communication and swallowing difficulties Flashcards
what is aphasia
the term to describe language impairments
4 types of aphasia
expressive (Broca’s); receptive aphasia (Wernicke’s); acquired dysgraphia (writing); acquired dyslexia (reading)
clinical presentation of receptive aphasia (5)
difficulties following commands; yes/no response unreliable; fluent speech but off topic/doesn’t make sense; islands of communication (able to recognise key social phrases e.g. hello); poor insight into difficulties
clinical presentation of expressive aphasia (7)
word finding difficulties; echolalia (repeating what you said); preservation (repeating phrases); frustration; variable range of ability; writing may be impaired; may be able to use drawings/gestures
what is dysarthria
a motor speech disorder caused by motor planning, programming, neuromuscular control, execution disorder
dysarthria clinical presentation (4)
speech sounds slurred/unintelligible; language intact; respiratory/phonatory etc. components may be affected; may be able to write
what may occur in severe brainstem strokes
‘locked in’ syndrome - anarthria (total loss of speech) + quadriplegia
how can apraxia occur
pathways between motor cortex and facial muscles have been disrupted resulting in difficulties with motor speech planning
apraxia clinical presentation (6)
reduced speech intelligibility; articulation errors; initiation difficulties; articulatory groping; speech slowed; inconsonant errors;
what is dysphonia
when the voice involuntarily sounds breathy, raspy, or strained
causes of dysphonia (6)
stroke (weakness of laryngeal muscles); malignancy (refer to ENT to rule this out); vocal nodules; polyps; muscle tension dysphonia; inflammation/irritation
what is done for stroke patients wit communicating difficulties
informal/formal language assessments; therapy with tablets/mobile devices; educate patients and family; other info abut interests and hobbies t tailor therapies; support communication by using pictures, symbols etc.; support communication during capacity assessments; refer patients for onward therapy
what is dysphagia
swallowing difficulties
cranial nerves involved in swallowing
trigeminal V; facial VII; glossopharyngeal IX; vagus X; spinal accessory XI; hypoglossal XII
4 stages of the normal swallow
- pre oral
- oral
- pharyngeal
- oesophageal
what occurs in the pre-oral stage(6)
voluntary control; lips closed and lip seal maintained; lateral and rotatory mastication; tongue manipulates and gather food into bolus; buccinators lightly contract to decrease escape of bolus into lateral sulci; soft palate lowered to prevent posterior leakage
what occurs in the oral stage (4)
tongue begins posterior movement of the bolus; tongue presses bolus against roof of the mouth - stripping action; swallow triggered when bolus reaches faucial arches; soft palate raises to stop nasal regurgitation
what occurs in the pharyngeal stage (4)
propulsion of bolus through pharynx (<1s); soft palate raised; tongue base retracts; pharynx constricts
what are the 3 levels of closure during the pharyngeal stage?
- the larynx elevate and the epiglottis folds over the larynx, vocal folds and false vocal folds adduct to stop food going below;
- cricopharyngeal sphincter (UES) relaxes - aided by bolus pressure;
3.breathing stops
impact of difficulties swallowing (8)
aspiration (food/liquid passing into airway below true vocal folds); aspiration pneumonia (pulmonary infection due to acute/chronic aspiration; choking (complete occlusion of the airway due to a foreign body); dehydration (insufficient fluids in the body to maintain health); malnutrition (insufficient food/nutrition); silent aspiration (food passes below true vocal folds with no cough response due to affected larynx sensation); missing key medications; impact on social interactions/QoL
what tests can a dysphagia assessment involve (2)
videofluroscopy (VFSS)/modified barium swallow; fibreoptic endoscopic evaluation of swallowing (FEES)
what is videofluroscopy?
a radiological dynamic study of swallow with a barium contrast; allows visualisation of both oral and pharyngeal stages of the swallow
what is fibreoptic endoscopic evaluation of swallowing (FEES)
a trans-nasal endoscopy that allows views of the larynx/pharynx and can view secretions; useful to test laryngeal sensation; good for those who cannot go to radiology
what therapy can be given to aid swallowing (5)
exercises; postural changes; swallowing manoeuvres; mcNeill dysphagia therapy program; compensatory strategies e.g. diet and fluid modification
what classification is used for modified food and drink thickness
international dysphagia diet standardisation initiative (IDDSI)
what is the implication of a modified diet for medications?
can’t have liquid medications; can’t swallow tablets
alternative methods of feeding (3)
nasogastric tube/bridle (NGT) - temporary; percutaneous endoscopy gastrostomy (PEG); radiological inserted percutaneous gastrostomy (RIG)
