Chapter1 Flashcards
What is Dysphagia?
A symptom, not a disease, with clinical signs
Difficulty moving food from the mouth to the stomach
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.
What is dysphagia (our text prefers this definition)
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”
Feeding Disorder vs. Swallowing Disorder vs. Eating Disorder
- Feeding: ____ of food in the mouth, ___ of food in the oral cavity prior to the initiation of the swallow including ____ and the oral state of the swallow when the bolus is propelled ____. ___ ___ and ___ ___ of the swallow
- Swallowing: techniques for ____ ____ in triggering the ___ ___, improving pharyngeal ___ ___ and the individual neuromotor actions comprising the pharyngeal stage of the swallow as well as all of the techniques to improve the ___ and ___ of the swallow –the entire act of ____ from ____ until ____
Feeding: 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
Swallowing: 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
Textbook differences between swallowing, feeding, and eating disorders
Swallowing disorder: the act of ____
Feeding disorder: result of ____ in the hand or arm used to _____
Eating disorder: ___ or ___: poor appetite, changes in dietary selections, problems with oral preparation of the bolus, may have swallowing difficulties.
- -Swallowing disorder: the act of swallowing
- -Feeding disorder: result of weakness or incoordination I the hand or arm used to move the food from the plate to the mouth
- -Eating disorder: anorexia or bulimia nervosa: poor appetite, changes in dietary selections, problems with oral preparation of the bolus, may have swallowing difficulties.
Who manages dysphagia?Dysphagia Team Members
-
- Speech Language Pathologist- often the team leader/coordinator
- Otolaryngologist
- Gastroenterologist
- Radiologist
- Neurologist
- Dentist
- Nurse
- Dietician
- Occupational Therapist
- Respiratory Therapist
- Physical Therapist
- Neonatal Development -Specialist
Jobs for SLPs
90% of SLPs in _____ work with dysphagia
84% in ____
50% in _____
11% in _____.
Recent Health Care survey (2002) SLPs in adult health care settings spend ___% of their time in services related to dysphagia
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
Incidence and Prevalence
Incidence: Reported frequency of ____
Prevalence: Number of ____
Prevalence and incidence help medical personnel who screen, hospital administrators, third-party payors, groups like ASHA.
Incidence: Reported frequency of new occurrences over a period of time (e.g. a year) related to a population
Prevalence: Number of cases in a population during a shorter period, often a specific setting
Prevalence and incidence help medical personnel who screen, hospital administrators, third-party payors, groups like ASHA.
Prevalence of dysphagia is highest among those with ____
Prevalence of dysphagia is highest among those with neurologic disease
prevalence
ASHA: about ___ to ____ new cases are identified annually.
Cherney (2001)
___ care= 1/3 of all patients are dysphagic
Acute ___. = 42%
____ Care = 60%
ASHA: about 300,000 to 600,000 new cases are identified annually.
Cherney (2001)
Acute care= 1/3 of all patients are dysphagic
Acute Rehab. = 42%
Chronic Care = 60%
General Community: Among ____ persons, dysphagia at 16-22%
Acute care intensive care units and skilled nursing facilities___
Varied reports: as high as 87% _____ residents at risk.
Acute General Hospitals: 13%
Acute Rehab. Hospitals: About ___
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:13%
Acute Rehab. Hospitals: About 1/3
levels of care
\_\_\_\_ Setting \_\_\_\_\_ Care Setting \_\_\_\_\_ Setting \_\_\_\_\_\_ Unit \_\_\_ Health
Acute Care Setting Subacute Care Setting Rehabilitation Setting Skilled Nursing Facility-SNF Unit Home Health
Signs/Complaints indicating Dysphagia
\_\_\_\_ \_\_\_\_: during or after a meal Food \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_- painful swallowing \_\_\_\_ Unexplained \_\_\_ \_\_\_ Nutritional \_\_\_\_\_
Coughing Choking: during or after a meal Food sticking Regurgitation Odynophagia- painful swallowing Drooling Unexplained weight loss Nutritional deficits
Most likely to be due to ____
Stroke: Acute=___% or more; reduced to 10-28% in a week.
Daniels: 65% of patients had dysphagia, 2/3 silent aspirators, long-term, __% returned to oral intake. Not dependent upon whether silent or not.
- -Most likely to be due to neurological diseases
- -Stroke: Acute= 50% or more; reduced to 10-28% 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.
CVA
Right CVA- ____ phase
Left CVA- ____ phase
Bi-lateral CVA- _____problems
Brainstem CVA- no swallow ____
CVA
Right CVA- Pharyngeal phase
Left CVA- Oral phase
Bi-lateral CVA- overall problems
Brainstem CVA- no swallow reflex
Head/Neck Cancer:
59% symptoms of dysphagia
Head injury: Reports range from ___% to ___% (due to different severity levels)
Head/Neck Cancer: Pauloski, et al: 59% symptoms of dysphagia
Head injury: Reports range from 4.5%-78% (due to different severity levels)
Traumatic Brain Injury
____ have dysphagia
delayed or absent _____
cognition
laryngeal penetration w/out __
Traumatic Brain Injury 1/4 have dysphagia delayed or absent reflex cognition laryngeal penetration w/out cough
Spinal Cord Injury
tongue base
___ _____
Spinal Cord Injury
tongue base
laryngeal elevation
Any ____ involving the alimentary tract
Dementia
____-related changes
Any Tumor involving the alimentary tract
Dementia
Age-related changes
Motor Neuron DIseases
Progressive Neurological Disorders
- ______
- Multiple sclerosis
- _____ ____
- ______ Disease
- ______ Disease
- Progressive Supranuclear Palsy
- _____ disease
- Progressive Neurological -Disorders
- Amyotrophic lateral sclerosis
- Multiple sclerosis
- Myasthenia gravis
- Parkinson’s Disease
- Huntington’s Disease
- Progressive Supranuclear Palsy
- Wilson’s disease
Other motor neuron diseases
\_\_\_ \_\_\_ \_\_\_\_\_\_ Syndrome Poliomyelitis Infectious disorders \_\_\_\_\_
Cerebral Palsy Guillain-Barre Syndrome Poliomyelitis Infectious disorders Myopathy
Other Disorders
Connective tissues/\_\_ Disorder Polydermatomyositis Progressive systemic sclerosis \_\_\_\_ disease Scleroderma Overlap syndrome Acquired Immune Deficiency Syndrome (\_\_\_ \_\_\_\_)
Connective tissues/Rheumatoid Disorder Polydermatomyositis Progressive systemic sclerosis Sjogren’s disease Scleroderma Overlap syndrome Acquired Immune Deficiency Syndrome (AIDS Dementia)
Iatrogenic Diagnoses:
\_\_\_\_ Therapy Chemotherapy Intubation or \_\_\_\_ Post surgical cervical spine fusion Post surgical \_\_\_ \_\_\_\_ bypass grafting \_\_\_\_\_ related
Iatrogenic Diagnoses Radiation Therapy Chemotherapy Intubation or tracheostomy Post surgical cervical spine fusion Post surgical coronary artery bypass grafting Medication related
other related disorders
_____ Infants
Severe ____ compromise
_____ conditions
Pre-mature Infants
Severe respiratory compromise
Psychogenic conditions
Consequences of Dysphagia
- _____: material enters airway below the vocal folds
- ____ ____: lung infection resulting from aspiration
- ____
- Immune System Failure (infection, sepsis, death)
- _____ Issues
- Aspiration: material enters airway below the vocal folds
- Aspiration Pneumonia: lung infection resulting from aspiration
- Dehydration
- Immune System Failure (infection, sepsis, death)
- Psychosocial Issues
Two hallmarks of dysphagia:
- Delay in ________
- _____ of bolus – enters airway
Two hallmarks of dysphagia:
Delay in propulsion from mouth to stomach
Misdirection of bolus – enters airway
Stages of the Swallow
(Anticipatory)- Logemann 1. 2. 3. 4. 5.
(Anticipatory)- Logemann Oral Oral Preparatory Oral Transit Pharyngeal Esophageal
