communication and swallowing difficulties

Question 1

what is aphasia

Answer 1

the term to describe language impairments

Question 2

4 types of aphasia

Answer 2

expressive (Broca’s); receptive aphasia (Wernicke’s); acquired dysgraphia (writing); acquired dyslexia (reading)

Question 3

clinical presentation of receptive aphasia (5)

Answer 3

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

Question 4

clinical presentation of expressive aphasia (7)

Answer 4

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

Question 5

what is dysarthria

Answer 5

a motor speech disorder caused by motor planning, programming, neuromuscular control, execution disorder

Question 6

dysarthria clinical presentation (4)

Answer 6

speech sounds slurred/unintelligible; language intact; respiratory/phonatory etc. components may be affected; may be able to write

Question 7

what may occur in severe brainstem strokes

Answer 7

‘locked in’ syndrome - anarthria (total loss of speech) + quadriplegia

Question 8

how can apraxia occur

Answer 8

pathways between motor cortex and facial muscles have been disrupted resulting in difficulties with motor speech planning

Question 9

apraxia clinical presentation (6)

Answer 9

reduced speech intelligibility; articulation errors; initiation difficulties; articulatory groping; speech slowed; inconsonant errors;

Question 10

what is dysphonia

Answer 10

when the voice involuntarily sounds breathy, raspy, or strained

Question 11

causes of dysphonia (6)

Answer 11

stroke (weakness of laryngeal muscles); malignancy (refer to ENT to rule this out); vocal nodules; polyps; muscle tension dysphonia; inflammation/irritation

Question 12

what is done for stroke patients wit communicating difficulties

Answer 12

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

Question 13

what is dysphagia

Answer 13

swallowing difficulties

Question 14

cranial nerves involved in swallowing

Answer 14

trigeminal V; facial VII; glossopharyngeal IX; vagus X; spinal accessory XI; hypoglossal XII

Question 15

4 stages of the normal swallow

Answer 15

1. pre oral
2. oral
3. pharyngeal
4. oesophageal

Question 16

what occurs in the pre-oral stage(6)

Answer 16

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

Question 17

what occurs in the oral stage (4)

Answer 17

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

Question 18

what occurs in the pharyngeal stage (4)

Answer 18

propulsion of bolus through pharynx (<1s); soft palate raised; tongue base retracts; pharynx constricts

Question 19

what are the 3 levels of closure during the pharyngeal stage?

Answer 19

1. the larynx elevate and the epiglottis folds over the larynx, vocal folds and false vocal folds adduct to stop food going below;
2. cricopharyngeal sphincter (UES) relaxes - aided by bolus pressure;
   3.breathing stops

Question 20

impact of difficulties swallowing (8)

Answer 20

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

Question 21

what tests can a dysphagia assessment involve (2)

Answer 21

videofluroscopy (VFSS)/modified barium swallow; fibreoptic endoscopic evaluation of swallowing (FEES)

Question 22

what is videofluroscopy?

Answer 22

a radiological dynamic study of swallow with a barium contrast; allows visualisation of both oral and pharyngeal stages of the swallow

Question 23

what is fibreoptic endoscopic evaluation of swallowing (FEES)

Answer 23

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

Question 24

what therapy can be given to aid swallowing (5)

Answer 24

exercises; postural changes; swallowing manoeuvres; mcNeill dysphagia therapy program; compensatory strategies e.g. diet and fluid modification

Question 25

what classification is used for modified food and drink thickness

Answer 25

international dysphagia diet standardisation initiative (IDDSI)

Question 26

what is the implication of a modified diet for medications?

Answer 26

can’t have liquid medications; can’t swallow tablets

Question 27

alternative methods of feeding (3)

Answer 27

nasogastric tube/bridle (NGT) - temporary; percutaneous endoscopy gastrostomy (PEG); radiological inserted percutaneous gastrostomy (RIG)