Dysphagia: Working with it and assesment Flashcards
What are some physical consequences of Dysphagia? What role might an SLT play?
- Choking
- Coughing
- Breathlessness
- Chest infections
- Aspiration pneumonia
- Malnutrition/Dehydration
- Death
ROLE OF SLT:
- Make assessment of swallow
- Modify dietary requirements
- Reduce risk of physical consequences
What are some emotional consequences of Dysphagia? What role might an SLT play?
- Embarrassment for modified diet
- Depression
- Social isolation
- Fear of choking
- Frustration
ROLE OF SLT:
-To provide support and counselling
What are some practical consequences of Dysphagia? What role might an SLT play?
- Taking medication
- Dietary requirements- (religious)
- Social eating: With friends or family
ROLE OF SLT:
- Give advice about planning ahead/meal prep
- Give advice about recipes/meals that are eaily modifyable
- Give advice about eating out at restraunts
What happens in the oral phase of swallowing?
See the bolus
Smell the bolus
Saliva starts flowing
Vocal cords adduct
Orbicularis Oris relaxes
Primary masticatory closers relax
Jaw openers activate
Base of tongue approximates palate to contain bolus
orally
Lingual surface grooves with midline drop to collect
bolus
Midline of tongue elevates to move bolus between
teeth
Bolus is moved around mouth to breakdown solids and
get bolus cohesion
Tongue tip followed by blade to palate pushes bolus in
to oropharynx (tongue stripping)
What happens in the Pharyngeal stage?
Many things happen in rapid succession:
hyolaryngeal excursion
velopharyngeal closure
base of tongue to posterior pharyngeal wall
approximation
shortening of the pharynx
airway protection
opening of the Upper Oesophageal Sphincter (UES)Which cranial nerves are involved in the process of swallowing?
CN’s:
5,7,9,10,12
5- Trigeminal 7- Facial 9- Glossopharyngeal 10- Vagus 12- Hypoglossal
Which cranial nerve controls the gag reflex? And what might impairment in this nerve lead to?
CN 9- Glossopharyngeal
- Reduced pharyngeal contraction
- Post swallow residue
- Impaired airway protection
- Decreased approximation by base of tongue and
posterior pharyngeal wall
If a patient is showing reduced elevation of hyoid and reduced superior/posterior placement of tongue, hyoid and larynx which cranial nerve might have damage to it? What other symptoms might they exhibit?
CN7- Facial
This patient might also experience poor facial control and poor oral containment of bolus
What is CN5? what are the motor and sensory functions of this nerve? And what implications might there be for damages to CN5 ?
CN5- Trigeminal
Motor: Jaw movement, biting
Sensory: Sensory to face, hard palate and tongue
Patient might exhibit reduced mastication, therefor reduced bolus preparation before swallowing.
John is a 70 year old dysphonic patient with poor airway management and Upper oesophageal problems. What nerve damage could possibly be present? What motor and sensory functions does this nerve have?
damage to
CN10- Vagus
Motor: Vocal quality, coughing
Sensory: cough reflex
What is the 12th cranial nerve and what is its funciton?
CN12- Hypoglossal
Motor only: Tongue movements/bolus control
What neurological conditions could impact on swallow?
Stroke Parkinson’s Disease Motor Neurone Disease Huntingdon’s Disease Dementia Cerebral palsy
What physical conditions could impact on a swallow?
Cleft Palate
Head and neck cancer
Cerebral Palsy
What does an SLT need to take into account when receiving a referral and making an assessment?
- Does the patient have dysphagia?
- What further assessments are required to establish a
level of functioning and decide if it is safe for the
patient to eat or drink? - What intervention is required to manage the
dysphagia, whilst maintaining positive quality of
life and reducing other medical or nursing costs. - How the dysphagia can be monitored for change
- What assessment can be done to evaluate cranial nerve function?
- What assessment can be done to evaluate how well the patient can protect their airway?
- an Oromotor exam.
2. Cough reflex testing
Whats an advantage of a bedside assessment?
- Easily incorporated in to a clinic or ward visit
- Non invasive and no exposure to toxic substances
Whats a disadvantage of a bedside assessment?
- Does not necessarily tell you about the underlying impairment
- Pharyngeal function is inferred
What does a ‘clinical bedside assessment’ include?
The SLT observes the feeding/swallowing process and feels for laryngeal palpitation to observe the externally assessable features of swallowing. (Pace, effort, strength and numbers of swallow)
SLT looks for signs of dysphagia and will note what consistency of fluid or foods prompted such reaction.
SLT’s must avoid “golden hands” remembering that since you cannot actually see whats going on inside, you can only ‘infer’ from a bedside assessment what is possibly going wrong.
What other assessments can be done to assess swallow?
- a Pulse Oximetry
- a Cervical Auscultation
- a Video Fluoroscopy
- a fibreoptic endoscopic examination of swallowing
What are some clinical signs for dysphasia being present?
coughing gurgly voice watering eyes shortness of breath change of colour in the patient’s face evidence of aspiration on videofluoroscopy
“Material enters the airway, remains above the vocal folds, and is ejected from the airway (i.e. with cough)”
“Material enters the airway, contacts the vocal folds, and is ejected from the airway (i.e. with cough)”
Are examples of?
Normal Swallow.
What is silent aspiration?
Material enters the airway, passes below the vocal folds, and no effort is made to eject (no cough)
