Dysphagia

Question 1

Describe the oral prep phase.

Answer 1

• voluntary
• food and drink conveyed in the mouth
• lips and jaw close to seal the mouth
• saliva is produced in response to smell, taste and sight of food
• bolus is made between tongue and hard palate

Question 2

What are the considerations for phase 1?

Answer 2

sight
hand-eye coordination
lip seal, tongue control
dentition issues
positionning
cognition
neurological conditions

Question 3

Describe the oral transport phase.

Answer 3

• voluntary
• bolus is transported by voluntary tongue movements to the back of the mouth into the pharynx
• soft and hard palate separate mouth from nasal cavity

Question 4

What are the main functions of saliva?

Answer 4

• moistening/lubrication
• initial digestion of CHO
• enhances taste
• serves as a buffer
• antibacterial protection/oral hygiene
• assisting speech

Question 5

Describe the pharyngeal phase.

Answer 5

• involuntary
• triggered when the bolus passes though the faucial pillars into the pharynx
• soft palate retracts and elevates to block the nasal cavity
• larynx moves upwards to protect the trachea
• breathing stops (co-coordination)
• closure of aryepiglottic folds
• contraction of the 3 constrictors of the pharynx to propel the bolus towards the upper esophageal sphincter
• pharyngeal peristalsis propels the bolus through the pharynx to the top of the esophagus at the circopharyngeal sphincter
• the circopharyngeal sphincter relaxes, allowing the bolus to pass into the esophagus

Question 6

Describe the esophageal phase.

Answer 6

• involuntary

- begins with relaxation of the upper esophageal sphincter, followed by peristalsis

Question 7

What is the muscle of the upper esophageal sphincter called and what is it referred to as?

Answer 7

circopharyngeal muscle -> referred to as pharyngoesophageal junction
serves as the main barrier in preventing laryngopharyngeal reflux

Question 8

What are the signs of phase 1&2 dysphagia?

Answer 8

• weak tongue and lip muscles
• difficulty propelling food to the throat
• drooling
• spillage of food or liquid from the mouth
• slow eating
• inability to complete meal due to weakness
• pocketing food in mouth
• reduced lip closure
• chewing forever
• reduced range of tongue motion

Question 9

What are the signs of phase 3 dysphagia?

Answer 9

• delayed swallow reflex
• swallow does not clear bolus from throat and bolus may penetrate the larynx, causing aspiration
• repeated swallowing and frequent throat clearing
• wet/gurgly voice
• complains of food stuck in throat
• repeated pneumonia
• chest/lung congestion

Question 10

What are the signs of phase 4 dysphagia?

Answer 10

• structural blockages
• pressure/discomfort in chest
• lump of fullness in the throat
• chronic heartburn