson’s disease

33
Q

Motor Neuron Diseases

A 
	Cerebral Palsy
	Guillain-Barre Syndrome
	Poliomyelitis
	Infectious disorders
	Myopathy: problem with nerves that drive the muscles
34
Q

Connective tissues/Rheumatoid Disorder

A 
	Polydermatomyositis
	Progressive systemic sclerosis
	Sjogren’s disease
	Scleroderma 
	Overlap syndrome

 Acquired Immune Deficiency Syndrome (AIDS Dementia)

35
Q

Iatrogenic Diagnoses

A 
	Radiation Therapy
	Chemotherapy
	Intubation or tracheostomy
	Post surgical cervical spine fusion
	Post surgical coronary artery bypass grafting
	Medication related
36
Q

Other related disorders

A

Pre-mature Infants: 90% have feeding and swallowing trouble
Severe respiratory compromise: COPD, emphazema
Psychogenic conditions

37
Q

Consequences of DysphagiaAspiration:

A

Aspiration: material enters airway below the vocal folds

Aspiration Pneumonia: lung infection resulting from aspiration

Dehydration
-Xerostomia: dry mouth

Under-nutrition

Immune System Failure (infection, sepsis, death)

Psychosocial Issues, quality of life issues

 Clinical Case 1-1- pg. 4 of Text
 Practice Note 1-2

38
Q

Delay or misdirection of bolus

Two hallmarks of dysphagia:

A
  1. Delay in propulsion from mouth to stomach

2. Misdirection of bolus – enters airway

39
Q

Instrumental Examination

A

The instrumental assessment of the aerodigestive tract most commonly is done by barium x-ray studies, direct visualization, and measurement of pressures within the aerodigestive tract during swallowing attempts

Modified barium swallow (videofluoroscopy): most common x-ray technique that assesses the oral, pharyngeal, and cervical esophageal phases of swallowing

Esophagram: standard barium swallow used to evaluate the esophagus

Direct visualization of the pharyngeal, laryngeal, and esophageal compartments is done by endoscopy

Pressure measurements during swallowing (manometry) are more routinely done for clinical purposes in the esophagus than in the mouth or pharynx

40
Q

Treatment options

A

The goal of most treatment plans is to ensure that the patient can consume enough food and liquid to remain nourished and hydrated and that the consumption of these materials does not pose a threat to airway safety resulting in aspiration pneumonia.

If treatment is indicated, four main areas are considered: behavioral, dietary, medical, and surgical

Behavioral

  - Engaging the patient in some change in swallowing behavior
  - Change posture of eating rate
  - Teaching the patient a new way to swallow
  - Strengthening muscles

Dietary
-Modifications of texture, taste, or volume

Medical

   - Change in medication negatively affecting mental status and swallow
   - Placement of a nasogastric feeding tube

Surgical

  • Mobilization of a weak vocal fold
  • Placement of a gastronomy tube
41
Q

Stages of the Swallow

A

(Anticipatory)- Logemann, Choice of food, size of food, texture of food

Oral

  • Oral Preparatory: lips until you anchor the tongue
  • Oral Transit tongue anchor on alveolar ridge and push bolus backward

Pharyngeal: at facial arches ends when it passes the UES

Esophageal: UES opens and travels down to the stomach

Dysphagia (8 decks)

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