Dysphagia Flashcards
What are the 4 phases of a swallow?
- Oral Preparatory Phase
- Oral (Voluntary) Phase
- Pharyngeal Phase
- Esophageal Phase
Swallow phase: Food is manipulated in the mouth. Lip seal is maintained. The food is chewed. Prior to the swallow, the food is generally pulled together into a cohesive bolus, and is held between the tongue and the anterior palate. The velum is pulled anteriorly and rests against the back of the tongue to keep materials in the oral cavity. The pharynx and larynx are at rest, and the airway is open.
oral preparatory phase
Swallow phase: The tongue moves anteriorly and posteriorly, propelling the food posteriorly until the swallow reflex is triggered. The swallow reflex is triggered when the bolus passes the anterior facial arches. This usually occurs within 1 second.
oral (voluntary) phase
Swallow phase: The reflexive swallow carries the bolus through the pharynx. The bolus divides when flowing through the pyriform sinuses and joins again at the opening of the esophagus. This usually occurs within 1 second.
pharyngeal phase
Swallow phase: Esophageal peristalsis carries the bolus through esophagus into the stomach.
esophageal phase
What cranial nerve? jaw movements for chewing and sensing of the bolus
5 (trigeminal)
What cranial nerve? lip closure and negative pressure
7 (facial)
What cranial nerve? sensing the bolus at the palate, and moving the larynx in and up
9 (glossopharyngeal)
What cranial nerve? elevating the soft palate to close off the nose
10 (vagus)
What cranial nerve? tongue movements, move the bolus anterior-posterior (bolus transit)
12 (hypoglossal)
performed by an SLP to assess the patient’s swallowing skills and determine if further testing is needed; can identify approximately 70% of the patients as having or not having aspiration, pharyngeal delay or pharyngeal swallowing problem; specifically assesses the oral phase
bedside swallow study
what are signs of aspiration?
- temperature
- drooling
- pocketing
- multiple swallows
- limited laryngeal movement
- wet sounding voice
- throat clearing
- coughing
- pneumonia
- reflux
- dehydration
- weight loss
- patient complaint
- changes in diet
What are some medication considerations?
- cause confusion or sedatin
- antibiotics may suppress lung infection 2* to aspiration
- cause dysphagia
- cause rymouth or xerostomia
- cause gastroesophageal reflux disease
Specifically assesses pharyngeal phase of swallowing; performed by SLP and radiologist
modified barium swallow study
terminology: anything through the vocal folds
aspiration
- frank = horrible amount
- trace = tiny amount
terminology: anything above the level of the vocal folds - sounds gurgly
penetration
- flash = anything that enters and comes back out without a trace
terminology: accumulation in the valleculae or pyriform space that can be measured, other than a trace coating
stasis
terminology: bolus comes out the nose
Nasal reflux
At the level of the vocal cords (recurrent laryngeal nerve)
power cough reflex
At the level of the laryngeal trachea (vagal nerve)
delayed tracheal cough reflex
- material is in your lungs if this is all you have
When patient is “NPO” what should they not have?
Water
Ice Chips
Ice cream, sherbert, Jello and ice chips can turn into thin liquids in the mouth.
Postural changes can increase airway protection and/or can direct food down the stronger side of the throat. What is a good position if someone is at risk of aspirating food?
pt should tuck chin or turn head to one side
- food can fall over the back of the tough and risk entering airway
What are S and S of oral phase difficulties?
- Pocketing
- Drooling
- Poor lip closure
- Support lip
- Apply pressure to the cheek
- Remind the patient to sweep his mouth with his tongue and/or finger
What are residue compensatory techniques?
- Effortful swallow
- Alternate bite with sip
- Dry swallow between bites
What are delayed swallow compensatory techniques?
- Thermal/tactile stimulation- Dip the mirror in ice; Rub the mirror along the anterior faucial arches; Have the patient swallow
- Eat cold or sour foods
What are decreased lifting of the larynx compensatory techniques?
Mendelssohn Maneuver
- Place your finger lightly on your larynx when swallowing
- When you feel your larynx reach its highest point, hold it up by pushing your tongue against the roof of your mouth and keeping it there
What are decreased closure of the larynx compensatory techniques?
- Super-supraglottic Swallow - Take a breath; Let a little out then hold your breath as tightly as possible; Swallow, squeezing hard; Cough; Then swallow again
- Periodic Cough/Throat Clear
