Dysphasia Flashcards
Disorder of swallowing
SLP’s who treat dysphagia are part of a team Swallowing disorders increase risk of choking **May lead to aspiration and pneumonia
GASTROESOPHAGEAL REFLUX
Lifespan perspective
Problems occur in children and adults
Newborns, may be unable to such/ingest
nutriment
May refuse food, develop unhealthy habits
Outcomes of swallowing disorders include
*Malnutrition and ill health
*Weight loss
*Fatigue
*Frustration
*Respiratory Infection
*Aspiration
*Death
Swallowing process
Anticipatory Phase
Oral phase
Pharyngeal phase
Esophageal phase
Anticipatory Phase
Anticipatory Phase
*Salivating, positioning, response to aroma, personal rituals
Oral phase
Oral Phase
*Oral Preparatory
*Preparedliquid/solidboluspositioned *Oral transport
*Moved to back of mouth *Swallow reflex triggered
Oral phase
Oral Phase
*Oral Preparatory
*Preparedliquid/solidboluspositioned *Oral transport
*Moved to back of mouth *Swallow reflex triggered
Pharyngeal phase
Pharyngeal Phase
*Velum stops bolus from entering nasal cavity *Creation of pressure
*Pharynx contracts and squeezes
*Hyoid bone rises, larynx up and forward
*Vocal folds close, epiglottis lowered
*Cricopharyngeal sphincter opens
Esophageal phase
Esophageal Phase
*Muscles of esophagus move bolus down in peristaltic contractions
Disorder of swallowing
Anticipatory phase
Anticipatory Phase
*Lack of interest in food
*Sensory Impairment
*Poor positioning
Disorder of swallowing
Oral phase
Oral Phase
*Poor Lip Seal
*Difficulty Chewing
*Insufficient saliva production *Reduced tongue function
Disorder of swallowing
Pharyngeal phase
Pharyngeal Phase
*If swallow delayed or not triggered,
aspiration can occur
*Open velopharyngeal port allow food into the nasal cavity.
*Insufficient pharyngeal pressure
Disorder of swallowing
Esophageal phase
Esophageal Phase
*Incomplete bolus movement
*Residue can cause infection and nutritional problems.
Pediátric dysphasia
*Inadequate growth, ill health, difficulty learning, poor parent-child relationships
Can be due to:
*Cerebral Palsy
*Spinal Bifidia
*Mental Retardation/Developmental Delay
*Autism spectrum disorders
*HIV/AIDS
*Structural/Physiological abnormalities
Cerebral palsy and swallowing
Cerebral Palsy
*Most common cause
*Muscle tone, coordination, posture, discoordination, gag
*May require gastrostomy tube feedings
Spina Bífida and swallowing
Spina Bifida
*limited sensation and motor difficulties
*Can affect all phases of swallow
Mental Retardation/Developmental Delay
Mental Retardation/Developmental Delay
*Delayed motor coordination
*Inability to express food preferences.
Adult dysphasia
Dysphagia in Adults
*Over 6 million Americans over age 60 DUE TO:
*Stroke
*Cancer of the mouth, throat, larynx
*HIV/AIDS
*Multiple Sclerosis
*Amyotrophic Lateral Sclerosis
*Parkinson’s Disease
*Spinal Cord Injury
*Medication and nonfood substances
*Dementia
*Depression and Social Isolation
Stroke
Stroke
*All phases likely to be slow, impaired
*Poor coordination of swallowing/breathing
Cancer
Cancer of the mouth, throat, larynx
*Likely after cancer treatment, depends on treatment type
HIV and AIDS
HIV/AIDS
*Esophageal ulcers, esophagitis
*Multiple Sclerosis
*Multiple Sclerosis
*Delayed swallow reflex, reduced pharyngeal peristalsis
Amyotrophic Lateral Sclerosis (ALS)
Amyotrophic Lateral Sclerosis (ALS)
*Reduced tongue mobility, laryngeal elevation, pharyngeal peristalsis
Parkinson’s Disease
Parkinson’s Disease
*Rolling tongue pattern, Pharyngeal swallow delayed, poor
laryngeal closure, esophageal abnormalities.
Spinal cord injury
Spinal Cord Injury
*Esophageal dysphagia, sometimes oral phase/pharyngeal
weakness
Medications and Nonfood Substances
Medications and Nonfood Substances
*Medication side effects, tardive dyskinesia
*Smoking, excessive caffeine
Dementia
Dementia
*Attention/orientation to food, oral prep/transport impaired, delayed pharyngeal swallow, reduced laryngeal elevation
Depression and Social Isolation
Depression and Social Isolation
*Diminished interest in food, cooking for self, restlessness, fatique
Evaluation of swallowing
Silent Aspiration
Screening for Dysphagia
*Failure to Thrive
*Non-Instrumental Clinical Evaluation
*Checklist for older adults are available *3-ounce water swallow test
*Inappropriate weight
Case History and Background Information
Three areas of concern:
*Observe difficulties during eating and drinking
*Client appears to be at risk for aspiration
*Client appears not to be receiving adequate nourishment
OBTAIN INFORMATION ABOUT:
*Location of swallowing problem
*Consistencies that are easiest/hardest to swallow
*Nature and Severity of Disorder
Evaluation of swallowing g cont
Clinical Assessment
*Caregiver and environmental factors
*Cognitive and communicative functioning *Head and body posture
*Oral mechanisms
*Laryngeal functioning
*Bedside Swallow evaluations
*Managing a tracheostomy tube
Caregiver and Environmental Factors
*Caregiver attentiveness, distractions,
position, expressing food preferences
Cognitive and Communicative Functioning
*Alertness/wakefulness, ability to follow directions, general functioning
Head and Body Posture
*Note position and whether patient can change position as directed.
Evaluation
Oral mechanism
Oral Mechanism
Note Abnormalities, asymmetry, sagging, motor difficulties, oral reflexes, sensation, drooling, infection, upper airway obstruction
Evaluation
Pharyngeal function
Laryngeal Function
Hoarse, gurgly, breathy voice
If voice problems, may need to refer to otolaryngologist
Bedside evaluation
Reaction to food/drink
Oral mechanisms throughout swallow
Inability to cough/poor airway protection
Nasal regurgitation
Observe movement of hyoid bone/thyroid cartilage
Record number of swallows
Vocal quality changes
Difficult and safe consistencies
Preferred Placement
Managing a Tracheostomy Tube
Managing a Tracheostomy Tube
*Swallowing evaluation may still be
completed
*Physician approval
Procedure
*Cuff is deflated
*Secretions are suctioned
*Patient covers tube before each swallow to normalize tracheal pressure
Modified Barium Swallow Study
*Videofluoroscopy
Modified Barium Swallow Study
*Videofluoroscopy
*Barium on food or in liquid
*X-Ray recorded for later analysis Used for determining
*Oral vs. Nonoral feeding *Safest food textures
*Appropriate therapy
Fiberoptic Endoscopic Evaluation of Swallowing
Fiberoptic Endoscopic Evaluation of Swallowing
*For adults too ill for MBSS
*Flexible-laryngoscope through nose into
pharynx
*Swallow dyed food
*May reveal premature spillage, airway closure
*Provides information about desirable posture, preferred food types.
Scintigraphy
Scintigraphy
Computerized technique
Measures amount of aspiration
Radioactive tracer mixed with food
SLP positions, suggests swallow procedures, interprets results
Ultrasound/Ultrasonography
Ultrasound/Ultrasonography
*Transducer placed externally
**Generatesandreceivessoundwaves *Acoustic Images are taped
*Assesses
*Oralphaseduration
*Structure/movementofhyoidboneand tongue
Feeding Environment
Feeding Environment
Minimize Distraction
Relaxed and Unhurried
Develop self-feeding skills if possible
Appropriate utensils
Body and Positioning
Body and Positioning
*Upright, 90 degree hip angle, symmetrical
*Reduce extraneous movement
*Chin Tuck
*Head back
*Head tilt and head rotation
May lie on one side if pharyngeal residue is present
Modification of Foods and Beverages
Modification of Foods and Beverages
*Textures, Quantities, and Temperatures
*May only tolerate certain consistencies
*Straws usually not recommended
*Swallow twice
*Vary temperatures
Placement
*Place where intact sensation and adequate muscle strength
Behavioral Swallowing Treatment
Behavioral Swallowing Treatments Strengthening Exercises Effortful and double swallows Supraglottic swallow Mendelsohn Maneuver
Medical and Pharmacological Approaches
Medical and Pharmacological Approaches
*Drug Treatments
**Medications can either help or cause/contribute to swallowing disorders
Prostheses and Surgical Procedures
*Prosthetic devices if swallowing mechanism not
intact
*Remove cervical growths, increase vocal fold dimension, elevate larynx, suture vocal folds closed
Nonoral Feeding
*Nasogastric tube, Pharyngotomy, Esophagostomy, Gastrostomy
Nonoral Feeding
Nonoral Feeding
*Nasogastric tube, Pharyngotomy, Esophagostomy, Gastrostomy
Objective
Objectives
*Improve food and drink intake
*Prevent Aspiration
* Success determined by cause, severity, onset of treatment
*Treatment beneficial at least 80% of the time
*Sometime preventable
*Can be related to poor dentition
*Avoid certain substances
