Dyspagia Lecture 1 Flashcards
What is Dysphagia
Difficulty swallowing, difficulty moving bolus from mouth to stomach
Etiologies of Dysphagia
Conditions that weaken/damage muscles/nerves(CVA, PD, TBI)
Infection, structural malformation, surgery
Dysphagia is a secondary condition, something causes it
Consequences of Dysphagia
Dehydration
Malnutrition
Aspiration pneumonia
Decreased quality of life
What is aspiration pneumonia?
Caused by aspiration of food or liquids in repeated bouts will accumulate and cause bacteria
Types of Dysphagia
Oral, pharyngeal, oropharyngeal, and esophageal
In oral Dysphagia, what is involved?
Tongue movement, lip closure, pocketing, and transport
In pharyngeal Dysphagia, what is involved?
Airway closure, residues, motility, UES
In oropharyngeal Dysphagia, what is involved?
At least one component from oral Dysphagia and pharyngeal Dysphagia must be present.
In esophageal Dysphagia, what is involved
Motility, LES, fistula, diverticulum, HCI-reflux, ulcer
How long should each stage take to complete?
1) oral
2) pharyngeal
3) esophageal
1) completely dependent on bolus consistency
2) 1 second
3) 10 Seconds
Signs and symptoms of oral and pharyngeal Dysphagia
Coughing or choking with swallow Difficulty initiating swallow Food sticking in throat Drooling/spillage Penetration Aspiration Recurrent pneumonia Change in diet
Signs and symptoms of esophageal Dysphagia
Sensation of food sticking in the chest or throat Chest pain Oral Or pharyngeal regurgitation Change in diet Recurrent pneumonia Reflux Aspiration
Explain silent aspiration
There are no signs or symptoms
No cough reflux
Possible signs - tearing, runny nose, and maybe yawning
Cranial nerve responsible for cough reflux
CN X: vagus
Define feeding
Placement of food in the mouth before initiation of swallow
Define swallowing and what stages it includes
Transfer of good/drink from mouth to stomach includes oral, pharyngeal, and esophageal stage.
Salivation is part of swallowing-oral stage
What does a swallow screening consist of?
10-15 minute administration/observation of a small bolus
A bedside clinical assessment should include:
Medical history Level of alertness Patient interview Oral motor exam Assess swallow with small bolus-most important part
What are some signs and symptoms to look for during the swallow screening?
Spillage Oral residue Long transit time Cough Throat clear Gurgly voice Tearing Runny nose Wrong sound (auscultation)
A swallow screening is a pre-diagnostic and cannot
Assess anatomy and physiology
Diagnostic procedures involve:
1) ID symptoms that explain abnormalities in A & P causing Dysphagia
2) examine physiology
3) examine immediate effect of to
4) imaging: FEES/FEESST, video fluoroscopy, scintigraphy
5) non imaging: EMG, EEG, acoustic
When examining physiology, what are you
Looking at?
Timing, tongue base motion, epiglottic dysfunction, laryngeal excursion, UES dysfunction, peristalsis, paralysis, sensitivity
What are some treatments for Dysphagia?
Diet modification Compensatory strategies Maneuvers Exercise Stimulation Experimental Prosthetic Surgery
Explain what diet mod includes
Volume, viscosity, texture, temperature, NPO- NG tube, G tube, PEG, J tube, TPN
What are compensatory treatments?
Positional: posture, chin tick, head rotation, multiple swallows
What is a maneuver tx?
Super glottis, super- supra glottis, Mendelsohn, effortful swallow
What is an exercise for tx of Dysphagia?
Shaker
Masako
Oral
Muscle strengthening
What does stimulation tx involve?
Thermal and tactile stimulation
Experimental tx includes
Neuromuscular electrical stimulation (NMES- “vitalStim”)
Deep pharyngeal neuromuscular stimulation DPNS
Myofacial release
Botox
Prosthetic tx involves
Palatial lift
Obturator
Surgery for Dysphagia tx can include:
CP myotomy
Diverticulectomy
Dilation
Who is involved in the multidisciplinary team?
SLP OT PT Physician/neurologist/ENT Nursing Dietician Radiologist Pharmacist Social Worker Psychologist
