Dysphagia Flashcards
damage to cortex
affects the oral prep/oral stage, lack of awareness of bolus, possible apraxia of swallowing (difficulty initiating the swallow)
damage to the UMN
delayed initiation (slow, not confused)
damage to subcortex
dont swallow salvia spontaneously (PD), difficulty initiating swallow, hypokinesia/rigidity = reduced movements
damage to the brainstem/CN
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
effects of aging on dysphagia
- reduced anterior hyoid strength
- increased airway penetration o ver 50y/o
- esophageal motor activity decreases
***aging does NOT cause a dysphagia
3 valves
- VP closure
- Laryngeal valving
- UES opening
coughing prior to the swallow means…
incomplete airway protection (pen/asp prior to swallow)
-likely due to mistiming or late laryngeal closure
coughing after the swallow means…
presence of residue resulting in pen or asp after the swallow
–likely due to reduced bolus clearance
multiple swallows means…
residue preset
aspiration during the swallow…
due to reduced laryngeal closure (which is likely due to reduced hylolaryngeal excursion or reduced glottis closure)
swallowing timing guidelines
1-2 = normal
3=outside limit
-on command…. .5 seconds is normal
what about if complaining of secretions?
**Murray et al. (1996) — secretions are predictive of aspiration in elderly hospitalized pts
swallow apraxia
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
chin down/chin tuck
reduced depth of penetration (Bulow, 2001)
- –delayed swallow onset
- reduced BOT retraction
- decrease airway protection
- aspiration during the swallow
chin up
-aids in bolus transport to pharynx using gravity
…use with problems in the oral stage
head turn
- closes off weak side
- positions damaged VF in midline
- reduces UES pressure & Increased duration of UES relaxation
shaker
-includes isometric and isokenitic movements
- improves excursion
- emlinates aspiration
- improves UES opening which lets residue go down
IOPI
-tongue strengthening exercises
“improved tongue strength” - Yeates, 2008
LVST
- for people with poor lingual ROM and coordination
- slow transit time
—“improved lingual ROM/coordination; quicker swallow” (El Sharkawi et al., 2002)
EMST
expiratory muscle strength training
- used for people who pen/asp
- —-decreases pen/asp scores and improves cough, speech, breathing, swallow fan
pharyngeal squeeze
-for people with poor pharyngeal constrictors
effortful pitch glide
for people with:
- weak pharyngeal squeeze
- pharyngeal residue
—-increases hylolaryngeal excursion, pharyngeal approximation
mendelsohn maneuver
“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
effortful swallow
“increased effort increased posterior movement of BOT (Logemann, 1990)
use for pts:
- poor tongue based retraction
- residue in valleculae
supraglottic swallow
“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
controlled swallow
- direct technique to alter timing
- controls bolus at swallow onset
McNeil Dysphagia Treatment Protocol (MDTP)
–> swallow hard and fast
“improved swallow in chronic dysphagia after 3 weeks of this” - Carnaby-Mann, 2011
Protocol 201
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
