Dysphagia

Question 1

damage to cortex

Answer 1

affects the oral prep/oral stage, lack of awareness of bolus, possible apraxia of swallowing (difficulty initiating the swallow)

Question 2

damage to the UMN

Answer 2

delayed initiation (slow, not confused)

Question 3

damage to subcortex

Answer 3

dont swallow salvia spontaneously (PD), difficulty initiating swallow, hypokinesia/rigidity = reduced movements

Question 4

damage to the brainstem/CN

Answer 4

V = jaw weak
VII = lips weak
IX/X =pharynx and larynx weak
XII = tongue weak

–in general probably a weak swallow and airway closure leak

Question 5

effects of aging on dysphagia

Answer 5

• reduced anterior hyoid strength
• increased airway penetration o ver 50y/o
• esophageal motor activity decreases

***aging does NOT cause a dysphagia

Question 6

3 valves

Answer 6

• VP closure
• Laryngeal valving
• UES opening

Question 7

coughing prior to the swallow means…

Answer 7

incomplete airway protection (pen/asp prior to swallow)

-likely due to mistiming or late laryngeal closure

Question 8

coughing after the swallow means…

Answer 8

presence of residue resulting in pen or asp after the swallow

–likely due to reduced bolus clearance

Question 9

multiple swallows means…

Answer 9

residue preset

Question 10

aspiration during the swallow…

Answer 10

due to reduced laryngeal closure (which is likely due to reduced hylolaryngeal excursion or reduced glottis closure)

Question 11

swallowing timing guidelines

Answer 11

1-2 = normal
3=outside limit

-on command…. .5 seconds is normal

Question 12

what about if complaining of secretions?

Answer 12

**Murray et al. (1996) — secretions are predictive of aspiration in elderly hospitalized pts

Question 13

swallow apraxia

Answer 13

significant delay or inability to elicit swallow w/ verbal command

– they can complete more automatic OMEs

symptoms — searching movements of tongue, holding bolus w/o initiating oral activity

Question 14

chin down/chin tuck

Answer 14

reduced depth of penetration (Bulow, 2001)

• –delayed swallow onset
• reduced BOT retraction
• decrease airway protection
• aspiration during the swallow

Question 15

chin up

Answer 15

-aids in bolus transport to pharynx using gravity

…use with problems in the oral stage

Question 16

head turn

Answer 16

• closes off weak side
• positions damaged VF in midline
• reduces UES pressure & Increased duration of UES relaxation

Question 17

shaker

Answer 17

-includes isometric and isokenitic movements

• improves excursion
• emlinates aspiration
• improves UES opening which lets residue go down

Question 18

IOPI

Answer 18

-tongue strengthening exercises

“improved tongue strength” - Yeates, 2008

Question 19

LVST

Answer 19

• for people with poor lingual ROM and coordination
• slow transit time

—“improved lingual ROM/coordination; quicker swallow” (El Sharkawi et al., 2002)

Question 20

EMST

Answer 20

expiratory muscle strength training

• used for people who pen/asp
• —-decreases pen/asp scores and improves cough, speech, breathing, swallow fan

Question 21

pharyngeal squeeze

Answer 21

-for people with poor pharyngeal constrictors

Question 22

effortful pitch glide

Answer 22

for people with:

• weak pharyngeal squeeze
• pharyngeal residue

—-increases hylolaryngeal excursion, pharyngeal approximation

Question 23

mendelsohn maneuver

Answer 23

“increased laryngeal movement and prolonged elevation keeps the UES open longer (Kahrillas, 1991)

use for patients who:

• decreased range/duration of hyolaryngeal elevation
• decreased range/duration of UES opening
• decreased swallow coordination

Question 24

effortful swallow

Answer 24

“increased effort increased posterior movement of BOT (Logemann, 1990)

use for pts:

• poor tongue based retraction
• residue in valleculae

Question 25

supraglottic swallow

Answer 25

“good to close the VF’s/airway before swallowing to reduce aspiration (Logemann, 1997)

for pts:

• aspiration during the swallow
• reduced airway protection @ level of VF

Question 26

controlled swallow

Answer 26

• direct technique to alter timing

- controls bolus at swallow onset

Question 27

McNeil Dysphagia Treatment Protocol (MDTP)

Answer 27

–> swallow hard and fast

“improved swallow in chronic dysphagia after 3 weeks of this” - Carnaby-Mann, 2011

Question 28

Protocol 201

Answer 28

RCT regarding efficacy of thickened liquids

-better to do thin liquids w/ chin down instead of increasing consistency (Robbins & Hind, 2008)

–no sig difference in PNA incidence