Dysphagia

Question 1

What is a normal swallow?

Answer 1

the entire act of swallowing, from placement of food in the mouth through the oral cavity and down through the throat until the food or liquid enters the esophagus.

Question 2

Four Phases of a Swallow

Answer 2

Approximately thirty mouth and throat muscles and multiple nerves are involved in transporting food or fluid through the mouth, pharynx and safely into the esophagus. Swallowing can be divided into 4 stages:

1. Oral Preparatory Stage
2. Oral Stage
3. Pharyngeal Stage
4. Esophageal Stage

Question 3

oral stage

Answer 3

The Oral Preparatory stage is voluntary and involves the preparation of the bolus with the aid of saliva, good lip seal, jaw movement and chewing. During the oral stage, the tongue elevates and rolls back, sequentially contacting the hard and soft palate, moving the bolus backwards.

Question 4

Pharyngeal Stage

Answer 4

The pharyngeal stage involves elevation and retraction of the soft palate; laryngeal closure and suspension of respiration; relaxation and opening of the sphincter at the top of the esophagus; bolus is propelled into the esophagus.

Question 5

Esophageal Stage

Answer 5

An involuntary process whereby food finally passes through the esophagus into the stomach.

Question 6

Signs and Symptoms

Answer 6

Several diseases, conditions, or surgical interventions can result in dysphagia. General signs include:
Coughing during/after eating or drinking
Wet or gurgly sounding voice during/after eating or drinking
Extra effort or time needed to chew or swallow
Food or liquid leaking from the mouth or getting stuck in the mouth (pocketing)
Recurring pneumonia or chest congestion after eating
raised respiratory rate during/after eating
Discomfort or pain during swallowing
Weight loss or dehydration from not being able to eat enough

Question 7

role of OT

Answer 7

Occupational Therapists can attend specific dysphagia education courses and incorporate dysphagia into the treatment plan along with ADL and feeding goals. This could include screening, identifying symptoms of the normal vs. abnormal swallow, evaluating, treating, and documenting in accordance with Medicare codes and guidelines.
This could be a valuable service in facilities (such as long term care) where access to SLPs is limited.

Question 8

role of OT continued

Answer 8

In settings in which there is an SLP as the primary dysphagia therapist, the OT still has a valuable role, including:
Understanding and adhering to modified food textures within your facility
Adapting the mealtime environment
Assisting with proper positioning
Reinforcing mealtime strategies to maintain or enhance swallowing abilities
Training for caregivers in individualized feeding and swallowing strategies to enhance eating and feeding performance
Be aware of signs and symptoms of dysphagia and notify SLP directly or make the referral

Question 9

OT goals

Answer 9

OT goals that may assist with self-feeding and improve swallowing may include:
Improve head and neck control
Improve sitting posture
Increase fine motor skills
Increase use of adaptive equipment 
Increase visual scanning

Question 10

diets

Answer 10

puree
ground
mechanical soft (ground beef and soft veggies)
soft (meat off bone, nothing crunchy/chewy)
regular diet

liquids: thin- water
nectar thick
honey thick