Disordered Swallowing Symptoms and their Causes Flashcards
What do we look for during a swallow eval?
observe and identify the symptoms
connect the symptoms to hypothesized causes/disorder (may go in either direction)
think in terms of “cause & effect”
treat the cause/disorder,, not the symptom
If the patient is not responding, what would the cause be?
poor level of consciousness or Rousal
If the patient is refusing to eat, what could the cause be?
any phase problem, behavioral/psychological/cognitive problems
What are some oral preparatory phase problems?
- weak oral structures
- weak lingual strength, motility, ROM
- Poor dentition condition
- Decreased jaw excursion/closure
ON EXAM
What does trismus mean?
reduced range of motion of jaw
What does weak labial strength/motility result in, and how would you report it?
results in: difficulty taking material from utensil, difficulty with buccal tension in gathering food resulting in pocketing, leakage of material out of oral cavity
Report: “Poor labial skills resulted in anterior leakage of material out of oral cavity” p
What does weak lingual strength/motility/ROM result in, and how would you report it?
Results in:
- Oral pocketing in lateral or anterior sulci
- Difficulty manipulating food into a bolus
- Lingual stasis
- Premature spillage of material into pharyngeal area
Report: “Decreased lingual strength/motility resulted in difficulty manipulating the food into a bolus which resulted in residue in the left lateral sulci
What does Poor dentition condition result in, and how would you report it?
•Results in: Decreased ability or inability for mastication/breakdown of the material
Report: “Pt. is edentulous which resulted in inability to masticate solids beyond pureed consistency.”
What does decreased jaw excursion/closure result in, and how would you report it?
•Results in: Poor lip closure (see slide 5)– Poor mastication/breakdown of the material
Report: “Decreased jaw closure resulted in poor labial closure which in turn resulted in…”
What are some Oral Transit Phrase Problems?
-Poor tongue motility/control
What does Poor Tongue Motility/Control result in, and how would you report it?
•Results in:
- Tongue pumping (common in PD)
- Increased oral transit time
- Tongue thrusting
Report: “Oral transit phase time was increased due to poor tongue motility with difficulty propelling bolus into pharyngeal area.”
What must you be able to do during the oral transit phase?
must be able to propel the bolus back into the pharyngeal area to initiate a swallow response
What are some pharyngeal phase problems?
- poor velo-pharyngeal closure
- Swallow Delay
- Decreased Posterior tongue retraction
- decreased pharyngeal all contraction
- decreased laryngeal elevation
PHARYNGEAL PHASE
What does Poor Velo-pharyngeal closure result in, and how would you report it? (don’t worry about strategy -for now)
Results in: Nasal penetration of material or nasal regurgitation
Strategy: Try a hard, effortful swallow
Report: “Pt. presented w/ poor V-P closure resulting in nasal penetration.”
*This may be part of the oral phases too—maybe with VPI or cleft-palate
PHARYNGEAL PHASE
What does a swallow delay result in and how would you report it?
Results in: penetration or aspiration-it does not result in residue!!!
Strategy: chin tuck
Report: Swallow delay noted resulting in penetration/aspiration of thick liquids
What must the velum do to close off the velopharyngeal port once a swallow is initiated?
retract and raise
What must the tongue do to get good supra-glottic pressure?
tongue should retract back to pharyngeal wall to get supra-glottic pressure
What does decreased posterior tongue retraction result in, and how would you report this?
Results in: Poor S-G pressure & residue coating the tongue base
Strategies: Hard swallow, Repeat/extra swallows, Alternate solids w/ liquids
Report: “Dec. post. tongue retraction noted resulting in residue on tongue base
PHARYNGEAL PHASE
What does decreased pharyngeal wall contraction result in, and how would you report this?
Results in: Poor S-G pressure & residue coating pharyngeal wall
Strategies: Hard swallow, Repeat/extra swallows, Alternate solids w/ liquids
Report: “Dec. pharyngeal wall contraction resulted in residue on posterior pharyngeal wall.”
PHARYNGEAL PHASE
What does decreased laryngeal elevation result in, and how would you report this?
Results in:
Poor epiglottic inversion which in turn results in:
Residue in the valleculae
Decreased airway protection
Results in: Poor Crico-pharyngeal opening which in turn results in:
Residue in the pyriform sinuses
Backflow of material into laryngeal vestibule from CP
What must the hyoid bone do during the pharyngeal phase?
hyoid must be pulled forward as the larynx is elevated
PHARYNGEAL PHASE
What does decreased hyoid excursion result in? How would you report this?
See above under laryngeal elevation
report: Come up with one :)
What can cause decreased epiglottic inversion (not from laryngeal elevation)?
Although the epiglottis inverts mostly due to laryngeal elevation (some post. tong. retrac. too), but it may be inhibited from inverting by anterior placement of the cervical vertebras
Osteophytes: Calcification of the vertebrae that can jut out and get really large which can inhibit the epiglottis from inverting.
Scar tissue may cause the epiglottis from inverting
Radiation (BIG TIME) affects the epiglottis from inverting.
PHARYNGEAL PHASE
What does decreased epiglottic inversion not from laryngeal elevation result in? how would you report this?
Results in: Residue in the valleculae
Strategies: Hard swallow, extra/repeat swallows w/ head turns, alternate solids w/ liquids
Report:–
Which individuals would have poor vocal fold closure and be at risk for aspiration?
people with paretic or paralyzed VF
PHARYNGEAL PHASE
What does poor vocal fold closure result in, and how would you report this?
Results in: Decreased airway protection w/ possible aspiration
Decreased S-G pressure
Strategy: Super supra-glottic swallow
Report: “Poor Vocal fold closure resulted in decreased airway protection which in turn resulted in aspiration”
PHARYNGEAL PHASE
What does poor C-P opening (not from laryngeal elevation) result in, and how would you report this?
Results in: Residue in the pyriform sinuses & laryngeal vestibule
Backflow of material from C-P
Strategies: Hard swallow, Repeat/extra swallows, Alternate solids w/ liquids, Shaker exercise
Theory is that our body’s defense against GERD/issues in the esophagus is to make our muscle tight, which creates a C-P bar.
During the Pharyngeal phase, what must the C-P sphincter do?
must relax to open to allow food to enter the esophagus
What would we look for in an MBS for Unilateral pharyngeal weakness?
look for residue symmetry on A-P view
What does unilateral pharyngeal weakness result in? how would you report this?
Results in: More residue on one side (the weak side)
Strategies: Head turns, Repeat/extra swallows, Alternate solids w/ liquids
Report: ?
What are some structural anomalies that may impact the pharyngeal phase?
Zenker’s Diverticulum
CP-Bar
Osteophytes
Swelling s/p surgery
What are Zenker’s caused by?
dysfunction of the cricopharyngeal sphincter
Describe CP bar
is part of the cricopharyngeal sphincter. This could lead to Zenker’s. This would make things get stuck. As soon as you see CP bar, there is likely something wrong with the esophagus.
Describe ostephytes
can cause a dysfunctional swallow. But not necessarily great for surgery because this can lead to further issues with swallowing.
