Dysphagia Flashcards
Phases of the swallow
anticipatory, oral preparatory, oral phase, pharyngeal phase, oesophageal phase
During which phases can breakdown in swallowing occur?
Anticipatory, oral preparatory, oral, pharyngeal, and oesophageal phases
What does the term “aspiration” refer to in the context of dysphagia?
Entry of material below the level of true vocal cords
Which of the following is NOT a predictor of aspiration pneumonia?
- a) Smoking
- b) Dependency for feeding
- c) Regular exercise
- d) Multiple medical diagnoses
regular exercise
What is the purpose of the Penetration Aspiration Scale?
To assess the degree of material entering the airway
The Functional Oral Intake Scale (FOIS) is used to assess the level of oral intake of food and liquid. True or false
True
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) requires the use of radiation. True or false
false
What are complications of dysphagia
Aspiration pneumonia, malnutrition, dehydration, weight loss, choking episodes, prolonged hospital admissions, impaired QOL
Describe safe swallowing strategies that can be used for patients with dysphagia.
Chin tuck, effortful swallow, multiple swallows, thickened liquids, small bites/sips, upright positioning
What are the key components of a Clinical Swallow Examination (CSE)?
Medical and social history, oro-facial examination, cranial nerve assessment, swallow trials with various consistencies
Explain the difference between aspiration and penetration in the context of swallowing disorders.
Aspiration refers to entry of material below the level of the true vocal cords, while penetration refers to entry of material into the laryngeal vestibule but not below the vocal cords
Name three instrumental examinations used in the assessment of dysphagia.
Videofluoroscopic Swallow Study (VFSS), Fiberoptic Endoscopic Evaluation of Swallowing (FEES), Pharyngeal manometry
What are the two main types of swallowing impairment?
Safety (aspiration) and Efficiency (residue)
List 3 signs of dysphagia in the oral preparatory and oral phase.
- Anterior spillage
- Difficulty with bolus formation and propulsion
- Build up of material in lateral sulci
What are immediate signs of possible aspiration?
- Wet vocal quality
- Multiple swallows
- Coughing when drinking/during meals
- Respiratory wheeze
- Drop in oxygen levels
Name delayed signs of possible aspiration.
- Spiking temperature
- Weight loss
- Repeated chest infections
- Malnutrition
- Dehydration
- Pneumonia
List 5 possible causes of dysphagia
- Stroke
- Cancer
- Neurological disorders (MS, MND, PD, Dementia)
- Gastroenterological disorders (GORD)
- Respiratory conditions (COPD)
Name predictors of aspiration pneumonia.
- Smoking
- Dependency for feeding
- Tube feeding
- Multiple medical diagnoses
- Polypharmacy
- Dependency for oral care
What are the key components of dysphagia evaluation?
- Dysphagia screening test
- Clinical swallow exam
- Instrumental examination
Name two screening tools for dysphagia.
- GUSS (Gugging Swallowing Screen)
- 3oz water swallowing test
What are the main categories of CSE outcome measures?
- Physiological
- Clinical
- Functional
- Patient reported
What does FEES stand for and what does it evaluate?
FEES stands for Fiberoptic Endoscopic Evaluation of Swallowing. It evaluates:
1. Airway protection
2. Adduction of true vocal cords
3. Management of secretions
4. Mucosal surface
5. Sensation (FEEST)
6. Pharyngeal constriction
List 3 limitations of FEES.
- “White-out period” during swallowing
- Unable to observe oral stage
- Cannot visualize hyo-laryngeal excursion
What are the key aspects to observe during liquid swallow trials?
- Labial closure while liquid is in mouth
- Hyolaryngeal speed and elevation
- Signs and symptoms of dysphagia (e.g., coughing, multiple swallows)
What strategy should be used if a patient demonstrates signs of dysphagia with current liquid consistency?
Attempt thicker consistencies
What are other oral observations to make during examination?
- Dentition
- Oral hygiene
- Dry/moist mucosa
- Signs of infection (e.g.,
candidiasis/thrush) - Concerning lesions
possible breakdowns in oral preparatory and oral phase and associated sign of dysphagia
- Reduced lip seal - Anterior spillage
- Increased tone in lips/cheeks - Difficulty sucking, bolus formation and propulsion
-Reduced buccal tone - Build up of material in lateral sulci - Reduced oral sensation - Biting of tongue/cheeks and impaired bolus formation
- Reduced tongue movement - Difficulty with bolus formation and propulsion
- Reduced jaw movement - Difficulty with mastication
- Tongue protrusion - Loss of bolus from oral cavity
- Tongue thrust - Difficulty placing spoon or teat. Food/liquid pushed out of
mouth. - Disorganised ant/post tongue movement - Difficulty propelling bolus posteriorly
- Dry oral mucosa - Difficulty breaking down bolus during mastication and
manipulating bolus. - Tardive dyskinesia (involuntary repetitive body movements - Involuntary tongue and lip movement
- Swallow agnosia
(brain can’t recognise something)/apraxia - Reduced recognition of bolus or inability to initiate swallow
Signs of dysphagia in pharyngeal phase
- Delay initiating the pharyngeal swallow
- Weak tongue base retraction
- Nasal regurgitation
- Reduced pharyngeal contraction
- Poor airway protection
- Reduced hyolaryngeal excursion
- Impaired UOS opening
- Reduced laryngeal sensation
- Weak reflexive cough
Signs of dysphagia in oesophageal phase
- Food “sticking” in lower chest
- Reflux/heartburn
- Regurgitation
Dysphagia phenotypes
- Cardiothoracic
- Gastroenterological
- Pulmonary
- Head and neck cancer
- Neurology
